The transition to menopause is called perimenopause, and it begins when the ovarian production of sex hormones starts to decline. Perimenopause can span many years and include a variety of signs and symptoms. These may differ widely from woman to woman and change from day to day and month to month.

During both early and late perimenopause, you might experience:

• Hot flushes
• Night sweats
• Sleep difficulties
• Mood swings
• Headaches
• Joint pain and stiffness
• Back pain
• Difficulty concentrating

Reproductive organs are not the whole picture of menopause. They don’t operate alone. Complex feedback loops of hormonal and nervous signals govern the entire system. This means that the effects of menopause occur throughout the body. The nervous system secretes hormones that tell our reproductive system what to do, so the central nervous system both causes and responds to the hormonal changes taking place.

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Brain and the Nervous System

In the central nervous system, when estrogen and progesterone levels change during midlife, women may notice changes in mood, increased anxiety or depression, brain fog, forgetfulness, or trouble concentrating. Because sleep is crucial for learning, memory, and regulating moods, sleep disruptions can exacerbate these issues.

Lifestyle practices can play a helpful role in supporting cognition and mental health. Having a regular exercise habit supports brain health and mood. Even a 10–15 minute brisk walk can decrease stress and regulate mood. More intense interval training or metabolic conditioning provides an important energy source for the brain and can help reduce the risk of neurodegenerative diseases.

Incorporating play into your daily exercise enhances focus, boosts mood, helps release dopamine, and builds social bonds. Explore new, fun, and challenging ways to move your body that require focus—your brain will thank you.

Sleep-wake cycles and circadian rhythms—our natural daily cycles that regulate almost all physiological processes—are also governed by the brain. Hormonal changes can make falling and staying asleep more difficult. In addition to affecting mood and cognition, sleep also impacts metabolic health, which in turn can affect appetite, hunger, body composition, and risk for chronic disease.

Fortunately, lifestyle habits can improve sleep. Create a simple, manageable pre-bed routine. Amplify light and dark signals during waking and resting periods. Do more calming activities in the evenings under dimmer lighting. These practices can enhance sleep quality, which will boost mood and energy for exercise.

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Cardiovascular Health

When estrogen and progesterone levels change during the menopause transition, the risk of cardiovascular disease increases. Women become more vulnerable to high cholesterol, blood clotting, inflammation, high blood pressure, and reduced lung capacity. All of these factors can impact exercise performance and recovery, especially in sports that rely on high VO2 max and aerobic capacity.

The most important things women can do to protect cardiovascular health are to exercise regularly, eat a nutritious diet, manage stress, and prioritize good sleep and recovery.

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Metabolism and Body Composition

Adipose tissue influences hunger, appetite, and reproductive health. During menopause, as estradiol and progesterone levels decrease and FSH levels increase, women often notice increased fat accumulation, particularly around the midsection. FSH promotes weight and fat gain by inhibiting thermogenesis and favoring fat storage. While menopause does not directly cause weight gain, it is often associated with a shift toward more visceral and abdominal fat—commonly referred to as "belly fat."

Body fat plays a role in full-body energy homeostasis—how much energy we consume versus how much we expend. When estrogen is high, it suppresses appetite and increases energy expenditure through the central nervous system. When estrogen drops, appetite increases, and it becomes easier to overeat.

That said, having some body fat during menopause may be beneficial. Adipose tissue secretes leptin, a hormone that helps regulate appetite. More body fat generally means more leptin, which signals the body that sufficient energy is stored. Higher leptin levels are also associated with better bone mineral density.

Like muscle, women lose bone mass with age and hormonal changes. Bone mineral density decreases starting in perimenopause, especially in the lumbar spine. The most significant loss occurs late in perimenopause, around one year before menopause. Smaller women may be more affected due to having less skeletal mass to begin with. However, this loss can be mitigated with proper nutrition and consistent full-body resistance training.

Perimenopause can be a challenging time, but you can manage these changes with a combination of diet, strength training, aerobic conditioning, and supportive lifestyle behaviors.

Recovery tends to be slower, with more aches and pains. Older bodies require longer warm-ups and cool-downs, greater focus on mobility and movement prep, and more careful attention to technique. Incorporating daily movement, honoring your body's cues, and prioritizing recovery are essential.