More and more I am seeing women in practice who are empowering themselves to understand the effects of perimenopause and menopause on their lives. There are some remarkable researchers and healthcare professionals who are changing the face of our understanding of midlife for women. I feel remiss, as I have only recently begun to truly understand the effects of female hormones on pain, bone density, and the musculoskeletal system.

The following is designed to help you begin implementing research-based strategies that provide a foundation of information while also inspiring meaningful, personalized action. My hope is that this guide helps you feel more clarity, confidence, and control as you navigate this transformative chapter of life.

My specific area of expertise lies in the musculoskeletal system, particularly as it relates to strength, posture, pain, and performance. This guide also touches on other key areas such as mood, hormones, and gut health. For deeper exploration in those areas, please don’t hesitate to reach out—I’m happy to connect you with trusted professionals who bring deeper expertise to those fields.

This guide supports women navigating midlife who are seeking strength, stability, energy, mood resilience, hormonal support, and longevity. It incorporates expert-backed practices and emphasizes hormone literacy, gut and musculoskeletal health, protein and strength strategies, and social-emotional nourishment.

Disclaimer: This guide is for informational purposes only and is not a substitute for medical advice. Always consult with your physician or qualified healthcare provider before making changes to your health routine, medications, or hormone treatments.

Daily Routine Outline Example

I have highlighted morning workouts as there is some research suggesting that adherence is higher with a morning workout routine, according to a 2020 NIH publication on morning exercise and body composition. However, this protocol can and should be adapted to fit your life and daily routine.

MORNING: Wake Up + Move with Intention

1. Pre-Workout Fuel

• Consume 15g protein within 30 minutes of waking alongside your morning caffeine (collagen coffee, mini protein shake). This supports cortisol rhythm and jumpstarts muscle preservation. Even if you’re not working out first thing, protein with your coffee can lower the possibility of caffeine causing dysregulation of your cortisol rhythms. If you don’t drink coffee or tea, the protein on its own is a great kick start to your morning. 
• There is emerging research to support the benefits of morning workouts, particularly due to the body’s natural cortisol rhythm. In healthy individuals, cortisol levels peak approximately 30–45 minutes after waking—a response known as the cortisol awakening response (CAR). Exercising during this window may help align physical activity with the body’s innate hormonal surge, potentially enhancing fat metabolism, supporting circadian alignment, and promoting better energy regulation throughout the day.

2. Training for Longevity

• Strength Train 3–4x/week. Focus on lifts you enjoy and can do without pain. Aim to lift heavy (relative to your capacity). Compound lifts like squats, thrusters, bench presses, and push-ups are ideal, but you can work up to these. Start with heavy bicep curls, tricep pulldowns, and rows. There are lots of online resources for training routine but please reach out if you would like more information here. 
• Low rep, high load: 3–5 sets of 5–8 reps. Work close to your max effort while maintaining good form.
• Zone 2 Cardio
  Incorporate Zone 2 cardio 1–2 times per week to build aerobic capacity (although high intensity training also works aerobic capacity) and to support cardiovascular and mitochondrial health. This moderate-intensity work—where you can still maintain a conversation—provides benefits without spiking cortisol.

However, during perimenopause, long-duration cardio may do more harm than good. Due to increased cortisol sensitivity, extended endurance sessions can heighten stress, disrupt hormone balance, and undermine muscle maintenance.

Prioritize strength training and short, high-intensity intervals (HIIT), which are more effective for supporting metabolism, preserving lean muscle, and enhancing resilience. We’ve long been told that hours on the treadmill or stairmaster are the gold standard—but current research suggests that, for midlife women, these prolonged efforts can actually work against your goals. Focus on exercise quality over quantity.

When you are in the clinic we will run a HRV test on you, once we have a few data sets on your HRV that can be critical in understanding if you are training in a supportive or unsupportive way. 

• VO2 max intervals: 10 minutes per week to maintain heart and brain health. This is a 30 sec to one minute full out sprint type interval. I use the rower, ski erg  or assault bike for this. 

 3. Post-Workout Recovery

• Rehydrate with 500–750ml water + electrolytes.
• Eat a protein-rich breakfast (30–40g protein + complex carbs + healthy fats).

DAY: Fuel, Focus, and Function

1. Protein Goals

• Aim for 1.4–2.2g/kg/day (0.7–1g/lb), evenly across 3–4 meals.
• Especially critical during perimenopause/menopause to preserve muscle and support metabolism (Sims, 2023).

2. Nutritional Strategy

• Focus on whole, anti-inflammatory foods: leafy greens, berries, nuts, oily fish.
• Limit processed foods and sugars to reduce blood sugar swings and inflammation.

3. Gut Health & Hormones

• Your gut plays a pivotal role in hormone balance—particularly estrogen—through a specialized group of bacteria known as the estrobolome. These microbes help metabolize and eliminate estrogen from the body. When gut health is compromised, estrogen metabolism becomes less efficient, potentially leading to symptoms like bloating, mood swings, or cycle irregularity.
• Supporting daily, healthy bowel movements is essential. Aim for 1–2 per day. If that’s not happening, it’s time to work with a naturopathic or medical doctor for personalized support. Start with fiber—strive for at least 30g per day through whole foods and, if needed, supplements. Many women find fiber intake harder to hit than protein, so don’t hesitate to supplement if necessary.
• A well-functioning gut doesn’t just help regulate hormones—it also supports mood stability, immune resilience, and reduced systemic inflammation.

EVENING: Wind Down + Restore

1. Wind-Down Routine

• No caffeine after 2PM.
• Dim lights post-sunset; turn off screens 60 minutes before bed.

2. Sleep Hygiene

• Aim for 7.5–9 hours of quality sleep.
• Support with calming tools if needed: magnesium glycinate, L-theanine, saffron, or ashwagandha.

 MUSCULOSKELETAL (MSK) HEALTH: Strength for Life

Midlife brings an underrecognized condition: Musculoskeletal Syndrome of Menopause (MSM). It affects ~70% of women in transition (The Lancet, 2023 source).

Key Findings:

• Bone loss accelerates significantly during perimenopause—research shows women can lose up to 10% of their bone density during this transition. This is a critical window. Resistance training becomes essential, not optional, as it’s one of the most effective ways to stimulate bone formation and slow this loss. Additionally muscle loss accelerates rapidly during this transition. One of the single most important markers for longevity and healthspan is the health of the muscular system. I cannot stress enough the importance of bone and muscle health as it pertains to living a vital and pain free life as we age. 

Fractures caused by osteoporosis, especially in the spine and hip, are not benign—they carry a high risk of long-term disability and increased mortality. Building and preserving bone strength now is one of the most powerful investments you can make for your mobility, independence, and quality of life in the decades ahead.

Recommendations:

• Prioritize strength training above all other training. 
• Supplement with: protein, creatine, vitamin D/K2, magnesium, and consider MHT if appropriate.

MOOD, MIND & CONNECTION

Mood Disruption is Common—Not Inevitable

• Perimenopause is linked to spikes in depression and anxiety.
• Seek a qualified therapist—don’t normalize persistent low mood and anxiety.  Discuss hormone support with your MD or ND. If dismissed, consider a menopause clinic.

Reclaiming the Narrative

• Menopause has been historically mischaracterized as “emotional instability.”
• Today, it’s seen as a neuroendocrine transition.
• Researchers like Dr. Stacy Sims, Dr. Mary Claire Haver, and Dr. Jen Gunter are changing the narrative.

Social Connection as Medicine

• Reinvest in female friendships—they’re vital to emotional resilience and longevity.

TIMELINE: Women-Led Menopause Research-this research is all still relatively new highlighting the lack of data that still exists surrounding women’s health. 

• 1976 – Dr. Estelle Ramey debunks sexist views of hormonal instability.
• 1980s – Dr. Nanette Santoro pioneers menopause transition research.
• 1991–2002 – Women’s Health Initiative studies women’s health outcomes.
• 2000s–Present – Boom in female-led research: exercise, hormones, MSK, metabolism.

Note: Dedicated female-focused studies are still the exception, not the rule.

EXPERTS TO FOLLOW

• Dr. Stacy Sims — Exercise physiology & protein science
• Dr. Mary Claire Haver — Galveston Diet & menopause advocacy
• Dr. Jen Gunter — Myth-busting OB/GYN (The Menopause Manifesto)
• Dr. Louise Newson — Balance App & menopause treatment
• Lara Briden, ND — Hormone Repair Manual, gut-hormone focus
• Dr. Jerilynn Prior — CeMCOR; progesterone & ovulation
• Drs. Avrum Bluming & Carol Tavris — Estrogen Matters, MHT defense

References

• The Musculoskeletal Syndrome of Menopause, The Lancet, 2023 – Link
• Sims, S. (2023). Optimal Protein Intake for Women – DrStacySims.com
• Haver, M.C. (2022). The New Menopause
• Briden, L. (2021). Hormone Repair Manual
• Gunter, J. (2021). The Menopause Manifesto
• Bluming, A., & Tavris, C. (2018). Estrogen Matters
• Tandfonline Menopause Exercise Study, 2024
• NIH PMC: Morning Exercise & Adherence, 2020
• Stacy Sims – What Women Need to Prioritize