Perimenopause Prescriptions?

by | | Female Hormones

Perimenopause is a critical phase in a woman’s life, marked by significant hormonal fluctuations that can lead to physical and mental health challenges. For active women, musculoskeletal injuries during this period can exacerbate these issues, leading to weight gain, muscle loss, and struggles with mental health. These challenges are not a matter of willpower—they are the result of complex physiological changes that require medical support and intervention.

Injury and Mental Health

Physical activity is a cornerstone of mental well-being, stress management and metabolic health. However, in the luteal phase of a woman’s cycle she can be more prone to injury especially during perimenopause. When injuries occur at this time, reduced mobility can create a cascade of difficult effects, including:

Loss of muscle mass (sarcopenia), which further slows metabolism.
Weight gain, especially around the abdomen.
Increased joint stress and inflammation, making movement harder.
Mental health and stress management challenges, including frustration, anxiety, and depression.

In perimenopause, hormonal changes are also affecting metabolism, cardiovascular health, and body composition.

Hormonal Changes

Perimenopause brings about cardiometabolic shifts as estrogen, progesterone, and testosterone levels fluctuate:

Estrogen helps regulate metabolism, insulin sensitivity, and cardiovascular health. As it surges and declines fat stores can be redistributed, cholesterol levels can rise, and women can be at risk of heart disease.
Progesterone plays a calming role in the brain and regulates sleep. It also balances estrogen. As it declines this can lead to insomnia, anxiety, and increased sensitivity to stress.
Testosterone is essential for maintaining muscle mass, strength, motivation, and libido. Its decline contributes to fatigue, muscle loss, and reduced physical performance. And yes, women have testosterone and need it to function optimally.

Insulin is another hormone affected by perimenopause. Decreased insulin sensitivity at this time in life makes it harder to regulate blood sugar and contributes to unexplained weight gain—even for those who maintain a healthy lifestyle.

HRT? Medication? Or tough it out…

The right medical support during this transition is a right and not easy to access. It can be life-changing and prepare women for the second half of life being a time of excellent health. I’m a big advocate of diet and lifestyle medicine however holistic medicine means we include everything including supplements and prescriptions. Medication can literally be life-saving during this transition.

Hormone Replacement Therapy (HRT)

Restores estrogen and progesterone balance, improving sleep, mood, and metabolism.
Preserves muscle and bone density, reducing the risk of osteoporosis and frailty.
Supports cardiovascular health by reducing LDL cholesterol and improving arterial function.
Testosterone or DHEA can help maintain muscle mass, energy, and cognitive function.

GLP-1 Receptor Agonists (Mounjaro, Ozempic, Wegovy)

These medications, originally developed for type 2 diabetes, offer far-reaching benefits beyond weight loss:

✅ Improve insulin sensitivity, reducing fat accumulation and stabilizing blood sugar.
✅ Enhance cardiovascular health, lowering blood pressure, cholesterol, and inflammation.
✅ Help preserve bone mineral density, counteracting the bone loss seen in perimenopause.
✅ Support brain function, improving focus and potentially reducing food noise/emotional eating.

Comprehensive Medical Support

The challenges of perimenopause—especially when compounded by injuries, metabolic shifts, and muscle loss—are not something women should just have to “push through”.

With the right support women can:

✔ Maintain muscle mass, the #1 predictor of long-term health.
✔ Protect heart health by reducing metabolic and cardiovascular risks.
✔ Support brain function and emotional well-being.
✔ Extend their health span, ensuring an active, strong, and fulfilling second half of life.

Women deserve access to knowledge, medical care, and life-changing treatments. Perimenopause can be an opportunity to set the stage for a fulfilling second act in life and long-term health.