How to Optimise Exercise and Lifestyle Through Menopause and Perimenopause – Part 1
- 6 days ago
- 5 min read
Written by Dan Raynham, The Fitness Scientists
Dan Raynham is a leading innovator of biohacking, peak fitness, and age reversal. He is the founder of The Fitness Scientists, the world's only measurable wellbeing system. His latest passion project, "The Biohacking Handbook," is a TV show that aims to democratize peak health, combining his background in science and the arts.
The hormonal shifts of menopause and perimenopause can have far reaching effects on women’s health and wellbeing. In my previous article on training and periods, I highlighted the shortcomings of traditional fitness advice for women. The historical neglect of menopause research and the dismissive treatment of women seeking support has been shameful. However, things are changing rapidly. It is time to fully address and end this neglect.
As a health professional, I stress the importance of preparing for menopause to my younger female clients and anyone who will listen. It resonates with them once they grasp its significance, even though they may have 30 or more years to go. This issue concerns everyone. Men, too, should read on to become informed allies.
Given the prevalence of menopause related queries I receive, I believe a biopsychosocial model works best. Hormones, for some, therapy, lifestyle, social support, education, and exercise can make a tangible difference. I will cover the basics of menopause, explore exercise and lifestyle options and their implications, and bust some myths, aiming to provide clarity and support where it is needed most.[1][2]
What occurs at menopause?
1. Estrogen decline
Estrogen’s decline, with estradiol or E2 being the most potent form, affects more than just muscle mass, bone density, and body composition. It also impacts skin health, including thinning and dryness, vaginal health, including dryness and pain during sex, mood regulation, including mood swings and anxiety, sleep patterns, and metabolism and fat distribution, including increased belly fat.
2. Testosterone changes
Declining testosterone in women, and men to some extent, can lead to decreased libido and sexual satisfaction, fatigue and decreased energy, loss of muscle mass and strength, and mood changes, including depression and irritability.
3. Cortisol and insulin sensitivity
Increased cortisol can promote belly fat storage, disrupt sleep, increase blood pressure, affect bone density, and impact mood and cognitive function.
4. Other lesser-known changes
Leptin is a hormone that regulates appetite and metabolism. It is often disrupted during menopause, leading to increased hunger and weight gain. Ghrelin is a hormone that stimulates appetite. It may increase during menopause, making weight management more challenging. Adiponectin is a hormone involved in glucose regulation and fat breakdown. It is often decreased in menopause, contributing to insulin resistance. Serotonin is a neurotransmitter that regulates mood, appetite, and sleep. It is often imbalanced during menopause, contributing to mood swings and depression. Melatonin is a hormone that regulates sleep and wake cycles. It is often disrupted during menopause, leading to insomnia or sleep disturbances.[3]
What is perimenopause?
Perimenopause is the menopausal transition. It is the years leading up to your last period, when hormones start misfiring.
Ages and timeline
Early perimenopause usually occurs between ages 40 and 45, but it can start in the late 30s and lasts 4 to 8 years on average. Late perimenopause often occurs from the mid to late 40s to early 50s and lasts 1 to 3 years. Menopause usually occurs between 45 and 55, with 51 being the average age in the UK and the US. Menopause is confirmed after 12 consecutive months without a period. Postmenopause begins from menopause onward and lasts for the rest of one's life.
Around 5% of women reach menopause before 45, and around 1% before 40, which is known as premature ovarian insufficiency. Smoking, genetics, chemotherapy, and radiation can shift it earlier.
What is happening biochemically? 3 key shifts
1. Your ovaries become erratic
Estrogen swings wildly. It does not simply decline, which is a big myth. Estrogen does not smoothly drop. In early perimenopause, FSH spikes as the brain pumps out more follicle-stimulating hormone because fewer follicles are left. Estradiol, E2, the strongest estrogen, rockets and crashes. You can have higher estrogen than in your 20s during some cycles, then near-zero levels in others. Swings of 10 to 1,000+ pg/mL can occur in the same month. Inhibin B drops as your small follicles make less of this, so FSH is not held back. AMH plummets, as Anti Müllerian hormone tracks ovarian reserve. Very low levels may suggest the final period is approaching, but AMH is best used for predicting time to the final period, not symptoms.
As a result, 60-plus day cycles, skipped periods, heavy bleeding, or two periods in one month can all occur in perimenopause. Heavy, prolonged, or unusual bleeding should still be discussed with a health professional.
2. Progesterone tanks first
You stop ovulating reliably in your late 30s and 40s. No ovulation means no corpus luteum, which means no progesterone for that cycle. Without progesterone to balance it, estrogen can become unopposed, causing heavy periods, breast tenderness, anxiety, and sleep issues. When you do ovulate, progesterone may be low or short-lived, and PMS may worsen.
3. Neurotransmitters and inflammation change
Estrogen and progesterone are not just sex hormones. They regulate brain chemistry. Estrogen boosts serotonin, so hormonal swings can lead to mood and anxiety dips. This is one reason why some SSRIs and SNRIs are prescribed to help VMS, or vasomotor symptoms, including hot flashes and night sweats. Progesterone metabolises to allopregnanolone, a GABA A agonist, so low progesterone can mean worse anxiety and poor sleep. Estrogen withdrawal narrows the thermoneutral zone in the hypothalamus, increasing norepinephrine and resulting in hot flashes triggered by small temperature changes. Estrogen has anti-inflammatory effects, so as it fluctuates, IL-6 and TNF-α may rise, leading to joint pain and brain fog. Insulin resistance can also increase as muscle becomes less sensitive to insulin. The same calories may result in more belly fat.
Late perimenopause: Clues you're close
Periods 60 or more days apart can be a sign of the late stage. This often happens around 1 to 3 years before the final period. FSH may be elevated alongside missed periods, but hormone levels can fluctuate significantly. Many women experience hot flashes and night sweats here, driven by that shrunken thermoneutral zone.
Why symptoms can feel worse than menopause itself
Postmenopause means low but stable hormones. Perimenopause means hormonal chaos. Your brain and body cannot always adapt because the target keeps moving. That is why anxiety, rage, insomnia, and heavy bleeding often peak before periods stop.
Blood tests: Useful or not?
Hormone levels on a single day are usually not reliable data in perimenopause because they can change significantly. Doctors generally diagnose by age, symptoms, and cycle changes.
The AMH, or Anti-Mullerian Hormone, test is best for predicting time to final period, not symptoms.[4]
Continued in Part 2: Exercise, HRT, Diet, and Mental Health
Read more from Dan Raynham
Dan Raynham, The Fitness Scientists
Dan Raynham is a science-driven biohacker who believes that everyone should have access to optimal health. As a child, he suffered poor health, and didn't start exercising until his 30s. Now, at 51, he is an elite athlete who outperforms teens to 20s and professional athletes. Over the course of 20 years, he has honed a ground-breaking system that activates the body into peak fitness and age reversal. It works at a cell and molecular level in an incredible display of biochemistry. An ardent supporter of science-led, compassionate health and mythbusting, his company, The Fitness Scientists, offers the first and only data-driven wellbeing plan in the world.
References:
[2] Vallée A, Ayoubi J. From silence to science: the future of menopause research. The Lancet Obstetrics, Gynaecology, & Women's Health, 2025; 1, e166–e167.
[3] Strelow B, O'Laughlin D, Anderson T, Cyriac J, Buzzard J, Klindworth A. Menopause Decoded: What's Happening and How to Manage It. J Prim Care Community Health. 2024;15:21501319241307460. doi:10.1177/21501319241307460
