The Ultimate Guide to Menopause: How to Boost Your Metabolism, Build Muscle, & Balance Your Hormones

In this podcast episode, Mel Robbins sits down with Stanford University's Dr. Stacy Sims to explore the science of menopause, women's health, and exercise. They provide clarity on the biological changes that happen during menopause and perimenopause, debunk common myths, and emphasize the empowering role women can play by understanding their bodies. The discussion highlights how strength training, targeted nutrition, and mindful lifestyle choices can profoundly influence metabolism, hormone balance, mood, and overall well-being during this phase of life.

What Is Menopause?

Dr. Stacy Sims defines menopause as a single day marked by 12 consecutive months without a menstrual period. The time leading up to this date is perimenopause, and the phase following is postmenopause. Menopause represents a new biological state rather than a health problem. By conceiving it as a natural transition—akin to a reverse puberty—women can reframe their understanding and embrace empowerment through knowledge.

Hormonal Changes and Their Impact

Estrogen and progesterone have wide-reaching effects on nearly every system in the body. During puberty, the surge of these hormones initiates profound physical and neurological changes. Conversely, menopause involves a significant decrease in these hormones, which impacts brain function, metabolism, mood, muscle and tendon strength, fat distribution, and gut health. The drop in estrogen reduces serotonin and dopamine production, contributing to mood swings, anxiety, and cognitive changes. Progesterone, often overlooked, regulates the autonomic nervous system, so the loss of progesterone disrupts heart rate, breathing, and stress response.

Brain and Neuroplasticity During Menopause

Menopause causes a decline in brain volume and affects brain metabolism due to the reduced sensitivity to glucose fueled by lower estrogen levels. This results in problems with cognition, mood, and neurotransmitter balance. As estrogen levels become consistently low, the brain struggles to operate efficiently, which explains symptoms like brain fog and emotional variability. However, Dr. Sims explains that the brain's neuroplasticity can be enhanced through strength training, which helps to rewire neural pathways and improve cognitive function despite hormonal changes.

Body Composition and Fat Distribution Changes

Lower estrogen leads to increased visceral fat accumulation, often referred to as the "menopot" or "flesh fanny pack," which is stored dangerously around internal organs. Simultaneously, women lose muscle and bone mass, particularly around hips and thighs, leading to a shrinking of these areas even though fat remains. Fat also tends to accumulate in unique places such as under the triceps and around the shoulder blades, partly related to the body's need for heat regulation through brown fat storage.

Muscles, Tendons, and Injury Risk

Estrogen affects muscle contraction strength, muscle repair, tendon health, and nerve conduction via acetylcholine, a neurotransmitter critical for muscle activation. During menopause, these systems decline, leading to weaker muscles, slower responsiveness, and increased injury risks such as frozen shoulder and plantar fasciitis. Loss of strength is often sudden and pronounced because of these neurological and biological changes.

Misconceptions About Menopause

A prevalent misconception is that menopause is solely a hormone deficiency syndrome, with the assumption that hormone replacement therapy (HRT) is the only answer. Dr. Sims clarifies that while menopause hormone therapy (MHT) can slow some changes, it does not stop them. The body's dynamic hormonal receptors respond differently during this transition, making continuous hormone dosing an imperfect substitute for natural fluctuating hormones.

The Power of Strength Training

One of the most transformative discoveries Dr. Sims discusses is the profound impact of strength training during perimenopause and menopause. Strength training acts as a central nervous system stimulus that promotes neuroplasticity and muscle adaptation. It essentially teaches the body to work with its current hormonal environment by increasing acetylcholine availability and improving muscle contraction power. Importantly, strength training can reverse some body composition changes, increase lean mass, and build stress resilience.

How to Start and the Ideal Strength Training Routine

For beginners, Dr. Sims recommends starting with simple movements using bodyweight or light dumbbells for about 10 minutes, three times a week, to develop neural adaptations and comfort with movement. The ideal routine consists of three full-body heavy lifting sessions per week focusing on compound lifts like squats, deadlifts, bench presses, and overhead presses. The exercise intensity should be around 80% of one's maximum effort, aiming for quality over quantity with adequate rest periods between sets to target nervous system recovery. Programs emphasizing progressive overload and functional strength are key to long-term success.

Cardio: Quality Over Quantity

Dr. Sims emphasizes that moderate intensity cardio classes often marketed to middle-aged women may not provide meaningful benefits and can lead to excessive fatigue or injury. Instead, she recommends shorter bouts of true high-intensity interval training (HIIT) or sprint interval training, which involve near-maximal effort for 20 to 30 seconds followed by full recovery. These focused, high-quality sessions activate metabolic adaptations, improve cardiovascular health, and complement strength training.

Nutrition Strategies for Perimenopause and Menopause

Many women mistakenly reduce calories and carbohydrates fearing weight gain, which often backfires by increasing stress and fat retention. Dr. Sims highlights the importance of consuming adequate protein—around one gram per pound of body weight—to support muscle preservation and repair. She encourages a diverse intake of whole grains, fruits, and vegetables to enhance insulin sensitivity and nurture gut microbiome diversity, which in turn supports serotonin production and overall health. Incorporating varied protein sources at each meal, including plant-based options and small amounts of dairy or meats, helps meet daily requirements without excess.

The Role of Stress and Sleep

Menopause increases sympathetic nervous system activity, making it harder to access restorative parasympathetic states essential for deep sleep. This worsens symptoms like hot flashes, brain fog, and anxiety. Dr. Sims stresses the importance of cognitive behavioral therapy and mindfulness practices to improve sleep quality and reduce stress. Mindfulness exercises, even brief moments of calm in a busy day, can enhance parasympathetic tone and mental well-being.

Supplements That Support Mood and Sleep

Certain supplements such as L-theanine, an amino acid found in green tea, and apigenin, a compound in chamomile, promote parasympathetic activation and help reduce anxiety. Creatine monohydrate is another supplement backed by research to improve brain metabolism and can assist in alleviating depressive symptoms faster than traditional medications in some cases. These supplements may enhance mood resilience alongside lifestyle interventions.

Exercise's Impact on Mental Health

Strength training not only improves physical health but also positively influences mood and anxiety by modulating brain synapses and stress resilience. Studies show that young people experiencing anxiety and depressive symptoms benefited significantly from regular strength training, supporting the idea that movement is a powerful non-pharmaceutical tool to help regulate mental well-being, especially important during menopause when hormonal fluctuations affect neurotransmitter balance.

Empowerment Through Understanding and Action

Dr. Sims encourages women to shed fear around menopause by educating themselves and actively implementing strengths and nutrition strategies. Menopause is not a state of decline but rather a phase ripe with potential for thriving. Women are urged to view menopause as a biological milestone that they can learn to control through knowledge and targeted lifestyle choices such as strength training, mindful nutrition, high-intensity exercise, and stress management to optimize health both now and into later life.