One of the more bewildering experiences of midlife is discovering that your body no longer seems to respond the way it once did.
The exercise routine that used to make you feel fantastic leaves you exhausted. You’re not sleeping properly. Your digestion changes. You might experience palpitations, mood changes, brain fog or stubborn weight gain.
And perhaps most frustratingly, you can be doing all the things you’ve always considered “healthy” and still feel as though something is off.
In my conversation with Dr Christina Enzmann, we explore why perimenopause and menopause can change the way the body responds to stress — and why stress itself is much bigger than deadlines, family responsibilities and having too much on your plate.
Your Body Experiences Stress Too
As oestrogen and progesterone fluctuate and eventually decline through the menopause transition, the relationship between hormones, sleep and the body’s stress-response systems also changes.
For some women, this can mean that the pace of life or amount of training they previously tolerated well suddenly becomes much harder to recover from.
But Christina makes an important distinction: stress doesn’t only come from the mind.
The body can experience physiological stress too.
Nutrient deficiencies, inadequate nutrition, blood sugar changes, environmental exposures and simply not eating enough for the amount of activity you’re doing can all place additional demands on the body.
Exercise is another form of physiological stress.
Of course, exercise is enormously beneficial in midlife. But more isn’t necessarily better, particularly when your body is already struggling to recover.
This can create a frustrating cycle for active women.
You begin gaining weight or feeling less fit, so you train harder. You reduce your food intake. Maybe you add more cardio or get up earlier to squeeze in another workout.
But if that early workout comes at the expense of sleep and you’re not eating enough to support your training, pushing harder may leave you feeling even worse.
Instead of energised, you become wired but tired.
Are You Actually Eating Enough?
One of the most interesting parts of our conversation is Christina’s explanation of energy availability, a concept commonly used in sports science.
It refers, essentially, to whether the body has enough energy available after exercise to support everything else it needs to do.
Women can spend years gradually reducing calories in an attempt to control their weight, particularly as their body begins changing through midlife.
But chronic under-fuelling combined with significant training demands can have consequences for recovery, muscle and metabolic health.
And this is where the solution can feel counterintuitive.
Rather than exercising more and eating less, Christina sometimes works with women to bring training back to a sustainable level and gradually increase food intake.
The aim is to properly fuel the body again, support muscle and recovery, and create a healthier foundation before considering any deliberate period of fat loss.
It’s a very different approach from the relentless eat less, exercise more message many women have heard for decades.
Blood Sugar, Insulin and Midlife
We also explore insulin resistance and the role blood sugar regulation can play in metabolic health through menopause.
Hormonal changes, sleep disruption, stress, nutrition and activity all interact, which means weight changes in midlife are rarely as simple as calories in versus calories out.
Christina prefers a lower-glycaemic approach for many women rather than automatically recommending something highly restrictive such as a ketogenic diet.
She also shares some simple ways of experimenting with how you eat.
For example, the order in which foods are eaten may influence the glucose response to a meal. Starting with fibre-rich vegetables, followed by protein and fats and then carbohydrates is one strategy we discuss.
Meal spacing may also be useful for some women, while extended fasting isn’t necessarily beneficial if it leaves you stressed, hungry or sleeping poorly.
Continuous glucose monitors can provide another interesting window into your individual response to food. Something considered universally “healthy” may affect your glucose very differently from somebody else.
The goal isn’t to become obsessive about every glucose spike. It’s to gather information about your own body and use it intelligently.
Where Does HRT Fit?
Hormone replacement therapy is another important part of our conversation.
HRT can be extremely effective for particular menopausal symptoms, especially hot flushes, and may have important benefits for bone health for some women. But Christina cautions against assuming hormones will automatically resolve every symptom that appears during midlife.
Brain fog, fatigue, weight gain and poor metabolic health can have multiple contributing factors.
That means it can be worth looking more broadly at sleep, nutrition, stress, movement, alcohol, caffeine and overall metabolic health alongside conversations about hormone therapy.
We also discuss genitourinary syndrome of menopause (GSM) — a collection of symptoms that can occur as oestrogen levels decline, including vaginal dryness, painful sex, urinary urgency and recurrent urinary tract infections.
Local vaginal oestrogen is one of the treatment options Christina discusses for these symptoms, and it’s an area of menopause care that many women still know very little about.
Maybe You Don’t Need to Push Harder
There’s a bigger message running through this entire conversation that I think many women in midlife need to hear.
When your body changes, the answer isn’t necessarily to become stricter with it.
You may not need another diet, another early morning workout or another attempt to push through exhaustion.
Perhaps your body is asking for something different.
More sleep. Enough food. Strength rather than endless cardio. Better recovery. Less alcohol. A different relationship with caffeine. Support for symptoms that you’ve been putting up with for far too long.
Menopause isn’t simply something to survive until you eventually emerge on the other side.
It can also be an opportunity to reassess the way you’re living and begin working with the body you have now.
And perhaps come out the other side stronger than you went in.
This article was generated with the assistance of AI from the original podcast transcript and edited for readability. The ideas and conversation are drawn from the original episode of The Midlife Rebel Podcast