Perimenopause, Menopause, and the Active Body: What’s Changing and Why It Matters

First, what is perimenopause and menopause?

Definition & Prevalence

Perimenopause is the transition toward menopause marked by irregular hormone patterns and menstrual changes. This phase can last several years and often begins in the mid 30-40s, though timing varies widely.

Menopause is defined retrospectively after 12 months without a menstrual period and represents a new hormonal baseline rather than a single event.

Athlete Considerations

Female athletes may notice subtle changes earlier because hormonal fluctuations interact with training stress, recovery, and fueling needs. While research in athletic populations is still emerging, available evidence shows that hormonal changes can affect body composition, metabolism, and training responses.

Practical Example

• A runner who previously recovered well on 5–6 days of training may notice lingering soreness or disrupted sleep despite unchanged mileage.

  
  

Common Experiences During the Transition

• Fluctuating cycles and irregular fertility signals

• Body composition shifts

• Sleep disruption

• Mood variability and fatigue

• Changes in appetite, recovery, and performance

These experiences often overlap with symptoms athletes recognize from periods of high stress or low energy availability. The difference is that during perimenopause, these changes can occur even when training volume hasn’t increased, making the transition feel confusing or frustrating.

Second, what's going on physiologically?

Hormonal Shifts

Estrogen and progesterone become more unpredictable over time, not just lower. This variability influences metabolism, tissue signaling, and how muscles, bones, and fat tissue respond to training and nutrition.

Practical Example

• You may notice that a training plan that “always worked” suddenly feels inconsistent: some weeks feel strong, others feel unusually hard with no clear reason.

Body Composition

Research shows a trend toward decreased muscle mass and increased adiposity during the menopause transition. These changes are linked to altered anabolic signaling and hormone balance rather than effort or discipline.

Muscle and Bone

Lean mass and bone mineral density (BMD) decline during the transition, increasing the risk of sarcopenia and osteoporosis. Importantly, higher physical activity levels and targeted resistance training are associated with better muscle and bone outcomes.

Bone and muscle loss can occur even when daily activity stays the same, which is why intentional loading matters.

Strength & Performance

Longitudinal studies show declines in strength and power during the transition, but physical activity level strongly influences how much decline occurs.

So what can you do nutritionally?

Hormonal changes during perimenopause can affect energy regulation and body composition, including a potential reduction in basal metabolic rate, increased visceral fat, and gradual loss of fat-free mass. These shifts often occur without changes in eating or training habits and reflect physiological adaptation rather than lack of effort.

Muscle mass and strength are influenced by both hormonal context and nutrient availability. Adequate energy intake and sufficient protein are essential for supporting muscle protein synthesis as anabolic responsiveness changes. For athletes, perimenopausal changes often overlap with symptoms associated with low energy availability. Fatigue, impaired recovery, and body composition changes may signal inadequate intake rather than aging alone. Consistent protein intake across the day and meeting overall calorie needs can help attenuate declines in lean mass, as well as, support training adaptations and maintain performance through this transition.

Practical Application

• Multiply your current body weight by 1-1.2g x (weight) kg to see how much protein you should at least be consuming to maintain bone health. Then divide this total number by 3-4 to get an idea of how much protein this looks like between 3 or 4 meals/snacks per day. For more active individuals/athletes, protein (along with calories) will be much higher. Work with a dietitian to find your sweet spot!

Micronutrient adequacy also plays a key role. Calcium and vitamin D support bone health, magnesium contributes to muscle function and recovery, and iron needs should be assessed individually. Maintaining sufficient intake supports metabolic health, tissue repair, and training recovery.

Practical Application

• For calcium, (1) eat or drink at least 2 servings of milk, cheese, or yogurt daily- consider lactose-free options as needed; (2) Eat calcium-rich foods like beans, salmon, almonds, figs, or fortified cereals and breads; (3) Ask your provider whether you need a calcium supplement, and how much you should take.

• For vitamin D, (1) eat and drink things like salmon, sardines, tuna, egg yolks, mushrooms, milk, juice, and grains; (2) consider a vitamin D3 supplement

Now the biggie...MOVEMENT

Movement plays a central role in supporting health and performance through the menopause transition. Resistance and weight-bearing exercise are strongly supported for preserving muscle mass and improving bone health through midlife, with meta-analyses showing moderate benefits for bone density and body composition. Importantly, structured strength training provides a more effective stimulus for muscle and bone than everyday activity alone.

Aerobic exercise continues to support cardiovascular health and metabolic flexibility, and the best functional outcomes are seen when endurance training is combined with regular strength work. Together, these forms of movement help counteract systemic changes associated with menopause, including shifts in insulin sensitivity, declines in lean mass, and alterations in bone remodeling.

EMPOWERING Take Aways

Reframe the Transition

This phase isn’t a loss of function, it’s an adaptive shift in how the body responds to training, fuel, and recovery.

Focus on What Works

Small, consistent habits, adequate fuel, structured strength work, quality recovery align with the evidence and support autonomy.

Not Everything at Once

It’s not “everything you have to do now.” It’s choices that support long term vitality, not punishment or restriction.

Partner With the Body

Menopause is a change in hormonal context, not a failure. It’s a signal to respond thoughtfully, not fearfully.

Closing Thought

“Supporting your body through this phase isn’t about opposing change, it’s about using what we know to help it perform, feel strong, and stay healthy moving forward.”

References

Bondarev, D., Finni, T., Kokko, K., Kujala, U. M., Aukee, P., Kovanen, V., Laakkonen, E. K., & Sipilä, S. (2021). Physical performance during the menopausal transition and the role of physical activity. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 76(9), 1587–1590. https://doi.org/10.1093/gerona/glaa292

Juppi, H.-K., Karppinen, J. E., & Laakkonen, E. K. (2025). Menopause and body composition: A complex field. Seminars in Reproductive Medicine, 43(2), 85–105. https://doi.org/10.1055/s-0045-1809531

Sims, S. T., Kerksick, C. M., Smith-Ryan, A. E., Janse de Jonge, X. A. K., Hirsch, K. R., Arent, S. M., Hewlings, S. J., Kleiner, S. M., Bustillo, E., Tartar, J. L., Starratt, V. G., Kreider, R. B., Greenwalt, C., Rentería, L. I., Ormsbee, M. J., VanDusseldorp, T. A., Campbell, B. I., Kalman, D. S., & Antonio, J. (2023). International society of sports nutrition position stand: nutritional concerns of the female athlete. Journal of the International Society of Sports Nutrition, 20(1), 2204066. https://doi.org/10.1080/15502783.2023.2204066

Collaboration with Melanie Sulaver MS, RD, CDN, CISSN

Special Contribution

Melanie Sulaver (MS, RD, CDN, CISSN) is the founder and small (but mighty) business owner of Nutrition by Mel. She is a registered dietitian working to bridge the gap between women’s health and performance nutrition. As a speaker, counselor, and coach, Mel works with women in sports, educating them on disordered eating, low energy availability, relative energy deficiency in sports, menstrual health, the perinatal window, and menopause. Her goal is to change the narrative surrounding what it means to navigate life as a woman, an athlete, and a mother. 

You can connect with Mel on Instagram @nutritionbymel or through email at mel@nutritionbymel.com

Be sure to check out her services and offerings at www.nutritionbymel.comathletes.

About the Author

Jourdan Delacruz is a 2X Olympian and represented Team USA in the sport of Weightlifting for both the 2020 and 2024 Olympic Games. Jourdan holds a bachelor's in nutrition and dietetics from the University of Northern Colorado. She is pursuing her master's degree in sports nutrition with hopes of becoming a sport-registered dietitian. Jourdan is the founder of Herathlete, a brand committed to supporting female athletes through education and community.