Protocols / WOMEN'S HEALTH

The Perimenopause Protocol

Stay strong through the change.

Around your final period, fat gain speeds up and muscle and bone start to go. This protocol builds a strength and impact plan on the LIFTMOR trial and the ESSA guidelines, sets protein, calcium and vitamin D within EU limits, and uses only the hot-flush and sleep options the evidence supports: CBT, weight loss and CBT for insomnia. Hormone therapy is your doctor's decision with you; the PDF gives no hormone advice.

€9 · one-time payment · instant PDF · by Anthony Falcone

What's included

  • Strength + impact plan for muscle and bone
  • Protein, calcium and vitamin D within EU limits
  • Hot flushes: what the evidence supports
  • CBT for insomnia, alcohol and caffeine
  • Red flags: when to see a doctor
  • 12-week plan and symptom diary
  • 27 peer-reviewed references

Built for

More Energy · Sleep & Recovery · Peak Performance

Inside the PDF: 10 chapters

  1. Before You Start: This protocol covers what you can do yourself through perimenopause and the years after. It is not medical treatment. Some symptoms always need a doctor, and some decisions are your doctor's to make with you.
  2. What Is Happening: Perimenopause is the transition to your final period. Your periods change, and for many women hot flushes, night sweats and poor sleep start. It also changes your muscle, fat and bone, which is where training and food come in.
  3. Strength Training for Muscle and Bone: Strength training is the most useful single habit in this phase. It is safe for most women, including those with low bone density, when it is built up step by step.
  4. Impact for Bone: Bone responds to loads that are high and fast. Walking is good for your heart and mood; jumping, hopping and skipping add the quick, hard loading that bone responds to.
  5. Protein, Calcium and Vitamin D: Training sends the signal; food supplies the building blocks. Three nutrients matter most for muscle and bone in this phase.
  6. Hot Flushes: What Works: There is a lot of advice about hot flushes and much of it is untested. The North American Menopause Society reviewed the evidence for non-hormonal options in 2023. Here is what it found.
  7. Sleep: Night sweats, worry and a changing body clock all hit sleep in this phase. Poor sleep then makes everything else harder. Insomnia here is treatable, and the best treatment is not a pill.
  8. Alcohol and Caffeine: Many women notice that alcohol and coffee affect them differently in this phase. Here is what the evidence does and does not show.
  9. Pelvic Floor, Heart and Check-Ups: Three more things deserve a place in your plan: your pelvic floor, your heart and regular check-ups.
  10. Your 12-Week Plan: Put it together in three steps. Each step adds one habit to the ones before. Our coaching sequence, built on the chapters above.

Safety notes

  • Hormone therapy is a medical treatment and a decision for you and your doctor. This protocol gives no advice on whether to take hormones, which ones or at what dose. Everything here works with or without hormone therapy.
  • With osteoporosis or a past fracture, avoid loaded forward bending and twisting of the spine, and learn the lifts with a physiotherapist or qualified coach first (Beck et al., 2017).
  • Skip impact and ask a physiotherapist first if you have osteoporosis with a past fracture, joint pain in the hips or knees, or leak urine when you jump. Pelvic floor training can help with leaking (see the Pelvic Floor chapter).
  • If you have kidney disease, kidney stones or take medicines for bone, heart or blood pressure, ask your doctor or pharmacist before taking calcium or vitamin D supplements or raising your protein intake.
  • Be careful with 'menopause supplements'. The NAMS review does not recommend herbal or dietary supplements for hot flushes (NAMS, 2023). Some herbal products can interact with medicines; tell your doctor or pharmacist what you take.
  • Loud snoring, gasping in your sleep or heavy daytime sleepiness can mean sleep apnoea. See your doctor.
  • If you drink more than you want to, or find it hard to cut down, talk to your doctor. If you have palpitations or high blood pressure, ask your doctor before using caffeine before training.
  • Any bleeding after menopause, a new breast lump, or leaking with a feeling of heaviness or a bulge in the vagina: see your doctor. Do not wait for your next routine check.

References (27)

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  2. Avis, N.E. et al. (2015). Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Internal Medicine, 175(4), 531-539. doi.org/10.1001/jamainternmed.2014.8063
  3. Greendale, G.A. et al. (2019). Changes in body composition and weight during the menopause transition. JCI Insight, 4(5), e124865. doi.org/10.1172/jci.insight.124865
  4. Greendale, G.A. et al. (2012). Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women's Health Across the Nation (SWAN). Journal of Bone and Mineral Research, 27(1), 111-118. doi.org/10.1002/jbmr.534
  5. El Khoudary, S.R. et al., American Heart Association (AHA) (2020). Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation, 142(25), e506-e532. doi.org/10.1161/CIR.0000000000000912
  6. Beck, B.R. et al. (2017). Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. Journal of Science and Medicine in Sport, 20(5), 438-445. doi.org/10.1016/j.jsams.2016.10.001
  7. Bull, F.C. et al. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451-1462. doi.org/10.1136/bjsports-2020-102955
  8. Fragala, M.S. et al. (2019). Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 33(8), 2019-2052. doi.org/10.1519/JSC.0000000000003230
  9. Watson, S.L. et al. (2018). High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research, 33(2), 211-220. doi.org/10.1002/jbmr.3284
  10. Morton, R.W. et al. (2018). A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British Journal of Sports Medicine, 52(6), 376-384. doi.org/10.1136/bjsports-2017-097608
  11. EFSA Panel on Dietetic Products, Nutrition and Allergies (2015b). Scientific Opinion on Dietary Reference Values for calcium. EFSA Journal, 13(5), 4101. doi.org/10.2903/j.efsa.2015.4101
  12. EFSA Panel on Dietetic Products, Nutrition and Allergies (2012). Scientific Opinion on the Tolerable Upper Intake Level of calcium. EFSA Journal, 10(7), 2814. doi.org/10.2903/j.efsa.2012.2814
  13. EFSA Panel on Dietetic Products, Nutrition and Allergies (2016). Dietary reference values for vitamin D. EFSA Journal, 14(10), e04547. doi.org/10.2903/j.efsa.2016.4547
  14. EFSA Panel on Nutrition, Novel Foods and Food Allergens (2023). Scientific opinion on the tolerable upper intake level for vitamin D, including the derivation of a conversion factor for calcidiol monohydrate. EFSA Journal, 21(8), 8145. doi.org/10.2903/j.efsa.2023.8145
  15. The North American Menopause Society (NAMS) (2023). The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 30(6), 573-590. doi.org/10.1097/GME.0000000000002200
  16. The North American Menopause Society (NAMS) (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767-794. doi.org/10.1097/GME.0000000000002028
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  26. Dumoulin, C., Cacciari, L.P. & Hay-Smith, E.J.C. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 10, CD005654. doi.org/10.1002/14651858.CD005654.pub4
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General education, not medical advice. If you have a medical condition, take medication, or are pregnant or breastfeeding, talk to your doctor before you start.