It’s Time to Talk About Menopause

Menopause and perimenopause loom over women of reproductive age like a guillotine—or at least it can feel that way. And though the conversation surrounding these phases has fortunately been more open in recent years, there can still be a lot of surprises once you reach your thirties, forties, and fifties. 

To get to the bottom of it, STRONG spoke with experts who offered their insights into how these stages can affect your body, mind, mood, and much more.

Performance and Muscle Growth

“The media has traditionally treated women over 40 as if they are fading into the background,” laments Amanda Thebe, a 30-year veteran of the fitness industry and the author of Menopocalypse: How I Learned to Thrive During Menopause and How You Can Too! “The narrative continues to focus midlife women as either trying to look 20 years younger or dealing with a crisis. We rarely see women in their forties, fifties, and beyond portrayed as vibrant, athletic, powerful, and at the absolute peak of their lives.” But Thebe stresses that this major physiological phase doesn’t mean the end of strength or performance. “You don’t have to settle for feeling less-than or assume your fittest days are behind you,” she insists.

Still, fluctuating hormone levels will affect how you perform during your workouts, and studies have shown that during menopause fat mass increases while lean mass decreases, up to 0.6 percent annually in those who aren’t strength training. That’s a huge double-whammy to your body composition. 

The best way to counteract this flux is—drumroll, please—strength training, of course. “Strength training is one of the most powerful tools we have to combat muscle loss, support bone density, and improve metabolic health during menopause,” says Dr. Mary Claire Haver, MD, FACOG, CMP, a board-certified obstetrics and gynecology specialist, founder of The ‘Pause Life, and author of The New Perimenopause. Health organizations around the world generally recommend that women in perimenopause and menopause schedule two or three days of load-bearing exercise each week to help counteract the drop—but as you may imagine, a few more well-planned weekly sessions can help even more. Work with a reputable trainer or coach to figure out the best plan for you.

Recovery

It’s not just how you exercise that can be affected by the rollercoaster of hormonal changes that occur during this time. How you recover following your workouts must change, too.

“Recovery absolutely has to change during this phase because lower estrogen levels mean the body naturally takes a bit longer to repair muscle tissue after a hard workout,” explains Thebe. “If we don’t adjust our lifestyle to accommodate this shift, we end up chronically sore, tired, and much more prone to nagging injuries.” This not only means spacing out your workouts to include rest days in between but also eating enough high-quality protein to support muscle repair. For active menopausal women, the Mayo Clinic recommends at least 1.0 to 1.2 grams of protein from a variety of plant and animal sources for each kilogram of bodyweight. And while some experts suggest spreading your protein across a number of meals, research has been mixed as to how effective this advice is for older adults. 

But back to getting the rest your changing body needs. “Women who have been active may notice they need more recovery time and a greater focus on progressive overload and protein intake,” says Haver. “The goal shifts from just staying active to training with intention.”

There’s also another related issue that’s increasingly receiving attention: musculoskeletal syndrome, a term first coined in 2024 in the journal Climacteric. Basically, it’s intense joint and muscle pain that occurs in up to 70 percent of perimenopausal and menopausal women, with 25 percent unable to function normally because of it. Once again, this is due to the drop in estrogen that women experience—but the good news is that this can be supplemented with patches, pills, and creams prescribed by a doctor.

“The goal shifts from just staying active to training with intention.”

Bone Health

After your twenties and thirties, when your hormone levels are high and you’re likely following a consistent muscle-building plan, your bone density can dramatically plummet. According to the Cleveland Clinic, you can lose up to 20 percent of your bone density in the first five years of menopause. But that doesn’t mean fractures and osteoporosis are a sure thing. 

“To feel stronger than ever, it’s not about giving up cardio or the workouts we love, but rather ensuring we intentionally prioritize strength training alongside them to give our muscles and bones the direct stimulation they need to stay strong and healthy,” says Thebe.

What else can you do? Test your bone density, ask your doctor about medication options like hormone therapy and bisphosphonates, watch your calcium and vitamin D intake—and definitely start doing weight-bearing and resistance exercises if you haven’t already.

Defining Phases

Good news, ladies—or maybe good-ish news. While perimenopause and menopause may not be avoidable, as a society we’re beginning to move toward a place of understanding.

“We’re finally seeing women speak openly about their symptoms and demand better care, and social media has accelerated that conversation in a powerful way,” says Haver. “For too long, perimenopause was dismissed or misdiagnosed, but now patients are connecting the dots and pushing the medical community to catch up.”

But there’s still some confusion as to what perimenopause and menopause truly are, even for the women experiencing them. To shed some light, we asked Dr. Francesco Callipari, MD, for the real, honest-to-goodness medical definition. 

“Perimenopause is actually a transition, not a point in time; it’s a continuum that occurs variably for many women,” he says. “For some it can be as short as a year or two, but for others, it can extend to over 10 years.” The main feature is that it’s a period of time when estrogen production begins to decline in the lead-up to menopause, affecting many different systems across the body. Menopause, on the other hand, is when menstruation has stopped for at least 12 months, signaling the end of one’s reproductive years.

But no matter where you are on the reproductive spectrum, remember that you know your body best, and if you feel your concerns are being dismissed by your healthcare professional, don’t hesitate to speak up.

“Advocate, advocate, advocate,” advises Callipari. “If you don’t feel heard, reach out to a different clinician. The field of menopausal medicine is rapidly advancing. We are learning so much more than what was taught to us in our medical training. Seek out a new physician that will listen to you thoughtfully.” Which is excellent advice for any condition, come to think of it. 

“Energy levels in your forties and fifties often take a hit.”

Hair, Skin, and Teeth

Skin elasticity and hair thinning are two side effects of menopause that are largely overlooked, says Haver. “Changes in oral health, including gum sensitivity, can also emerge during this time,” she adds. “These symptoms are all tied to declining estrogen and are very real, even if they are not widely discussed.”

And according to Dr. Francesco Callipari, MD, FACOG, medical director of the Carolyn Rowan Center for Women’s Health and Wellness, and chief operating officer for the OB/GYN service line at the Mount Sinai Health System, it’s not just the face that’s affected. “The skin may also change texturally, and in particular, there is thinning of the genital skin,” along with an increase in vaginal dryness, he points out. Luckily, there are hormonal creams and nonhormonal medications that can help, such as vaginal moisturizers and lubricants. Still, it’s not one size fits all. “We approach our recommendations through a careful history with the patient and an individualized approach,” he explains. 

As Haver noted, fluctuating hormones can also impact the health of your teeth and gums, increasing your risk of gingivitis and dry mouth (xerostomia, or reduced saliva production). Falling estrogen levels impact mucus membranes, including those in your mouth, so to keep ahead of issues try chewing gum, avoiding caffeine and alcohol, and keeping plenty of water handy. Using a humidifier at night can also help. 

Brain Drain and Mood Swings

It’s not just in your head—it’s harder to remember things and keep your cool as menopause creeps up. “There are definite correlations between perimenopause/menopause and irritability, and often, there are mood swings. This can lead to a predisposition for depression,” notes Callipari.

“Brain fog and memory changes are very common [in menopause] and are often tied to fluctuating estrogen levels,” Haver agrees, adding that the good news is that for most women these symptoms improve over time. She says that supporting sleep, managing stress, and considering hormone therapy when appropriate are all ways to thwart these negatives. “Cognitive engagement and regular exercise are also key tools to help protect brain health,” she adds.

Sleep

Nighttime hot flashes can make getting to sleep, and staying there, difficult. Even worse, a lack of high-quality ZZZs can lead to irritability and depression—an unfortunate cycle that compounds the mood highs and lows that come with menopause.

“Energy levels in your forties and fifties often take a hit because fluctuating hormones can throw a major wrench into your sleep quality and quantity, leaving you dealing with night sweats and/or insomnia,” says Thebe. “On top of that, chronic fatigue is a direct symptom of menopause, which can leave you feeling completely wiped out regardless of how well you slept.” Resist the temptation to push through exhaustion or top up your coffee mug one more time; instead, try working out earlier in the day and invest in drug-free ways to assist your slumber, like eye masks, fans, and white noise machines or apps. Sweet (or at least a bit sweeter) dreams!