Menopause, Fatigue & Exercise

There's a strange irony in being a fitness writer who is experiencing perimenopause. Every week, I read articles and studies about the vital importance of regular exercise, especially during this stage of life. Yet there have been times (let's be fair, entire months) recently when simply walking to and around the supermarket has required a recovery window I would previously associate with an intense bout of cardio.

It wasn't always like this. Five years ago, at the tail end of my thirties, I used to cycle 40 minutes to work daily, tackling a hill so daunting that it has its own Strava segment. That meant a seriously sweaty arrival at the office. Still, it was a scarily fun treat to return down each afternoon. You'd also find me in a yoga or Pilates session most lunchtimes. On Saturday nights, I'd often be on a dance floor somewhere, burning up more of what felt like an unlimited energy supply.

Flash forward to the present, as I hone in on my 44th birthday next month, and that all feels like a distant dream. To illustrate, I recently visited a friend in Barcelona. Knowing I don't have the vibrancy I once enjoyed, I planned a slow five-day sojourn rather than my usual zippy weekend. Yet, despite having rested well for weeks in advance, where did I spend most of that trip? Not strolling around cute laneways, swimming at my favorite beach or dancing till dawn. No, the vast majority of the time I was in bed, streaming TV shows, too shattered (as we say in the UK) to move.

The thing is, I'm not old, far from it. My mum is 72 and still runs multiple businesses and climbs mountains for fun. So, I'm confident I still have decades of energetic pursuits ahead of me. What I'm experiencing is perimenopause, the years preceding that official graduation into menopause (i.e., the end of menstruation). And when they say years, they mean it quite literally. For many, it ends up being the best part of a decade.

Puberty in reverse

One of the best ways to understand perimenopause is to picture it as puberty in reverse. All those sudden, extreme changes to your body, skin, hormones, mood, and energy levels that made you want to shout WHAT ON EARTH IS HAPPENING TO ME when you were a teenager occur in similar (yet opposing) ways during middle age for those who menstruate. Initially, it starts with a few subtle hints, like how pubescent you would have been surprised to discover your first pimple or a bit of a growth spurt. And, then suddenly, one day, it's everything. Everywhere. All at once.

Which brings us to perimenopause fatigue. The conundrum of this time in your life is that we're told NOW you should step up your fitness game if you haven't already done so. Strength training is essential, as are regular HITT sessions. But I've yet to come across anyone who talks about how impossibly hard it can sometimes be to regularly work out during perimenopause. For example, over the past two years, I have promised myself that if I can regularly maintain bodyweight exercises at home for three months, I'll finally shell out the money for a PT to help get me started with proper weight training. A few years ago, that wouldn't have been an issue. Yet, the best I've managed so far is a couple of weeks (and depressingly, that was a while ago).

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Focus on flexibility

Clearly, incentivizing myself in a way that leaves me feeling so disappointed is the wrong approach. Dr. Carla DiGirolamo couldn't agree more. "Be kind to your body, and don't make it your "enemy," she implores. "If you're experiencing chronic fatigue, there is likely a reason that needs attention. But the key to getting through these times, is to engage in physical activities that you enjoy. The first step is to just show up with no preconceived expectations."

As a board-certified Reproductive Endocrinologist specializing in female athletic performance and menopause health, Dr. DiGirolamo can give the kind of informed pep-talk I've been needing. "Create a routine and be flexible," she recommends. "This is key because, on a day when you have scheduled a 5K run, you may wake up and feel like there is just no way." Instead, she suggests keeping your workout time but pivoting to what you have the capacity for, even if it's 15 minutes of gentle mobility exercises. "The point is to set aside time in a regular schedule to train or even just move, and be uncompromising on this. But within this time, have flexibility in the activities you engage in."

Beware of underfuelling

Ensuring that you're eating enough of the right foods is also essential for your energy levels. "A common reason for fatigue is a fueling imbalance," notes Dr. DiGirolamo. "Overtraining and underfueling is EXTREMELY common in athletic women in this age group." Even if, like me, you're unlikely to fit under the label of 'athletic,' understanding which types of food will give you the sustenance to get through the day will go a long way toward helping with perimenopause fatigue.

"The hormonal changes of menopause most certainly require consideration from the nutritional perspective," advises Dr. DiGirolamo. "First, declining muscle mass and irregularly cycling estrogen can lead to a relative insulin resistance where blood glucose is less efficiently controlled and can result in greater fat deposition. Processed sugars and alcohol may not be tolerated as well and lead to higher blood glucose levels. For this reason, it is important to focus on high-quality carbohydrates from whole foods (fruits, vegetables, root vegetables, beans) and grains optimally and avoid processed simple sugars."

"Second is a greater need for protein to stave off the declining muscle and bone mass and to promote recovery and muscle-building following training," she continues. "In general, one gram of protein per pound of ideal body weight is recommended each day during this stage of life by experts in the field like Dr. Stacy Sims." (Having heard Dr. Sims being interviewed on many science-backed health and fitness podcasts, she is definitely another menopause expert I would recommend checking out).

"Lastly, getting enough fuel and avoiding under-fueling is absolutely critical to recovering and making the fitness and performance gains you strive for," urges Dr. DiGirolamo. So, considering the increased likelihood of fatigue, do people experiencing perimenopause need a lengthier recovery window? "As a general rule, men and women need to pay more attention to recovery as they age," she confirms. "However, women who are in the menopause transition are often experiencing symptoms that can create obstacles to recovery - most notably sleep disturbance resulting from hot flashes, mood disturbance and the like, which can compound what they are experiencing simply as a result of aging."

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Work with experts

As it turns out, getting PT to work with me as I navigate perimenopause might not be the waste of money I assumed if I can barely move due to fatigue. The critical factor is working with someone who truly understands what I am experiencing and isn't going to push me in ways that I have no capacity for. "Find a coach/trainer who is 'menopause informed,'" urges Dr. DiGirolamo. "There are many good courses that personal trainers and fitness professionals can take that teach them the essentials of training women in this stage of life. Most coaches list menopause training in their credentials. But don't ever hesitate to ask!"

Getting professional help can be especially important if you've detrained after taking an extended break from exercise due to fatigue. "A menopause-informed coach provides human connection, an objective perspective and expertise so that you can re-enter training and achieve your previous performance level while avoiding injury," she notes. "They can help you to train WITH these changes that the body is going through rather than against it and trying to force things that worked in a 30-year-old body that no longer help."

So, dear reader, I'm happy to say that a few weeks ago I took Dr. DiGirolamo's advice. Turns out, there is a gym only 10 minutes from my house that is specifically for women in this stage of life and beyond. The trainers are super sensitive and supportive to the changes I'm experiencing, and the workouts are all geared towards specifically what my body needs now. Suffice it to say, there is a big emphasis on strength training and I'm loving it.

It's also inspired me to eat more wholesome carbs, which, yes, maybe I hadn't been eating enough of. So far, I haven't had any issues with fatigue. But I also feel really supported now by the friendly team at my gym. It's not unheard of them to check-in on me if I skip a session to check I'm ok.

So, rather than looking back at how fit I used to be, I 'm now focusing on what I could be. After all, with the correct information and especially the proper nutrition, this level of fatigue, thankfully, won't last forever. "Think of aging and menopause not as a decline, but rather a "detour," encourages Dr. DiGirolamo. "An opportunity to expand your horizons as an athlete - mentally and physically." So, while I may never cycle up that epic hill again five days a week, that doesn't mean I can't try climbing mountains like my mum. In fact, I think I'm nearly ready.

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