Bobbie, I’m in perimenopause. Should I start lifting heavy?” “Heavy” is relative. I don’t care whether the dumbbell says 15, 40 or 100 pounds. I care whether the resistance is challenging for you, whether you can perform it safely, and whether we’re progressively asking your body to adapt. Because picking up a pink three-pound dumbbell 50 times simply because you’re in menopause isn’t a physiological requirement. “If you’re brand new, we’re not testing your one-rep max tomorrow.” “If you’ve trained for 20 years, I’m also not making you start over because you turned 45.” “Meet the woman where she is. Then build.”

“Your joints hurt in perimenopause. Now what?” We’ve talked about the aches. Now I want to talk about what I think women’s-health content gets wrong: Naming a problem isn’t helping you solve it. If your joints suddenly hurt, recovery feels different or you don’t feel as strong as you used to, “it’s menopause” isn’t an action plan. 1. BUILD CAPACITY. Resistance training has substantial evidence supporting strength and function in postmenopausal women. Don’t abandon loading merely because you’re getting older. Progress it appropriately. 2. KEEP YOUR ENGINE. Walking is excellent, but cardiovascular fitness deserves deliberate attention too. Aerobic work, intervals when appropriate and simply accumulating more physical activity all have roles. 3. INVESTIGATE PAIN. Menopause can coexist with osteoarthritis, autoimmune disease, tendon pathology, injury, vitamin/mineral deficiencies and other conditions. Menopause should expand the differential—not become the diagnosis for everything. Finish: The goal isn’t to train like you’re 25. The goal isn’t to train like you’re fragile either. The goal is to figure out what your body can do today and progressively expand that capacity.

This week I want women with endometriosis to reflect on something that gets lost when health advice becomes “just push through it.” Endometriosis is a chronic disease affecting an estimated 190 million reproductive-age women worldwide. Pain can involve periods, the pelvis, sex, bowel movements and urination, and symptoms can affect mental health and daily functioning. There is currently no cure, but there are evidence-based medical, hormonal, surgical and supportive approaches that can help manage symptoms. And movement belongs in this conversation—but with some important honesty about the evidence. A 2025 systematic review found only 6 randomized trials totaling 251 women testing physical activity/exercise for endometriosis. Results were encouraging for quality of life, pain, mental health and pelvic-floor outcomes, but studies were small, different from one another and generally short. So “exercise cures endometriosis” would be a major exaggeration. More recently, a Norwegian randomized trial found that supervised exercise plus pelvic-floor muscle training improved current pelvic/genital pain, although it did not significantly improve the study’s worst-pain outcome. That’s exactly the kind of nuance I want us to keep: promising benefit does not equal universal cure. Your reflection Think about the last time symptoms interfered with your plan. Did you: A) force yourself through exactly what you planned, B) abandon movement completely, or C) adjust what you were doing to what your body could realistically handle that day? GOATGETheR isn’t about proving toughness by ignoring pain. It’s about learning the difference between “I don’t feel like doing this” and “my body is giving me information that should change today’s plan.” Your adjustment might mean reducing load, shortening the session, walking instead of running, changing an aggravating movement, doing your prescribed pelvic-floor/physical-therapy work, or recovering when symptoms genuinely warrant it. And persistent or severe pelvic pain deserves proper evaluation—not another TikTok telling you to stretch harder. Current international guidance treats endometriosis as something that may require individualized hormonal, surgical and multimodal management rather than one universal solution.

Menopause Is More Than Hot Flashes — What Happens to Muscle & Bone? We talk about hot flashes, periods stopping and mood changes when we talk about menopause. But while I was researching this week, I kept coming back to a different question: Why aren’t we talking to women earlier about what can happen to their muscle, strength and bones? And then I found something that surprised me even more. We actually don’t have nearly as much high-quality exercise research during the menopause transition as I assumed we did. Perimenopause isn’t simply estrogen slowly sliding downward in a perfectly straight line. Hormonal patterns fluctuate through the transition, and the menopause transition overlaps with an age when changes in body composition, muscle and bone are already occurring. Bone deserves particular attention because estrogen has an important role in regulating bone remodeling. Around menopause, bone resorption can outpace formation. Muscle is a little more complicated. Menopause, aging, physical activity, nutrition and other factors overlap, which makes it difficult to say: “This amount of muscle loss happened specifically because estrogen declined.” That’s an important distinction. WHY does this matter? Think about your body like a retirement account. You don’t wait until retirement to start saving. Muscle, strength and bone are similar. What you build and preserve in your 40s and 50s affects the physical reserve you’re carrying into your 60s, 70s and 80s. We’re not training simply because we want our arms to look good. We’re building the ability to: get off the floor, carry groceries, climb stairs, catch ourselves when we trip, tolerate a fall better, maintain independence and keep doing the things we actually enjoy. That’s a completely different reason to lift. The research gap I wasn’t expecting A 2025 systematic review asked a very specific question: Can exercise prevent bone and muscle loss during peri- and early postmenopause? Researchers searched five major databases for randomized controlled trials involving women ages 45–60 who were perimenopausal or early postmenopausal.

If somebody had told you at 30 that muscle and bone were something you were building for your 70-year-old self, would it have changed how you trained?