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Prioritizing Exercise During Menopause: A Key to Metabolic Health

Menopause is a critical time to prioritize exercise. Physical activity serves as a powerful defense against the physiological changes associated with menopause, such as weight gain and increased abdominal fat. However, the most significant benefit of exercise extends beyond achieving a slimmer waistline or more toned arms; it profoundly enhances metabolic health.


Metabolic health refers to the body’s efficiency in processing and utilizing energy by metabolizing macronutrients (carbohydrates, proteins, and fats) and micronutrients (vitamins and minerals). Essentially, the mitochondria, the powerhouses of every cell, must operate efficiently and effectively. Optimal metabolic health reduces the risk of chronic diseases such as heart disease, diabetes, and stroke.


There are five key markers of optimal metabolic health for women:

  • Fasting blood sugar below 100 mg/dL - Chronically elevated blood sugar levels increase the risk of metabolic diseases and various chronic health conditions. Elevated blood sugar, known as hyperglycemia, can lead to numerous health complications, including type 2 diabetes mellitus, heart disease, stroke, nerve damage, fatty liver disease, kidney damage, and vision loss. Over time, hyperglycemia can also induce insulin resistance, altering insulin production by the pancreas and diminishing cells' response to insulin.

  • Triglycerides below 150 mg/dL - Elevated triglyceride levels are another significant risk factor for cardiovascular disease.

  • HDL cholesterol above 40 mg/dL - Levels of HDL cholesterol that are too low is a cardiovascular risk factor and may lead to a higher risk of having a heart attack or stroke.

  • Resting blood pressure below 130/85 - If your blood pressure is consistently higher than 130/85, especially with other risk factors, you’re at risk of developing stiff arteries.

  • Waist circumference under 35 inches for women - Having excess fat around your abdominal area may be more dangerous to your health than having fat in other areas. This so-called “visceral fat” increases your risk of heart disease, high blood pressure, diabetes, high cholesterol, and sleep apnea.

Approximately 88% of American adults have at least one of these risk factors. The decline in estrogen levels during menopause leads to significant changes in metabolism, which can manifest as various symptoms.


  • Weight gain: Estrogen plays a crucial role in regulating metabolism and body weight. As estrogen levels decline, metabolism slows down, making it easier to gain weight, especially around the abdomen. This weight gain can lead to an increased risk of chronic diseases such as heart disease and diabetes.

  • Insulin resistance: A decrease in estrogen levels decreases the responsiveness of cells to insulin resulting in elevated blood sugar levels. This elevation in glucose can lead to diabetes if blood glucose levels remain chronically high.

  • Changes in blood cholesterol levels: Estrogen helps maintain healthy cholesterol levels by increasing the levels of HDL (good) cholesterol and decreasing the levels of LDL (bad) cholesterol. As estrogen levels decline during menopause, there may be an increase in LDL cholesterol and a decrease in HDL cholesterol, which can increase the risk of heart disease.

  • Decreased muscle mass and strength: Estrogen plays a significant role in maintaining muscle mass by promoting muscle protein synthesis and inhibiting muscle protein breakdown. The decrease in estrogen levels during menopause leads to an imbalance between muscle protein synthesis and breakdown, resulting in a net loss of muscle mass. Additionally, the decline in estrogen levels also contributes to increased insulin resistance, which further exacerbates muscle loss by impairing muscle protein synthesis.

  • Metabolic syndrome: The combination of these metabolic changes, including weight gain, insulin resistance, and changes in cholesterol levels, can lead to metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and diabetes.


Regular exercise can mitigate many of the adverse effects of menopause and directly improve metabolic health markers. Physical activity enhances insulin sensitivity, allowing the body to manage glucose levels more effectively. It also reduces LDL cholesterol and triglycerides, increases HDL cholesterol, and lowers the risk of heart disease and stroke. Exercise also improves body composition, with resistance training and high-intensity interval training (HIIT) being particularly beneficial to menopausal women for preserving and building muscle mass. As estrogen declines, resistance training can mimic estrogen’s effects on muscle cells, supporting metabolic health. By rebuilding muscle, strength training aids in weight management and improves glucose utilization. HIIT involves alternating short bursts of vigorous aerobic exercise with recovery periods of lower intensity. This training method rapidly boosts cardiovascular fitness and enhances the body’s ability to regulate glucose, thereby improving metabolic health. Additionally, all forms of exercise help reduce deep abdominal fat, a significant factor in many chronic diseases. Physical activity also positively influences other behaviors that affect metabolic health. Active women tend to adopt healthier eating habits and experience better sleep, both of which are essential for metabolic health.


You don’t need to spend hours at the gym or follow complex routines to benefit from exercise in midlife. Simplicity and enjoyment in the activities you choose are key to building consistency.


  • Aim for 150 minutes of aerobic exercise per week: This can be 30 continuous minutes five days a week or 20 minutes daily, broken up throughout the day. You can walk briskly, run, bike, swim, take the stairs - whatever works for you.

  • Include HIIT intervals two or three times a week: Alternate between higher-intensity and recovery periods during workouts. For example, you can do Tabata intervals with 20 seconds of maximum effort, followed by 10 seconds of rest. Build up to 3 rounds of 6-8 intervals with 3 minutes between each round. Choose any exercise you like - run, swim, bike, jumping jacks, burpees, etc.

  • Incorporate strength training one to three times a week: Challenge major muscle groups with resistance exercises. Shoot for 3 sets of 6-8 repetitions. Use a weight as heavy as you can lift safely. When you finish your final set, you should not be able to complete even one more repetition.


In addition to regular exercise, there are several other lifestyle factors that can promote metabolic health:


  • Increase intake of omega-3 fatty acids: Omega-3 fatty acids, found in fatty fish like salmon, walnuts, and flaxseeds, have been shown to improve insulin sensitivity and reduce inflammation, thereby promoting metabolic health.

  • Prioritize whole foods: Eat plenty of fresh vegetables and fruits that are rich in phytonutrients, along with fiber-rich seeds, nuts, and whole grains. These foods provide essential vitamins, minerals, and antioxidants that support overall health and metabolic function.

  • Maintain a low-glycemic diet: Focus on consuming carbohydrates that have a minimal impact on blood sugar levels, such as whole grains, legumes, and non-starchy vegetables. This can help stabilize blood sugar levels and improve insulin sensitivity.

  • Emphasize good-quality sleep: Aim for 7-9 hours of sleep per night, since inadequate sleep can disrupt hormone levels, increase appetite, and negatively impact metabolic health.

  • Manage stress: Find healthy ways to cope with stress, such as practicing mindfulness, meditation, yoga, or engaging in hobbies and activities you enjoy. Chronic stress can contribute to hormonal imbalances and metabolic dysfunction, so it's essential to prioritize stress management for overall health and well-being.


By incorporating regular physical activity and simple lifestyle changes into your life, you can significantly improve your metabolic health, mitigate the adverse effects of menopause, and enhance your overall well-being. The journey to better health continues through the rest of your life so choose activities that bring you joy.


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