Five Tips to Take Back Control in Perimenopause

At Skill of Strength, we’ve seen perimenopause affect so many of our members—from disrupted sleep and low energy to changes in strength, body composition, and overall confidence. For many women in their 40's and 50's, these symptoms are frustrating and discouraging.

It can feel like you’re doing everything right, yet not seeing the results you expect—or the ones that used to come more easily when you were younger.

The good news? You’re not powerless. Over and over again, we’ve seen how strength training can be one of the most effective tools for navigating this season of life. Not only does it help with energy and resilience, but it also supports bone density, muscle mass, and long-term health.

Strength training is one of the most sustainable and beneficial forms of exercise during this stage of life. In contrast, HIIT and long cardio sessions can place extra stress on the body during times of hormonal change. While we’d never discourage anyone from moving—something is almost always better than nothing—it’s important to remember that frequent high-intensity training can slow recovery, raise cortisol, and increase the risk of burnout. Strength training, on the other hand, supports muscle, metabolism, and long-term health in a way that’s both effective and sustainable.

Beyond strength training, many women at SOS have shared how transformative hormone replacement therapy (HRT) has been for them—helping them feel more like themselves again and reclaim their energy and vitality.

Enter Laura Brown, WHNP-BC, MSCP. We met Laura at a recent community event, and it was clear right away that we share the same mission: helping people feel their very best. Laura is a women’s health nurse practitioner, coach, and the Founder/CEO of Sapphire Women’s Healthcare. Her passion for educating and empowering women makes her a perfect partner for the work we do here at Skill of Strength.

At SOS, our goal goes beyond great training sessions in the gym. We want to give you the tools, knowledge, and support you need to thrive outside the gym as well. That might mean helping an athlete chase peak performance—or helping women in midlife navigate perimenopause and beyond with strength, confidence, and energy.

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Join us on Wednesday, October 9th at 7:30 PM for our special event: Perimenopause, HRT, and Healthy Aging with guest speaker Laura Brown. This event is free and open to the public, but registration is required.

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For a sneak peek of what Laura will cover at this event, check out her 5 Tips to Take Back Control in Perimenopause below.

Please note: this information is intended for educational and informational purposes only. It is not a substitute for individualized medical advice, diagnosis, or treatment. The information provided is based on general advice. Always consult with a qualified healthcare professional, such as a physician or registered dietitian, before making changes to your diet, supplement use, or training program. The author and publisher disclaim any liability for adverse effects resulting from the use or application of the information contained in this email.
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5 Tips to Take Back Control in Perimenopause

Perimenopause can sneak up on you. One minute you're feeling like yourself, and the next you're exhausted, not sleeping, gaining weight despite your efforts, and wondering why you can’t stand the sound of your partner’s breathing!

As a menopause specialist, I see this every day — and I want you to know you're not broken. You're just in a major hormonal transition. Here are my top 5 evidence-based strategies to help you feel better, stronger, and more like yourself again.

1. Hormone therapy is often the most effective tool — and yes, it's safe for most women.

Estrogen (with or without progesterone, depending on whether you still have a uterus) is the gold standard for treating hot flashes, night sweats, sleep disruption, and mood changes in perimenopause. According to ACOG and The Menopause Society, hormone therapy is safe for most healthy women under age 60 or within 10 years of menopause onset. You don’t have to wait until your periods stop to start treatment — in fact, starting earlier may help you feel better faster and protect long-term health, like preventing osteoporosis, cardiometabolic diseases, dementia and several kinds of cancers.

2. Local estrogen can completely change your vaginal and sexual health.

If sex is painful, you're feeling dry, or you’ve noticed more urinary tract infections, don’t ignore it. Genitourinary syndrome of menopause (GSM) is incredibly common and highly treatable. Low-dose vaginal estrogen or DHEA (like Intrarosa) is safe for most women, even many breast cancer survivors, with guidance. These local treatments don’t significantly increase systemic hormone levels and can restore comfort, confidence, and sexual pleasure, making them not only effective but also incredibly safe; local hormones have no age constraints on them the way systemic hormones might, so even you 93 year-old grandmother can (and should!) start these to prevent UTIs!

3. Testosterone may help with libido (and it’s not just for boys!).

If you’ve lost desire and hormone therapy isn’t enough, testosterone may be worth considering. It's not about turning you into someone you're not — it’s about restoring what’s been lost. The key is using physiologic, low doses meant for women, typically delivered as a transdermal cream or gel, and always under careful monitoring.

Important note: The use of testosterone pellets is not recommended. Pellets often result in supraphysiologic hormone levels and can cause potentially irreversible side effects like acne, voice changes, clitoral enlargement, and hair growth. This approach is not supported by guidelines from ISSWSH or The Menopause Society.

I follow the guidance of these expert organizations when prescribing testosterone and always start with a full evaluation that includes your libido, energy, relationship dynamics, stress, sleep, and pelvic health — because desire is never just about hormones.

4. Lift heavy things and eat protein — your body needs both now more than ever.

Your metabolism and body composition are shifting during perimenopause. Building muscle is one of the most protective things you can do — for your bones, brain, mood, and waistline. I recommend strength training at least twice a week and prioritizing high-quality protein (30–40g per meal). Dr. Stacy Sims and Dr. Gabrielle Lyon are leaders in this space and emphasize that women need to train and eat differently in midlife to thrive.

5. Sleep is not optional — protect it like it’s your job.

Poor sleep makes everything worse: mood, weight gain, brain fog, libido. If night sweats or early morning wakeups are disrupting your rest, hormone therapy often helps dramatically. Beyond that, create a consistent sleep routine, cut screen time an hour before bed, and make your bedroom cool and dark. No supplement or hack can replace good sleep hygiene — but hormones can make it possible again.

*6. Your Bonus Tip- See a specialist!

You do NOT need to wait until you’ve completed your menopause transition, or you have “suffered enough to deserve care” to actually start managing your symptoms. Perimenopause may last a decade or more, but you can get ahead of it.

Use the provider finder feature of The Menopause Society at www.menopause.org to find a Menopause Certified Practitioner near you, who will listen to your experience, validate your concerns and work alongside you to find the treatments – hormonal, lifestyle and otherwise – that fit your needs and meet your health goals.

References:

American College of Obstetricians and Gynecologists. (2012, reaffirmed 2021). ACOG Practice Bulletin No. 141: Management of menopausal symptoms. https://www.acog.org

International Society for the Study of Women’s Sexual Health. (2019). Clinical practice guideline for the use of systemic testosterone in women. The Journal of Sexual Medicine, 16(11), 1787–1800. https://doi.org/10.1016/j.jsxm.2019.08.011

Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., & Santen, R. J. (2015). Treatment of symptoms of the menopause: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 100(11), 3975–4011. https://doi.org/10.1210/jc.2015-2236

The Menopause Society. (2022). The 2022 hormone therapy position statement of The Menopause Society. Menopause, 29(7), 767–794. https://doi.org/10.1097/GME.0000000000002028

British Menopause Society. (2020). Managing the genitourinary syndrome of menopause in women living with and beyond cancer: Guidelines from the BMS and Women's Health Concern. https://thebms.org.uk

Rubin, R. (2023). Hormone therapy and sexual function in midlife women [Webinar]. International Society for the Study of Women's Sexual Health.

Sims, S. (2022). Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals Through Menopause and Beyond. Rodale Books.

Lyon, G. (2023). Forever Strong: A New, Science-Based Strategy for Aging Well. Legacy Lit.

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