Ep #151: Menopause & Fitness: Cutting Through the Confusion

This is the Strong Is a Mindset podcast, Episode #151. If you’re confused about how to build or maintain muscle during perimenopause and menopause, let’s talk about it.

This is the Strong Is a Mindset podcast, where you’ll learn how to build both a strong body and a strong mind by eating, moving, and thinking. I’m your host Physician, Personal Trainer, Certified Health Coach and Certified Life Coach, Carrie Holland. 

Hey, how are you? What’s new? What’s good? So, what’s good here? We are talking about muscle, menopause, maintaining strength, and all of the conflicting messages out there. So, this is a big one. This is a big topic to tackle for sure. And to be honest, this is a podcast I’ve hesitated to write because every time I sit down to outline it, I go down a rabbit hole of research articles, websites, podcasts, books, expert opinions, and social media posts that all say different things about what women should be doing in menopause and perimenopause when it comes to strength training, cardio, and building muscle.

And while I love the evidence, and I love learning, and I love reading, I also don’t want to make this more confusing than it needs to be because the truth is, it’s already confusing enough. But that doesn’t mean we should ignore it. When I was in medical school, we spent very, very little time on menopause, and even in my family medicine residency, we spent very little time in our gynecology rotation learning how to care for perimenopausal and menopausal women.

And there is a big, big knowledge gap about how to effectively manage and treat women at this stage, and the end result is a lot of confusion. But now, people are starting to pay attention, and this is very much a good thing. People are recognizing that this is a big deal and women do not have to suffer because this is just the way it goes now that we’re getting older.

So, when you combine this interest in menopause, plus the current focus in the health and fitness world on body composition and having muscle versus just looking thin, there’s been an explosion of information, incomplete information, and unfortunately, misinformation about what to do. And I’m going to try to reconcile some of that today.

So, here is where we’re going. I want to walk you through what is actually happening in your body during this phase of your life. We’re going to talk a little biology, but I’m going to keep it simple and accessible, so we don’t get too far into the weeds here. We’re also going to talk through what a solid approach to your exercise might look like. And most importantly, we’re going to talk about how to navigate the wide and vast sea of opinions and advice being thrown at you online and in the media.

And here’s what I’ll say before we really dive in. I am not here to sell you on a one-size-fits-all approach to strength and menopause. I’m also not going to tell you that there is one perfect workout or any one absolute right way to approach fitness and menopause, no matter what anyone says, okay?

There is no one right way to do this. But that being said, I do want to give you some grounded, honest thoughts so you can make sense of all the noise in this space and feel more confident taking action, even if that action isn’t flashy or trendy or follows exactly what a fitness influencer says. All right? So, let’s go.

So first, let’s talk a little science here. Let’s start with what is actually going on in your body during perimenopause and menopause. There are legit physiologic changes happening, and understanding these changes can help you make more informed decisions about how you eat, move, and train.

So, let’s start with your hormones. Estrogen and progesterone are both declining, and these hormones do a whole lot more than just regulate your period, okay? Estrogen, in particular, plays a wide range of roles throughout your body. It helps maintain your bone density. It helps maintain elasticity and hydration in your skin. It supports muscle mass and strength. It regulates your mood through neurotransmitters like serotonin and dopamine. And it also has a role in cognitive function like memory and concentration.

And another role of estrogen that’s of particular interest to perimenopausal women is the influence it has on body fat distribution. So, when your estrogen starts to decline, your fat tends to redistribute from your hips and your thighs towards your abdomen. And I point this out because this is often when you start to notice.

You may notice that you’ve got a belly and you’ve never had one before. Or if you notice that you seem to be putting on more fat in your midsection, it’s at least partly due to the decline of estrogen and the impact this has on your fat distribution. And this is very much an expected, though totally undesired change.

And not only does it not feel super awesome to seemingly overnight have a bigger belly than you did previously, but that increased fat in your abdomen also increases your risk for metabolic diseases, like type 2 diabetes, cardiovascular disease, and metabolic syndrome. So, let’s talk about this.

At a very basic level, when estrogen drops, blood sugar regulation can become more difficult. Estrogen helps improve your insulin sensitivity, which makes your body better at managing blood sugar. So, when estrogen declines, insulin sensitivity worsens, making it harder to regulate your blood sugar.

Now, estrogen also has protective effects on your cardiovascular system. It helps keep your blood vessels flexible, and it supports your HDL or your good cholesterol, and it helps lower your LDL or your bad cholesterol. And these effects are lessened as estrogen declines, making your risk of cardiovascular disease higher. The other thing to know is that declining estrogen can impact your stroke risk, in part because of the effect estrogen has on keeping your blood vessels relaxed and dilated, which is also lessened as estrogen declines.

And when estrogen falls, it impacts your temperature regulation and makes your body more sensitive to temperature changes. And this is when night sweats and hot flashes can become an issue. So the point in me going through all of this is so that you understand why estrogen matters. I know that was a high-level quick and dirty overview of estrogen, but I wanted to really zone in on the importance of estrogen and why its decline in perimenopause and menopause, why it matters.

And the takeaway here is that as estrogen declines in menopause, it results in you having an increased risk for type 2 diabetes, heart disease, stroke, dementia, and metabolic issues. And to be fair, these are just some of the issues. I wanted to highlight some of the major health issues that come up as estrogen declines, but there are even more things to be on the lookout for, like osteoporosis, urinary problems, sexual dysfunction, mental health issues, and others. So in short, estrogen, or really the fall in estrogen that happens during menopause, has a major role in multiple health issues.

Now, let’s talk about progesterone because that’s also important in menopause, even if it gets less attention than estrogen. So, during perimenopause, progesterone levels may be the first to decline, which can lead to symptoms like irregular periods and heavy bleeding. So, progesterone is known to have a calming, even sedating effect, and that helps to promote sleep and reduce anxiety.

So, when progesterone levels fall during menopause, that can lead to a range of symptoms like mood swings, sleep disturbances, weight gain, and changes in your sex drive. And progesterone may also help with memory function. So, when your progesterone levels start to fall, you may notice brain fog and memory loss. You may even notice more headaches and even increases in migraine headaches.

And because progesterone and estrogen commonly work together, progesterone has a role in many of the same processes as estrogen, like building bone, body temperature regulation, and immunity. So, yes, estrogen matters, but progesterone definitely matters too.

And let’s not forget about testosterone. Testosterone levels also fall in menopause, and it’s important related to what we’re talking about today. So, while we often think of testosterone as a male hormone, it’s also an important hormone for women. It works together with estrogen and progesterone to maintain bone health and muscle mass. It has a role in your sex drive and your energy level. Your testosterone levels will decrease during and after menopause. And while it’s not as dramatic of a shift as what’s happening with estrogen and progesterone, your testosterone will continue to fall after menopause.

And the impact of this decline in testosterone is far-reaching. It can lead to decreased libido, vaginal dryness, weight gain, fatigue, thinning hair, brain fog, mood swings, bone loss, muscle weakness, and muscle loss. So, even though estrogen and progesterone get much of the airtime when it comes to menopause, I also wanted to point out that testosterone matters too.

I know that I am just scratching the surface here, but I want to give you an idea of the important role that your hormones like estrogen, progesterone, and even testosterone play in menopause and what changes you can expect when they start to decline.

So, when you put this all together, the hormonal shifts of perimenopause and menopause can affect fat storage and body composition, bone health and fracture risk, blood sugar regulation, cardiovascular health, neurologic health, inflammation and your immune response, and mental health, all to name a few. And my point in mentioning all of this is simply to highlight that the hormone changes you’re experiencing in menopause, they are real, they are legitimate, they are serious, and they warrant us paying attention.

And now, the other thing to know, as it relates to what I really want to dive into today, is this: Menopause will have an important impact on your muscle mass and strength. So, let’s talk about this.

Estrogen has an important role in both your muscle mass and your muscle function. I’m going to get a little nerdy here. It influences a process called muscle protein synthesis, or in plain English, building muscle. Estrogen also impacts energy production within your cells, and it helps to regulate inflammation.

And all three of these processes contribute to the health of your muscles. So, when estrogen starts falling in perimenopause and menopause, all of these systems are impacted, which can lead to muscle loss and decreased strength. And declining estrogen can also negatively affect bone density and tendon and ligament function.

So, what we’re looking at here is a combination of weaker muscles, less sturdy connective tissues, and potentially decreased bone density. And it’s this combination that can make injury more common. And aside from injury, women may also experience a decrease in muscle power and strength. So, estrogen supports both muscle mass and strength. It helps maintain muscle building and reduces muscle breakdown. And when it declines during menopause, you lose that support. So it makes sense, if you lose muscle mass, then along with it, you will lose strength and you’ll lose power.

And so what we know at this point about muscle loss is that women lose about 3 to 8% of their muscle per decade starting at age 30 until menopause. Then, the rate of muscle loss accelerates to 5 to 10% for each decade after menopause. So, the fancy word for this is sarcopenia, which you may have come across in the news or on influencer pages in social media or in books.

And the thing I want to point out is that sarcopenia or age-related muscle loss that is associated with menopause, it is not just about feeling weaker. The loss in muscle increases your risk of falls, fractures, mobility, and the loss of functional independence as you age. So, this is not just about vanity and doing everything you can to look muscular as you get older. There is a lot more to it than that.

We’re talking about maintaining your ability to bend over and tie your shoes. We’re talking about being able to reach overhead and pull something out from a high cabinet. We’re talking about being able to go on hikes with your grandkids that involve a change in elevation.

So, if any or all of those things are important to you, then it’s imperative to start doing something about it now. And I want to acknowledge something here. I know it’s hard to even imagine what it’s like to be in that place. So I’m almost 47, and it is hard for me to imagine being in my late 60s or early 70s or even in my 80s. I don’t spend a lot of time thinking about it. But while I don’t spend much time envisioning what my life will be like when I’m 80, I do know that what I’m doing today and tomorrow and the day after that to build and maintain the muscle that I’ve got, I know that it matters a lot.

So, even though that time of your life may be decades away, this is not something you can address at the last minute. This is not cramming for a test, okay? This takes years of consistent work to build muscle and you can’t just rush that. So the time to start building muscle is now. The earlier you begin, or begin again if you’ve been away from strength training for a while, the more time you give yourself to build a body that supports you not just now, but also decades from now. And I want you to thank yourself later for the work that you put in today.

And so what does that actually look like? What are the habits and exercise that support your strength and muscle mass during and after menopause? That is where we’re headed next.

So, first, I know I just mentioned it, but I really want to hammer this home. Strength training is essential. So if you’ve been around here at all, you know I mentioned how much conflicting information there is in the science about most everything related to health and fitness.

There is one place where pretty much everyone agrees. Strength training and building muscle is essential before, during, and after menopause because of the wide range of benefits you get from it, especially as your hormones change. So this is one place where science agrees. So, let’s start with muscle mass. Remember that as estrogen declines, the natural process of muscle loss speeds up and that makes it harder to maintain strength and function.

So strength training is one of the most effective tools in your pocket to combat this. Strength training promotes muscle building. It helps preserve the lean mass that you already have, and it supports your power, balance, and mobility. And these are all things that become increasingly important as we get older. So, strength training, it’s also good for your bone density. The weight-bearing that comes from strength training, that puts a good stress on your bones. Lifting weights essentially is a message to your body that says, hey, hold on to your bones. And this is essential for preventing or even delaying the onset of osteopenia and osteoporosis. So regular resistance training can help slow your loss of bone density and lower your risk of fractures.

And then strength training also improves your metabolic health. So, more muscle contributes to a higher resting metabolic rate. And remember that muscle is more active than fat. It needs more energy in the form of calories to maintain itself. So, muscle is good for your metabolism. It improves your insulin sensitivity and it helps keep your blood sugar stable. And this is not just important for maintaining a healthy weight, but also for reducing your risk of type 2 diabetes and metabolic syndrome.

And it keeps getting better. Strength training will also contribute to your cardiovascular health by helping improve your blood pressure and your cholesterol profile. It can also help reduce the frequency and severity of hot flashes. It improves your mood, it reduces stress, and it enhances cognitive function.

And probably the most important benefit of strength training in menopause is that it supports your long-term independence. So, you can pick up and carry your groceries. So you can get off the floor, climb stairs, climb mountains, travel, and live your life the way you want to instead of being confined to a body that does not work optimally for you. So strength training will give all of that to you.

So, as I’m listing all of these benefits, do you notice anything? Strength training essentially fights or counteracts almost every negative impact that menopause can have on your body systems. Do you see that? Strength training will fight or mitigate many of the undesirable effects that are expected with menopause. Now, to be clear, strength training, it is not a cure-all, but its impact is significant and far-reaching.

So, I hope I’ve been able to convince you that strength training in perimenopause and menopause is essential. And again, this is one place where science wholeheartedly agrees. Amazing.

And now, here’s where it gets messy. If you go to the literature, or if you do a Google search, or if you go to social media, you may find that some people say you’ve got to lift heavy, like a barbell back squat and deadlift heavy or it doesn’t count. And others will say, just move your body and be consistent. Others will say, you’ve got to do HIIT or you’re not doing it right. And still others will say, no, it’s not HIIT, you’ve got to do sprints instead. So, what the heck is the answer?

And the answer, in my opinion, is this: you do what challenges you and you build from there. So, if you’re already lifting weights and feel confident with progressive overload, awesome, keep going. And as a reminder, if you’re not sure what that means, progressive overload is the key principle related to building muscle. It means that you gradually increase the stress you put on your muscles by adding weight, doing more sets or more reps, or reducing your rest time so that your body continues to adapt to that stress and get stronger. This is how muscle is built over time.

Now, if you’re brand new to strength training or coming back to it after a long hiatus, and using five-pound dumbbells is a legit challenge, that is also awesome. And you start there and you keep going. And the key here is choosing resistance that feels hard enough to push you outside your comfort zone while still being able to complete your sets and reps with solid form. So you don’t have to be in pain, and you don’t have to be drenched in sweat either in order for your strength training to count or to be effective. But you do need to feel like you’re working.

So that means using enough resistance to challenge your muscles, not just going through the motions with an easy weight. So if you want to build muscle, you’ve got to challenge yourself and go heavy. And when I say go heavy, what I mean is lifting a weight that feels like the last two reps of each set are hard, but you’re still able to complete them while maintaining good form. And as your muscles adapt to that stress and you get stronger and lifting that weight gets easier, you challenge yourself again.

So, this is not to say that you have to hit a personal record every time you pick up a dumbbell, but you do need to keep challenging yourself. And that might mean you pick up the next heavier dumbbell, and instead of getting eight reps in like you intended, maybe you only get six. But remember, those six reps that you got with the heavier weight this week, those could become eight reps with the same weight next week. And the only way you’re going to get to that next heavier weight is by trying it out. And you’re going to do this safely, of course, with the help of a trainer or a spotter if you need it.

And what also matters when you build muscle is that you are consistent. That means you show up week after week and lift the weights, even when it’s not convenient and it’s not glamorous. Strength training to build muscle, it is most definitely an exercise of falling in love with the grind, okay? This work is not sexy, but it’s hard. Sometimes it burns, and it’s always worth it.

And while I just hammered on going heavy, I also want to point out that ideally, your strength training involves training all major movement patterns, like the squat, hinge, push, and pull. And while many recommend training each muscle group twice per week, please don’t get stressed by that. You can train them once per week and make the sessions high-quality challenging sessions and still see gains.

Do not feel like you’re failing if you’re not getting every muscle group trained twice per week. What you’re trying to do is give your muscles the training stimulus to encourage muscle growth and maintain strength without it becoming a part-time job and without getting overwhelmed.

So, with all of that said, what should you do? How should you lift? And of course, this is a subject of great debate, and I’m going to hit this head-on in just a few minutes. But I would suggest strength training at least twice per week, hitting all your major muscle groups at least once. You want to go heavy, and we talked about what that means. It means the last two reps of your set are challenging, but you’re not falling apart and sacrificing form.

Now, as for sets and reps, again, so much debate here, which I’ll get to, but I would suggest three to four sets of six to 10 reps of your major compound moves. So those are moves like squats, deadlifts, bench press, rows, and overhead presses. I’ve outlined all of this previously and you can learn more about strength training from the guide I created, which includes one, two, and three-day lifting programs to get you started, and it’s linked in the show notes.

And while I know we’re talking about building muscle and strength training, let me also hit on cardio activity for just a minute because it frequently comes up and I want to address it. So, cardio exercise is essential during menopause for loads of reasons. So, remember the impact of declining estrogen and menopause. Things like increased arterial stiffness and vascular inflammation.

Well, this is where cardio will help. And this is in addition to all the other benefits that cardio exercise gives you. Things like decreased risk of heart disease, stroke, and diabetes. It also improves memory and cognition. It gives you better bone health, improved lung capacity, improved blood sugar control. It also reduces stress, anxiety, and better sleep.

So, there are loads of reasons to do cardiovascular exercise and they become even more important during menopause. So, what should you do? If you go to what we have in the evidence, you’ll see a recommendation of about 150 minutes of moderate or 75 minutes of vigorous cardiovascular activity per week. And ideally, this is spread out over the week.

So now, let me also hit on a specific aspect of cardio, and that’s HIIT training or high-intensity interval training. There is a lot of interest in this lately as we learn more about it. So let’s talk about it. So, HIIT training is made up of short bursts of high-intensity effort followed by short recovery periods. And what we’re starting to learn is that HIIT training may help reduce visceral fat. So that’s fat that surrounds your organs. It can also improve cholesterol, improve memory, and improve hot flashes and sleep disturbances that are associated with menopause.

So, with all of these potential benefits, it’s no wonder that HIIT training is getting so much attention as it relates to optimizing strength and fitness in menopause. And then, if you go to the evidence, there is no one gold standard protocol for how to do this. But what this could look like is two to three sessions per week. And your session includes four to eight intervals of 30 seconds to 1 minute of about 85% max heart rate with one to two minutes of active rest between intervals. So, let me break that down.

That looks like four intervals where you go 30 seconds on, 60 seconds off of whatever exercise. And you can do this with pretty much any exercise that gets your heart rate up quickly. So, this is things like jump squats, mountain climbers, jump lunges, high knees, treadmill sprints, stationary bike sprints, the rowing machine, kettlebell swings, battle ropes. Choose your exercise. Whatever gets your heart rate up and gets it up fast, that’s your exercise.

Now, while I’m talking about hit, let’s also talk about SIT or sprint interval training because you may have been hearing and seeing this term all over as well. So, sprint interval training, as it sounds, it is a sprint. It involves short bursts of maximal effort followed by longer recovery periods. So this is 10 to 30 seconds of all-out effort followed by two to four minutes of rest. And as I said, this type of exercise is a sprint. It’s all out, maximal intensity. Whereas with HIIT, you’re aiming for 30 seconds to a minute of a more high-intensity effort at about 80 to 90% of your max heart rate with shorter rest periods.

So, I know I just said a whole lot, so let me keep it simple. HIIT is about 80 to 90% effort for short bursts, while SIT is an even shorter all-out sprint level effort with longer rest.

So, SIT has gotten a lot of attention lately as it is being promoted as being particularly beneficial for menopausal women due to its efficiency in stimulating physiologic responses that are important in menopause. So, let me help you break this down and make more sense.

Sprint interval training aims to address various issues that are known to be associated with menopause. So, specifically, it’s thought to enhance muscle mass by engaging your fast-twitch muscle fibers, which are essential for maintaining muscle strength and muscle mass. SIT is also thought to improve your metabolic health by boosting insulin sensitivity and promoting fat oxidation. So both of these can help with weight management.

And SIT can help increase your aerobic capacity and improve your cardiovascular health. And it’s all of these benefits that are super helpful when we’re talking about optimizing muscle and fitness in menopausal women. And then the other benefit of SIT is that a little bit goes a long way and it’s time efficient.

When you’re going at all-out effort, we’re talking short bursts and not for prolonged periods. So you’re done pretty quickly with your workout. So, let’s talk about what this would actually look like. You’ve got a five-minute warm-up of light cardio, like easy jogging or cycling or even brisk walking. Then, you do intervals of 10 to 30 seconds of all-out work, followed by two to four minute rests in between. And you do this for four intervals. And then you cool down with a lower intensity cardio activity like slow jogging or walking.

And the point here is that whatever activity you choose for your SIT training, you go all out. So it could be on the bike, running, swimming, rowing, kettlebell swings, whatever it is. It’s max effort followed by longer rest. And even though you’re pushing super hard, it’s short. And that’s part of the appeal. It’s a good way to get in a solid workout without spending a ton of time.

So, let me take a step back for a minute. We’ve talked about a lot. We’ve talked about strength training, cardio, HIIT, and SIT. And so now, if your head is spinning, as mine was when I was preparing for this podcast, I’ve got you. And if you are wondering how to put this all together, let me give you the quick and dirty version.

So, this is what your week could look like, okay? So, if you want to optimize your body composition in perimenopause and beyond, strength training is essential. So that means I would aim for two strength training sessions per week, and you can do these as full-body sessions, training the five major moves that I mentioned earlier, or you can split this up into two sessions, one day of upper body exercises and one day of lower body exercises.

Now, as for your cardio, if you are not currently moving, meaning you’re not doing any regular cardiovascular activity, then please do not go straight into HIIT and SIT from the get-go. I would suggest building up to that. So, first, I would get comfortable with steady-state cardio activity, like walking, jogging, cycling, biking, stair master, rowing machine, whatever your cardiovascular exercise of choice is, get comfortable with that before you consider adding HIIT or SIT so that you don’t overdo it. It’s really important to build up to this.

So now, let’s say you already have a solid routine of strength training and you do mostly, if not all, steady state for your cardio. And I should be clear, when I say steady state, that means your 30 or 45-minute long run on the trail where you hold a pace, or your 50-minute bike ride, or your two-mile swim. So, if you’re looking to add or to change your cardiovascular exercise regimen based on what we’re talking about and based on what you’re learning about muscle and strength and menopause, you can adjust your approach.

So, if you’re already doing a fair amount of steady-state cardio and you want to change that up based on what you’re learning, here you go. So, you could consider one HIIT session per week and one to two SIT sessions per week. And this would take place of some of your steady-state cardio workouts.

So, I’m not saying you do not have to give up your steady-state cardio, but we’re swapping some of that out for some shorter, more high-intensity work. And again, this is not to say that your steady-state cardio is irrelevant or bad, but what we’re learning is that there may be an important place for HIIT and SIT when we’re talking about optimizing muscle and optimizing strength in perimenopause and menopause. So, that is where these suggestions are coming from.

And now, as for rest, some of you may want a full day of rest where you do no planned activity. Some of you may want a day of active recovery, like walking or yoga for mobility, and that’s fine and encouraged. And again, no one right way to do this.

So now that I have totally gotten into the weeds here, let me summarize and offer the approach I would take. So, strength training, in my opinion, is essential. Two sessions per week at minimum, training your major muscle groups at least once. And then you layer from there. So, if you are not doing any cardiovascular exercise currently and you want to, start with lower intensity, steady-state bouts of exercise to build up your endurance and stamina.

So that’s something like 10 minutes of walking where you gradually build more time and start to speed it up, maybe to a jog. Then, from there, you can layer in higher intensity work. So, that could look like adding in one HIIT session per week. And then when you get comfortable with that, you can take it up another notch and add in a SIT session once per week where you go all out. And there’s a theme here. Everything we’re talking about is layering. I do not want you walking away from this podcast thinking that you’ve got to scrap what you’re doing and start all over. Okay? No.

I also don’t want you thinking that you need four more hours to your week to get all this working out done. No. I want you to find what works for you, what makes sense for your life right now, and do that. And then, when you’ve got that movement locked in and it’s a habit, you can start adding to it if and when you’re ready and if it makes sense. These are all suggestions, and I definitely recommend taking a stepwise approach, no matter what type of exercise you do. Okay?

So, now that we’ve talked through this, let me take a big step back and address what was really nagging at me when I sat down to write this episode. And that is, why is there so much conflicting advice? Why is it that one day I’m reading that three to four sets of 10 to 12 reps of a strength training exercise is sufficient? And the very next day, I’m reading that, no, instead, I should be doing four sets of six to eight reps super heavy. Why is it that one day all I see is that HIIT is the be-all and end-all? And the next day I’m reading, no, when you’re in menopause, forget HIIT and do SIT instead. And forget about steady-state cardio.

And I haven’t even started talking about nutrition because that’s going to have to be a separate episode in itself because that is another huge issue to tackle. But why is all of this information so conflicting?

So here is what I learned when I dove in. Some of the recommendations that you’re hearing are based on solid physiology without all of the studies to back them up. So let me explain what I mean by this. We do know that declining estrogen impacts muscle mass, insulin sensitivity, and overall metabolic health. We do know that lifting weights can help counteract those effects by promoting muscle retention, improving glucose control, and improving your heart health.

We do know that building and maintaining muscle becomes more of a challenge as we get older, especially when we don’t have as much estrogen and testosterone to support those processes. But, now here is the big take-home that I really want you to hear. Just because something makes sense on a biological level does not mean that we’ve got the long-term, high-quality evidence showing that this is the one and only or that it’s the best way to train.

So, as an example, there are claims that all menopausal women must lift heavy, very heavy, reduce or even avoid steady-state cardio, and follow a specific split for lifting and high-intensity work. But the data is not definitive yet to make this the be-all and end-all.

And so here’s the other thing I want to mention. Some of the recommendations that you’re reading and hearing about strength training are ahead of the research. So that means these recommendations are based on short-term studies, clinical experience, or what we understand about muscle physiology. So that means these recommendations are not always based on longitudinal data that measures health outcomes over decades. So, that was a big mouthful. So let me make this simple.

Some of the recommendations that you hear about how much to train, how heavy to train, how much SIT versus HIIT versus low-intensity cardio, some of those recommendations are being made before we have long-term, high-quality research studies on menopausal women to back them up. We don’t have the research on real, female, menopausal humans yet to definitively say, this is the best way to exercise in menopause.

And if you’re wondering why that is and why we don’t have that information yet, it’s in part because science takes time. It often takes years to design and execute research and then take that research and translate it into guidelines. And if we want to know long-term impacts of various exercise regimens on menopausal women, we have to follow these women for decades, measure outcomes, review data, and then make recommendations based on that. And most of us don’t want to wait that long.

Remember that so much of what we know about exercise now is what we’ve learned from studying men and extrapolating that to women. And there is most definitely a lack of research on perimenopausal women. So, thankfully, that is starting to change, but we know that it’s going to take years, if not decades, to have more legit, solid information available to guide recommendations for optimal exercise in menopausal women.

And I’m sharing all of this because it doesn’t mean that these ideas are wrong. The recommendations I’ve shared with you aren’t incorrect, but they don’t have randomized controlled trials and meta-analyses to back them up yet. But some people don’t want to wait that long based on what they’ve learned so far about women in menopause, and that’s why you might be hearing a lot of noise in this space right now.

And for me, what I realized as I dug into this and what I want you to know is that we need to be careful about labeling anything as a universal truth. It is one thing to say that heavy resistance training can help with muscle mass and bone density. It is another thing entirely to say that you must do four sets of six reps at super heavy loads in order to build muscle. Those are very different.

So yes, we want to use what we know about physiology to guide decisions, but we also need to leave room for nuance, for personal preference, and for the reality that science is still very much evolving. There is a big difference between advice that is helpful and advice that is dogmatic, and it’s totally okay and encouraged to question what you hear, even when it comes from an expert.

And my goal today is not at all to knock anyone or take away from anyone’s work. I think it’s absolutely awesome and frankly, entirely overdue that so much attention is being paid to menopause and women in midlife. We need that. But I also want to be honest about where the science ends and speculation begins.

So just because something sounds smart does not mean that it’s been studied thoroughly. And just because something is trending doesn’t mean it’s right for you. So to be clear, even the experts disagree. Even the most popular voices in this space are making educated guesses at least to some extent. And that’s not a reason to throw it all away. Instead, it’s a reason to stay curious, keep asking questions, and give yourself permission to think for yourself.

So now, let me take this full circle and bring it back to you. What do you want to do with all of this? So remember that we are all unique. Your body, it is unique. Your schedule, preferences, limitations, your history, they are all unique to you and they all matter. So, you do not have to lift heavy at four sets of six reps if you hate it. You do not have to give up your Sunday long runs if you love them. You do not have to copy someone’s routine just because it worked for them. And you do not need to shake up your entire approach to fitness because of what one person, study, podcast, or book says.

So instead, please let this be your reminder that there is no one right way to move your body, whether you’re menopausal or not, okay? There is, nor do I believe there will ever be one right way to do this. So instead, please find movement that you enjoy, movement that you can stick with and that challenges you, and find what supports your long-term health, fitness, and physique goals.

So here’s my suggestion. Instead of asking, what is the best workout for menopause? Instead, ask, what am I willing to do consistently? What feels doable and effective? What helps me feel strong? And what am I interested in trying? And that is how you’re going to find what works for you. That’s how you sift your way through all of the noise around this, by coming back to what works and what makes sense for you.

Okay? So here’s the take-home message. Yes, your body is changing in perimenopause and menopause. Yes, strength training is incredibly helpful. And yes, some of the popular advice that you’re reading and seeing is based on emerging science. But no, that it is one way and not the only way.

You are allowed and strongly encouraged to start where you are. You are allowed to build gradually. You are allowed to do this imperfectly. You are allowed to veer from what you see and hear to exercise in a way that works for you. And the most powerful thing you can do is not follow someone else’s plan. It’s to show up for yourself. Again and again. One workout, one walk, one choice at a time. All right?

And if you want help figuring out how to make exercise work in your life without extremes and without the drama, let’s go. When you coach with me, we’ll build a plan that fits your life and your goals. Check out my website, go to www.CarrieHollandMD.com/contact. And let’s talk about how coaching will help you build habits that make you strong inside and out. Thank you again for hanging out with me, and I’ll catch you again next week.

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Hey if you want to build muscle but don’t know where to start, I’ve got you covered. Head over to CarrieHollandMD.com/buildstrength and download my free guide to help you maximize your strength training. Inside, you’ll find the essential exercises for building muscle, plus simple one, two, and three-day workout plans you can follow with just dumbbells and a bench.

You’ll also find strength training tips to help you train smarter and see real results. My goal is to help you get strong and this strength-training guide will help you do it. Go to CarrieHollandMD.com/build strength and check it out.

Thank you for listening to the Strong Is a Mindset podcast. If you want to learn more about how to build both a strong mind and a strong body by eating, moving, and most importantly, thinking, check out CarrieHollandMD.com.