Why Perimenopause is the Time to Invest in Your Health

For many women, perimenopause arrives with changes that can feel frustrating, confusing, and sometimes completely disconnected from the habits that once worked.

Energy may drop. Sleep can become less predictable. Body composition may shift. Strength, mood, recovery, and even the motivation to exercise can change.

But Abbie Smith-Ryan, PhD, wants women to look at this stage of life differently.

Rather than viewing perimenopause as something to simply endure, Smith-Ryan describes it as a “window of opportunity” — a period when relatively small changes in exercise, nutrition, and other daily habits may help shape health for decades to come.

“Perimenopause … truly is the highest leverage moment to invest in your long-term health,” Smith-Ryan told attendees during a recent UNC Nutrition Research Institute Appetite for Life presentation.

Perimenopause commonly begins in the early 40s, although symptoms may appear earlier, and the transition can last four to eight years. During that time, fluctuating hormones can coincide with changes in body composition, metabolic health, cardiovascular health, bone, sleep, and mood.

Smith-Ryan’s research suggests some of those changes become particularly pronounced during the transition from premenopause into perimenopause and then begin to level off after menopause.

That makes midlife an important time to act.

Start with muscle

One of Smith-Ryan’s strongest recommendations is resistance training.

Muscle does far more than affect appearance. It supports mobility and independence, helps regulate blood glucose, contributes to metabolic health, and allows us to continue doing everyday things like carrying groceries, getting out of bed, playing with children, and moving confidently through life.

Muscle size and quality can decline more quickly during perimenopause than through aging alone, Smith-Ryan explained. The good news is that muscle responds to training.

“Consistency beats complexity,” she said.

Women do not need to spend hours in a gym or lift extremely heavy weights every day. Smith-Ryan recommends finding a form of resistance training that can realistically be repeated, ideally a few times each week. Even once a week can provide benefit for someone who is not currently strength training.

Resistance bands, dumbbells, body-weight movements, and simple full-body workouts can all provide the necessary stimulus. For women who already exercise regularly, increasing the challenge or introducing a different type of movement may help.

Smith-Ryan’s laboratory recently studied six weeks of high-intensity resistance training in perimenopausal women. Participants made substantial gains in strength and improvements in muscle quality, cognition, and body composition in a relatively short period.

The scale, however, did not always tell the story.

In one example Smith-Ryan shared, a participant lost only about one pound of total body weight but gained approximately three pounds of muscle while losing roughly four pounds of fat.

That distinction matters.

Instead of focusing only on weight, Smith-Ryan encourages women to consider what their bodies can do, how they feel, and whether they are preserving the muscle and strength that support long-term health.

Exercise does not have to take an hour

Resistance training is only one part of the equation.

Smith-Ryan encourages women to move throughout the day and to remember that short bouts of exercise count.

A 15-minute workout, a walk, taking the stairs, a few jumping jacks, or what she calls “exercise snacks” can all add movement to a busy day. For cardiovascular health, interval exercise can also provide benefits without requiring a long workout.

One approach Smith-Ryan uses in research is one minute of harder exercise followed by one minute of easier movement, repeated several times.

“You don't have to have two hours a day,” she said.

The goal is not to create the perfect exercise program. It is to create one that can actually become part of daily life.

Do not respond by simply eating less

As bodies change during midlife, many women instinctively turn toward restriction.

Smith-Ryan cautions that the familiar advice to “eat less and move more” can backfire.

Her research has found that long periods without food and chronic underfueling may contribute to lower metabolism. Underfueling may also contribute to fatigue and brain fog — two complaints commonly associated with perimenopause.

That makes adequate nutrition particularly important.

Instead of concentrating on eating less, Smith-Ryan encourages women to focus on diet quality and adequate fuel.

Research points toward Mediterranean-style eating patterns, which emphasize vegetables, fruits, legumes, whole grains, quality protein, and healthy fats. Higher-quality diets have been associated with fewer vasomotor symptoms, better cardiometabolic health, and improved mood.

Smith-Ryan boils one recommendation down even further:

“Eat more vegetables.”

Adding a fruit or vegetable to meals, choosing more whole foods, increasing beans and legumes, and reducing some highly processed foods can steadily improve overall diet quality without requiring a complicated eating plan.

Protein becomes especially important

Protein is another priority during perimenopause because of its role in maintaining muscle and bone. Smith-Ryan recommends thinking not only about total protein intake, but also about how protein is distributed throughout the day.

A useful target is approximately 30 grams of protein at a meal, beginning with breakfast. Depending on a woman’s size, activity level, and goals, three meals containing 30 grams each still may not provide enough, so snacks such as Greek yogurt, a small meal, or a protein shake can help fill the gap.

She also recommends avoiding routinely going four to six hours without eating. Eating earlier in the day and spreading food and protein intake across the day may better support energy, metabolism, and hunger regulation than saving most food for later.

For women who exercise, eating around workouts may also be beneficial. Smith-Ryan described research suggesting that a small snack before training can support metabolism and post-exercise energy expenditure compared with consistently exercising while fasted.

Fiber deserves more attention

One of the most overlooked nutritional tools during perimenopause may be fiber.

Smith-Ryan recommends at least 25 to 30 grams per day.

Fiber supports digestive health and satiety and is associated with cardiovascular health, lower cancer risk, and longevity. Vegetables, fruits, beans, legumes, whole grains, nuts, seeds, and foods such as chia seeds can all make it easier to increase daily intake.

Diet quality may also influence sleep, another major concern during perimenopause.

For women who eat dinner early and wake during the night or experience night sweats, Smith-Ryan noted that a small evening snack containing a complex carbohydrate and protein may sometimes be helpful rather than adhering rigidly to rules about avoiding food after a certain hour.

Small changes can compound

Perhaps the most encouraging message from Smith-Ryan’s presentation was that women do not need to overhaul every aspect of their lives at once.

In previous research, her team evaluated women across the menopausal transition, provided information about their body composition, nutrition, and lifestyle, and followed them approximately two years later.

Women who incorporated some of those recommendations were able to maintain important measures of health even as they transitioned through perimenopause or into postmenopause.

That is why Smith-Ryan considers this period a window rather than a decline.

Habits built during these years can compound over time.

Her starting recommendations are straightforward: move consistently, add resistance training, incorporate some higher-intensity movement when appropriate, eat enough high-quality food, prioritize protein and vegetables, aim for at least 25 grams of fiber, stay hydrated, and protect sleep.

The goal is not perfection.

It is to recognize that perimenopause is a period of change — and that change creates an opportunity to invest in the strength, metabolic health, mobility, and quality of life women want to carry into the decades ahead.

For more of Smith-Ryan’s recommendations on exercise, nutrition, sleep and navigating perimenopause, watch the full Appetite for Life Presentation here.