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Tag: menstrual cycle

Mini Pause #107 | 9 Ways Your Cycle Affects Your Training 🩸

Posted on by stephanie-estima

The internet is loud when you’re a woman who dares to age.

It’s loud when you’re a woman who dares to lift heavy and build muscle.

It’s loud when you unapologetically educate midlife women about their own bodies.

And on my feed, you know who’s making (most of) the noise?

Well, let’s just say it ain’t me.

These are random, unqualified [insert expletive here] sitting behind their keyboards telling me what a woman “should” look like at 45. At 55. At whatever age they deem judgable. (I may or may not have gone off in my stories this week about this very topic.)

It’s wild, Betty.

You can dedicate your whole life to studying, training, building businesses, raising a family, and kicking ass in every domain… and you’re still reduced to your appearance. That’s the culture we’re in.

It’s the same culture that doesn’t study women’s health and instead treats us like small men… or tells us to suck it up when some troll on Instagram comments on our bodies.

So today, I want to talk about something that’s getting wildly oversimplified on the fitness internet: women’s physiology.

 

WHAT

The EBITS (Evidence-Based Internet Trolls… both men and a surprising number of women) keep shouting that the research shows “no significant difference in muscle-building capacity across the menstrual cycle.”

As if women are single-variable experiments. As if they have any clinical experience.

And technically? They’re not wrong. But they’re missing the entire body for the muscle fibers.Yes, women can build muscle in every phase.

Yes, progressive overload still works.

Yes, mechanical tension still drives adaptation.

No, you’re not wasting half your month.

But if we’re only measuring muscle, we’re ignoring everything else that makes us human.

 

WHY

Performance isn’t just muscle. It’s about a dozen other systems that shift in rhythm with your hormones.

Here’s what DOES change across your cycle, and why it matters, and how your performance may change across the menstrual cycle: 

  • Connective tissue: Estrogen fluctuates throughout the cycle and affects ligament laxity, tendon compliance, and joint stiffness. You’re still growing muscle, but the same lift can hit differently week to week, and that matters for injury risk.
  • Heat tolerance: Progesterone raises your core temperature during the luteal phase, making cardio feel harder at the same output. Ever wonder why indoor spin classes have fans all over the place? To decrease your perceived exertion and help you avoid overheating. If you’re getting tired earlier in the second half of your cycle, this might be why.
  • Fuel use: You’ll rely more on carbs at some points in your cycle, and more on fat at other points. This affects high-intensity repeat efforts, sprint tolerance, and fatigue when there is a fuel mismatch. Want bursts of energy and explosive power? You need carbs. High intensity? Call on your anaerobic system. If you’re not fueling well before training, you’re going to experience a lot of variation over your cycle.
  • Insulin sensitivity: The late luteal phase brings more blood sugar swings and lower insulin sensitivity. You might feel shaky mid-workout, tired earlier, or get ridiculously hangry post-workout. That reflects your increased recovery demands. You might need to take an extra day (gasp!) or two (!!) to recover. (You might need a deload week too, but I feel like I’m already pushing it by suggesting a day off!)
  • Coordination and balance: Your proprioception, timing, and motor unit firing efficiency change with hormone fluctuations – you’re not just clumsy. This might look like your lifts feeling “off” even if the strength is there, or your technique degrading earlier than expected. This is a good time to modify technical lifts because they require more cognitive effort to maintain form, aka protect from injury.
  • Breathing efficiency: Progesterone increases your respiratory drive, making conditioning feel harder even with the same VO₂. You’ll notice this most in metabolic conditioning finishers, interval work, circuit training, and even high-rep leg training. We’re more efficient breathers in the luteal phase. (Check out my convo with Patrick McKeown for a fascinating deep dive on this.)
  • Pain tolerance: Estrogen modulates your pain sensitivity and ligament and tendon behavior. Throughout the cycle, your path threshold will fluctuate, joint discomfort can feel more pronounced, and you might have puffy, inflamed days. This doesn’t necessarily mean injury, but the estrogen fluctuation does change tolerance and movement confidence.
  • Sleep and recovery: Hormonal changes affect REM depth, sleep continuity, and overnight recovery signaling, which explains why two identical sessions can feel wildly different. Heart rate variability dips without an obvious cause (mine always tanks after I ovulate up until I bleed), and motivation drops even when discipline is high.
  • Fluid balance: Hormones influence how your body handles sodium, water retention, and tissue pressure. This impacts joint stiffness, puffiness, heavy limb sensations, joint compression tolerance, and range of motion. Your tissues may be fine… they’re just holding more volume.

 

So yes, you can (and should)  train hard all month, but what “hard” looks like also changes from the follicular to the luteal phase, and pretending nothing changes in your body is just bad science. Things change, so any trained clinician would tell you that adaptations should be made.

Elite performance has always respected system-level shifts… because men have them too. Women just have fluctuations that can be mapped into a calendar.

 

HOW

This is where I bring in the Big Ovary Energy.

I’m not interested in “hacking” my cycle or “overcoming” my hormones. I’m interested in working with them.

Here’s what that looks like in real life:

During my follicular phase, I go heavier. I can go all out and still recover faster, sleep better, and push intensity. Here is where I typically push for PRs

In the luteal phase, I pivot. Shorter rest periods, lighter weights but higher reps, more tempo work, more walks, more recovery tools, and more social media and email rants to you.

In the context of muscle building (which yes is important but it is not the ONLY thing), I am always aiming to approach muscle failure, understanding that the load and intensity with which I will reach it will change.

I stay consistent, but I stop expecting myself to feel the same every day.

I track my cycle and my energy. If my lifts feel off because my joints or tendons feel a bit tweaky, I adjust the volume or technique to prevent injury. I don’t label myself as lazy.

This is what women’s performance looks like when you respect your biology. Adaptive, intelligent, dynamic, and still powerful as hell.

 

NOW

If your workouts have felt “off,” I want to invite you to see it as feedback rather than a weakness.

Note when your energy, sleep, and strength fluctuate this month.

Give yourself permission to adapt rather than push.

Remember that building muscle isn’t the whole story. Building awareness is key.

I’m tired of people pretending that women’s bodies are hormoneless and unchanging.

Last week, I laid out 6 New Rules of Femininity, and I might add this to the list: train with enough intelligence to handle a dynamic system and still dominate.

Go out there and lift something heavy, no matter where you’re at in your cycle.

 

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

 

 

Disclaimer: The information included in a newsletter, email, or on drstephanieestima.com is intended solely for educational purposes. It does not replace a direct relationship with your licensed medical provider and is not intended to diagnose, treat, cure, or prevent any disease.

Affiliate Disclosure: Products mentioned in a newsletter, email, or on drstephanieestima.com, may be part of an affiliate agreement in which Dr. Stephanie Estima receives a small commission on the sale of an item you purchase.

 

 

Mini Pause #66: Why You Shouldn’t Always Listen to Your Body

Posted on by stephanie-estima

TL; DR (Too Long; Didn't Read)

Our bodies often mislead us, nudging us toward overeating, under-exercising, or mistaking thirst for hunger. Surprisingly, elevated cortisol from poor sleep can enhance strength training by reducing perceived effort, and lifting during the luteal phase of your menstrual cycle is especially beneficial.

WHY

Our evolutionary wiring prioritizes energy conservation and calorie intake for survival. These biological instincts often clash with our modern wellness goals, tricking us into consuming more calories and being less active than we need to be. Additionally, hormonal shifts and sleep disturbances, common in perimenopause and menstrual cycles, further skew our internal signals.

WHAT

Common ways our bodies trick us:

  • Hunger masking as thirst (leading to unnecessary calorie consumption) 🤤
  • Fatigue signaling you to skip workouts (promoting inactivity) 🥱
  • Cravings for high-calorie comfort foods under stress (often due to increased cortisol) 🍕
  • Avoiding challenging workouts because they “feel too hard” 😭

Interestingly, elevated cortisol from a poor night's sleep can sometimes be beneficial, as it reduces your perception of heaviness during strength training sessions, potentially improving performance temporarily.

During your menstrual cycle, specifically the luteal phase, consistent strength training helps manage PMS symptoms, supports mood regulation, and maintains muscle mass.

HOW

Practical strategies to counter misleading body signals:

  • Hydrate first if you're hungry, then assess if you're truly hungry. 💧
  • Schedule workouts proactively to avoid deciding based on fatigue levels. 📆
  • Recognize cravings related to stress and cortisol—opt for balanced, protein-rich snacks. 😋
  • Leverage days of higher cortisol (after poor sleep) strategically for strength workouts, recognizing reduced perceived exertion. 💪
  • Maintain regular lifting routines, particularly in the luteal phase, to support hormone balance, energy levels, and overall mood. 🏋️‍♀️

NOW

Notice … have these tricky body signals ever confused you on what to do?

➡️ If you're hungry:

  • Try drinking some water with electrolytes and waiting 15 minutes to see if the “hunger” persists.

➡️ If you've had one bad night of sleep:

  • Use it to your advantage and use all those stress hormones for a great strength training session.

➡️ If your menstrual cycle feels awful:

  • Lighten the weights, but add volume in terms of reps and sets. This will release more anti-inflammatory compounds, helping to improve both your mood and your body.

What I Recommend

RED LIGHT SOLUTIONS FOR MIDLIFE HEALTH & RECOVERY

If you want to improve your skin, speed up your recovery, and enhance your sleep, red light is your midlife go-to. I depend on BON CHARGE devices because they deliver the targeted support and healing I need during perimenopause.

Here are a few favorites I recommend: Shop the Easter Sale Now to see all the choices and save 25%.

  • Red Light Face Mask + Red Light Neck & Chest Mask: My skin has never looked better!

  • Infrared Sauna Blanket: Targeted (and cozy!) relief after a hard leg workout in the gym.

  • Infrared PEMF Mat Max: When I’m stressed, have scrimped on sleep, and am worn out from work demands, this mat with its grounding frequencies is my saving grace.

  • Red Light Panels: These are the newest additions to my midlife recovery toolkit. The Mini Red Light Therapy Device is great for spot-healing aches and pains, while the larger Super Max benefits my whole body after a workout or before I go to bed.

BON CHARGE offers a red light device to fit your health needs and your budget. You’ll get 25% off storewide automatically applied to your order when you shop the Easter sale now through Monday, April 21, 11 p.m. EST.

VENISON FOR THE WIN: BEST PROTEIN-TO-CALORIE RATIO OF ANY RED MEAT

I've recently discovered what might be the most efficient protein source for hormonal health and metabolic flexibility. Maui Nui Venison provides the highest amount of quality protein in the fewest calories of any red meat–nearly twice the protein-to-calorie ratio of conventional beef. For women navigating hormonal shifts, this efficiency means supporting essential hormone production without excess calories that can trigger insulin resistance. Maui Nui’s wild-harvested, stress-free approach preserves compounds critical for thyroid function and metabolic health.

Visit mauinuivenison.com/stephanie and experience what truly wild protein can do for your hormonal balance. The nature of their work limits supplies, so secure your access to this amazing nutrition now.

KEEP WELL HYDRATED WITH BALANCED ELECTROLYTES

Now that spring is in full swing, I'm walking outside more. With the warmer temperatures, I have to remember to up my hydration, including proper electrolyte balance. This is where most people fall short. LMNT makes it easy with their single-pack flavor add-ins, which contain the balanced levels of sodium, potassium, and magnesium you need for optimal hydration.

Grapefruit is my personal spring flavor of choice, but Watermelon is my entire family’s favorite! Find your favorite flavor at LMNT and get a free sample pack with any purchase.

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

Mini Pause #41: How Nutrition Can Heal Your Hormones

Posted on by stephanie-estima

TL;DR (Too Long; Didn't Read)

Change is a good (and even great) thing when it means you’re open to new research, new understanding, and what we continue to learn about the body. What you need in any area of your life will evolve as you grow, mature, and gain new knowledge. Build a solid foundation that allows you to pivot as your body ages.

WHY

Were your ears ringing this week? I was talking about you, thinking about you, and discussing all the ways we are going to work together.

This week during a meeting with my team, we were talking about the future of Hello Betty, the Bettyverse, and of course, YOU.

We were thinking about what the immediate, midterm, and long-term needs of our Bettys are.

And we stumbled upon nutrition. Someone on social media this week commented that she is aggravated because I have “changed my stance” on carbohydrates and nutrition. And it got me thinking.

Had I changed my opinion? In some cases (like fasting) yes.

But others I have not changed, but simply evolved as my nutritional needs changed over time.

So when someone asks me to exactly describe how I am currently eating / training / recovering, the answer is a bit complicated.

There is what I do now, and there is also the foundation I built so that I can do what I do now.

WHAT

As many of you read in The Betty Body, I used to despise my menstrual cycle. It hurt. I was down for the count three or four weeks every month. I was medicating my pain, hating my body, and feeling like it was a curse to be female.

Looking at my labs back then, I had

  • elevated fasting insulin levels
  • high fasted glucose
  • high estradiol levels relative to my progesterone levels
  • high HbA1c levels (a measure of your blood glucose over the past three months)
  • elevated cholesterol levels (TG, LDL-c, and total) that were higher than what was considered normal
  • elevated hs-CRP (a marker of inflammation)

When I look at my life back then, I had a small group of people who were not real friends, just acquaintances. I was in the wrong marriage. I had young kids and limited support. My hair was falling out. I was anxious. And, if I’m honest, falling out of love with my work. I loved my patients and I loved the private practice, but the volume of paperwork and often incorrect staff hires wore me out.

If you’d told that girl to just eat more protein, don’t be scared of carbs, and just lift heavy weights–I would have fallen flat on my face.

Carbs felt awful in my body, I felt constantly hungry and snacky, and the afternoon energetic slump at 2 p.m. was REAL.

I was still lifting weights during this time, and having an almost identical amount of protein that I do now, but felt none of my hard work showed. My waist-to-hip ratio was not where I wanted it to be, and in my luteal cycle, bloating made it look like I was in my second trimester of pregnancy. My genetics revealed I was very prone to (although never formally diagnosed with) PCOS, as well as being on the spectrum for endometriosis.

So what gives?

The answer lies in the nutritional journey to healing.

HOW

For me (and the thousands of women who have gone through The Estima Diet), I needed to establish insulin sensitivity again.

I needed to go low carb first before I could go higher carb. I needed to mildly restrict protein for a bit (my formal thinking hypothesis here is that with protein restriction, you also get methionine restriction–a topic for another Mini Pause), and I just needed to drop some water weight and bloating.

This was the birth of Phase 1 of the Estima Diet.

Then I started cycling my macros with my menstrual cycle and Phase 2 of The Estima Diet was born.

I followed this style of eating for years. In doing so, I watched all my labs normalize, to the point now where my hsCRP now is undetectable, my glucose and insulin are optimal, and my cholesterol (all markers) are pristine.

As I built this foundation of metabolic health, I was able to easily transition to the type of diet I have now in my 40s. If I had to start over again, that would be the path I would take:

  • Estima Diet Phase 1

  • Estima Diet Phase 2

  • Move into the Maintenance Phase, with higher protein and carbs to suit my training demands

You’ve heard me say this before and I’ll continue to say it: The diet you follow to heal is not the one you will follow forever.

The diet that heals you is the one that sets you up for metabolic health so that you have the option to play with different styles of eating later on. With estimates that 88-92% of North Americans are metabolically unhealthy and meet the criteria for Metabolic Syndrome, it's likely that you might also fall into that category.

I did for years.

NOW

  • If you haven’t already, pick up a copy of The Betty Body and follow the nutrition plan in the book.
  • That program saved me, it saved my patients, and saved the thousands of women who went through the program.
  • Stay tuned in the coming months as we revise The Estima Diet in a whole new way. I can’t say much yet, but I can reveal it is going to be a game-changer in the industry.
  • Along with The Estima Diet relaunch, we are going to debut new programs for those of you who want to go deeper into your health journey and work with me.

If you have gone through The Estima Diet and are ready for more, as well as those of you interested in taking your health in a new direction, reply “ESTIMA DIET” to support@drstephanieestima.com.

We're Making a Q&A Change

You've asked and I've answered 40 questions in this column this year. Thank you to all my Bettys who took the time to write in and ask such great questions!

In September, we began offering full Ask Me Anything episodes in the new EVEN BETTER! Premium Membership. Each month we open up a new AMA to member questions on a specific topic. These Qs form the foundation of a full AMA episode which appears in the members' private podcast feed and on their membership dashboard.

Now that this membership feature is available, we'll be sunsetting the Mini Pause QOTW. To continue to get your questions answered about Meals, Muscle, Mindset and (Peri) Menopause (and more!), I'd love for you to join us in the EVEN BETTER! Premium Membership community.

Membership benefits are outlined for you directly below. You can sign up HERE.

What I Recommend: Sauna

Adding regular sauna sessions into my routine has made a significant difference in my recovery and overall health. The science is clear on sauna benefits. For their 25th Anniversary, Sunlighten is offering up to $600 off PLUS a FREE gift with purchase through Oct. 31. The FREE gift with purchase includes an at-home biomarker panel test and educational webinar.

  • The biomarker panel test covers 17 markers across six categories (Lipid and Cardiovascular Markers, Metabolic Health, Inflammation, Hormonal Health, Thyroid Function, and Nutritional Status).
  • The webinar will be hosted by Dr. Darshan Shah, who will dive deeper into understanding these biomarkers.

Link HERE to more about the Sunlighten sauna models and take advantage of this special promotion.

Now Open: EVEN BETTER! Premium Membership Subscription

Members have immediate access to numerous content pieces, with more coming online. The membership benefits were designed with input and insights from my community of women. Here's what you'll find within the membership:

  • Early and ad-free access to the weekly Better! podcasts.
  • A downloadable action guide for each podcast episode.
  • Private “Ask Me Anything” episodes based on member questions.
  • Surprise guests and solo shows only for members.
  • My insights from the guest discussion coupled with recommendations you can use to build habits and routines that support your goals.
  • Bonus content beyond the podcast episodes.
  • Exclusive discounts for brands I love.
  • Being a part of a community with like-minded Bettys!

Subscribe HERE to find several introductory membership options to fit your budget.

Mini Pause #22: Why Up Your Calories? More Muscle Growth & Less Fat Gain

Posted on by stephanie-estima

TL;DR (too long, didn't read)

Eat more calories to build muscle. At any weight. At any size. At any fitness level.

WHY

I’ve been writing over the last few weeks (Mini Pause #21 & Mini Pause #20) about why women need to stop punishing ourselves with overly aggressive caloric restriction. Bottom line: you need to eat more food to provide the building blocks to assemble new muscles.

But… just how much? And what kind? Are we talking a tub of Häagen-Dazs or is it extra steaks? How many calories above maintenance are we talking about here

WHAT

If muscle hypertrophy is the goal, you need to provide the muscle (and the bones, tendons, and ligaments that support it) extra calories to assimilate and build said muscle.

The best evidence [*] suggests that if you are a beginner, you can profit off the newbie gainz to utilize more food for muscle accumulation. If you have been training for less than a year consistently, progressing slowly in your muscle growth journey, it seems like a caloric surplus of 20-40%of your maintenance calories is ideal. This works out to somewhere between 500-1000 extra calories daily.

Remember, as a new lifter, your rate of muscle turnover is much higher than a seasoned lifter, and as such, will require more calories (hurray!)

If you are an experienced lifter, where your progress and strength gains are near maxed out, you still require a caloric surplus, but it’s much lower. Something around 10-20% caloric surplus, or somewhere between 250-500 extra calories daily.

When you are close to your natural potential in muscle size, unfortunately, your fat gain potential is higher, and so fewer calories are recommended here.

HOW

For the record–I totally get how shocking these numbers might be. Especially if you're someone who has been under-fueling and on some sort of “diet” for weight loss for a long time. Couple this with the cultural norms of women needing to be small, skinny, petite, and delicate, and it is a mind f*ckery at its finest.

I write about periodization of, well, your period, in The Betty Body where we increase calories every month in week 4 of your cycle by about 10-15%. I get 40% caloric surplus can feel like just too much too soon, so let’s start off nice and easy shall we?

There are so many benefits to nourishing your body in the way it requires and expects of you. You can gradually increase your metabolic rate, and your NEAT output (Non-Exercise Activity Thermogenesis), and give your organs, bones, and muscles the energy they need to operate properly.

Are you with me?

NOW

  • Pick up a copy of The Betty Body.
  • Start tracking your food intake to determine what you’re currently eating.
  • You can keep these calories consistent in the follicular phase of your menstrual cycle.
  • In your luteal phase, you’re going to pinky promise me you’re going to TRY and increase your calories a little bit. Deal?
  • If you are menopausal, congratulations. You don't have to worry about a cycle any more so you can just jump right into a caloric surplus of 10-15% today.

Question of the Week

Q: Should we be sore after a workout?

This question came in through my recent Ask Me Anything on IG. And there's A LOT of debate around this. Here is where I stand on it:

Whenever you change up your routine (which you should be doing regularly) because it is a novel stimulus, having some soreness is normal for the first or second time you do it.

The absence of soreness doesn’t mean you didn’t work hard enough.

That being said, if you are never sore (even from a workout you are familiar with) I find this problematic. Workouts should be a sufficient stimulus that induce soreness from time to time.

For me, I am gunning for soreness in weeks two and three of my cycle. I just have the most energy, motor coordination, mental stamina, and hormonal landscape to go for it. So I’ll increase volume, weights, or both during this time.

So… I guess what I’m saying is… it depends. You know yourself best, and you know when you’re ready for a stellar workout. When you feel well-rested, mentally sharp, and prepared to work–see what you're made of. Intermittent soreness is a good thing.

YOUR TURN!

I’ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com.

WHAT I RECOMMEND: A Health Toolkit

I get a lot of questions from my Bettys about what they can do, take, or try to look, feel, and perform better in their lives. That’s why I compiled and launched a Health Toolkit for you this year.

I’ve curated numerous resources on my new website for my Bettys who are still cycling, experiencing symptoms of perimenopause, or going through the menopause transition. You’ll find solutions for sleep, skin, longevity, protein, energy, red light therapy, cooling hot flashes and more! Everything I recommend, I use myself. That’s my rule.

I invite you to get curious about the ways you can uplevel your health. Check out the Health Toolkit here.

And to answer the Betty question that came in regarding why I don’t use a sauna blanket anymore–I still do! (And now I interchange it with time in my Sunlighten sauna.) I love the sauna blanket for recovery after especially heavy lifting days. My preference is the BON CHARGE model. Use code DRSTEPHANIE for an exclusive discount on either sauna style you prefer.

Mini Pause #21: How Caloric Deficits Impact Your Bones, Muscles & Tendons

Posted on by stephanie-estima

TL;DR (too long, didn't read)

Caloric deficits impact the trajectory of women’s bone density and muscle mass. Caloric deficits also can impact women’s height, ability to build muscle, and menstrual cycle. We must reframe our thinking from being as skinny as possible to being as strong as possible.

WHY

Oh, look! I have more to say about chronic caloric deficits. Hold my beer.

Just kidding. I never drink the stuff. But… I have been thinking about chronic caloric deficits and the impact it has on a woman over her lifetime. Specifically, I want to talk about not getting enough calories in and how seriously it affects your bones, muscles, tendons, and joints, and injury risk.

Last week, I touched on the idea that eating in a caloric deficit can have deleterious effects not only on your gainz, but also on other important areas of female health like menstruation, bone health, brain health, and hormone production.

Let’s tuck into this a bit.

WHAT

One of the things I couldn’t shake after writing last week’s Mini Pause #20 is that most of us have been on some kind of diet for all of our lives. That means that for many women, we have been trying in some form or another to starve ourselves skinny. So at best, we have underestimated our calories thinking we are in a deficit, and at worst, we’ve fostered a real, chronic caloric deficit that impacts organ function and tissue remodeling and maintenance.

I wanted to expand on last week’s newsletter because it has real consequences on our body’s ability to function normally.

Most obviously, chronic caloric restriction is going to affect the regularity and cadence of our menstrual cycle. I write about this extensively in The Betty Body and why women are still getting periods (no matter how irregular they may be).

If your body fat percentage is too low, you run the risk of depriving yourself of ovulation, which is the main point of your menstrual cycle. In doing so, you also deprive your body of progesterone. This sex hormone is only produced when you ovulate.

Progesterone has wide-sweeping effects on the body like promoting good sleep, calming anxiety centers in the brain down, and supporting thyroid function–all three of which perimenopausal women tend to struggle with.

But there are other, perhaps more deleterious effects of prolonged caloric deficits, such as the effects it has on your bones and muscles.

Young women who under-eat and have lost their menstrual cycle as a result of over-dieting are at risk for developing irreversible damage to their skeletal system because 90% of our bone mass peaks at about 18 years of age [*]. This means that without adequate nutrition, a teenager who is undereating will impair her bone strength; change the architecture of the bone itself, causing it to have a higher affinity for bone fractures; and can even change her final height [*]. It puts this young woman at a higher risk of vertebral fractures throughout the rest of her life, even if she resumes normal eating patterns.

Having seen my fair share of vertebral fractures in my clinic, this is something you want to avoid at all costs. It is painful and disruptive, and the rehab is incredibly difficult from both a physical and mental point of view.

Amenorrheic episodes (months without ovulation) also impact your anabolic hormones like estrogen. Without a regular menstrual cycle, you would be considered hypoestrogenic, which is not too dissimilar to what we see in the final stages of perimenopause and menopause.

In both age groups, we see a fraying of the bone architecture, an increased susceptibility to fractures, and reduced bone strength. We want bones that are more “bendable” to withstand the forces on them. The more brittle and less “bendy” a bone is, the more likely it is to snap.

The other deleterious effect chronic caloric deficits have are on our body’s ability to repair and grow new muscle tissue. Muscle is so much more than aesthetic, as you know. Undereating is associated with impaired myofibrillar and sarcoplasmic muscle protein synthesis [*], compared to training with optimum energy availability.

Being on a chronic diet for YEARS is going to measurably impact your muscle mass, bone density, injury risk, and organ health. And it will catch up to you eventually.

HOW

I wish I could snap my fingers and wake us all up from the collective spell of wanting to be skinny, but the truth is, each of us will have our own paths to this awakening. What I can say to the well-intentioned woman (possibly the one reading with a touch of cynicism who gets what I’m saying intellectually but emotionally still desires to be small) is that your worth is not what the scale says.

If you have a lot of muscle mass, you are likely going to be heavier than whatever arbitrary number you have in your head. That number by the way has been subtly implanted from reading Cosmo, Teen Cosmo, and whatever other junk we grew up reading.

Think deeply about the images of thinness growing up. Women in perimenopause know this intimately because if you are around the same age I am, you grew up with Kate Moss and the advent of the grunge and heroin-chic look.

I distinctly remember as a teenager who was studying fashion magazines, that my body was just not built like the girls on these pages. I have thighs that are always going to touch. I have hips made for childbearing. I am just built differently.

Of course, these physical qualities have been in vogue as of late, which also just goes to show you the standards of beauty are always changing. So find the beauty in your own damn self and stop looking for external validation. Love your freckles, your scars, your hair color. Because soon stars will take out their BBLs, strong Roman noses will be the new ideal, and thin eyebrows will be back.

Point is–the house always wins. So be the house. Not the player.

NOW

  • Play India Arie’s “Because I Am a Queen”
  • Think about your relationship with food and dieting and what messages your daughters and sons are receiving. Is it good? Bad? Neutral
  • Contrast that with how you would like to show up for yourself, your family, and your community.
  • Can you experiment with eating a little more? What if you started with simply 100 calories more of protein? Could you make that work?

Q: I know I need more calories in my luteal phase. Can I increase fat? Or do I need to add more carbs?

Short and to the point for Divie3 from Instagram today.

Yes, if you are hungrier you definitely need more calories. I usually recommend something like 10 to 15 percent more than you are eating in your follicular phase. The first thing is to make sure your protein intake is adequate. Typically something like 1g of protein/per ideal pound of body weight. After that you can dial up fat or carbs; whatever tickles your fancy!

YOUR TURN!

I’ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com.

What I Recommend: Red Light Therapy

I’ve added another component of light therapy to my recovery practice. (Yes, that's really me lying on it in the photo).

While my Bettys know how much I rely on science when it comes to all things wellness, I’m going to admit that the PEMF Mat by Bon Charge both soothes and energizes in ways I wasn’t expecting–and I loved it right away.

It’s a pulsed electromagnetic field mat that works with your body’s natural magnetic field and uses bioactive wavelengths combined with red and near-infrared light. An additional far-infrared light component warms your body.

You can use the PEMF Mat during yoga, stretching, or grounding while lying down. You can even read a book or take a nap. The Mat’s programming allows you to choose sleep, grounding, focus, or meditation and relaxation.

And ever searching for ways to be more efficient, I combined my Red Light Face Mask and Red Light Neck & Chest Mask with time on the PEMF Mat. It’s a triple win for wellness. Speaking of triple, the PEMF Mat now comes in three sizes: a sitting pad, a demi size, and the full size.

View the entire Red Light Therapy Collection here and use code DRSTEPHANIE to save 15% off sitewide.

Mini Pause #5: What’s Better: Fasted or Fed Workouts?

Posted on by stephanie-estima

Fasted or Fed Exercise?

TL,DR (too long, didn't read)

Most evidence suggests that fuelling before a workout is better for performance in the gym, and has the same outcome on body composition as fasted workouts. That is not to say that working out fasted is pointless and ineffective. As long as you are fuelling appropriately in the peri-exercise time around your lifts — your body is a genius and knows what to do with the stimulus.

WHY

There are so many of you who struggle with not only what to do in the gym, but what to do in the window that surrounds your workouts.

Fasted or fed training?
Fasted or fed cardio?
What to eat?
When to eat it?
How much to eat?

With conflicting evidence abounding, it can get overwhelming really fast. And based on the comments from a recent Instagram post, you're also trying to figure out what works, too.

Personally, I used to train fasted (both my lift sessions and cardio) for years, and have since changed my approach.

At the beginning of my fasting journey (when I was completely discounting the fact that I was female) I would work out in the morning and then continue my fast until noon. Needless to say, I was starving, and angry, and as soon as noon came around, I had a very large meal. Larger than what was necessary. The same continued at each subsequent feeding. It was hard for me to admit, but fasting until noon was not working the way I had hoped and the way it seemed to be for many others (mainly men) I admired and respected.

Over time, begrudgingly admitting this was not working well for me, I shifted my fasting window to eat immediately after my workout. I was still fasting for long lengths of time, but the phasic shift to earlier in the day was helpful. This worked well for me for years.

It was only until one of my kid’s soccer practices was moved early in the morning on the weekend that I changed things up again. Since I wasn’t able to get to the gym before his practice, I had the opportunity to experience fed training sessions.

I had breakfast, took him to practice, had another snack, and worked out afterward.

I was shocked at how well I performed. Was it the food? That I had more time to limber up my joints? My core body temperature? I wanted to figure this all out.

WHAT

So in examining this topic, let's review the literature on the effectiveness of fasted versus fed workouts. Is there a difference?

Fasted Workouts

This meta analysis looked at several studies where the intervention was either:

  • fasted exercise with a standardized post-exercise meal
  • fasted exercise without a standardized post-exercise meal
  • fed exercise with a standardized post-exercise meal
  • fed exercise without a standardized post-exercise meal

What they found was the second intervention (fasted exercise and no post meal) appeared to be the most effective strategy to produce a short-term decrease in energy intake. But there was a catch: it also resulted in increased hunger and lowered energy expenditure afterward.

This is known as metabolic adaptation. If you have a higher energetic expenditure but are not fuelling properly either pre -or post-workout, you might be able to temporarily decrease caloric intake. But, the body will compensate over time by increasing hunger and/or lowering your total energy expenditure. This is the “calories out” part of “calories in, calories out.”

Said another way, aerobic exercise performed in the fasted state with no post-workout fuel induces higher fat burning WHILE DOING THE EXERCISE, but will then correct for energy output after the exercise is finished. This means, there is nothing inherently superior to fasted workouts.

Another study looked at 20 healthy young females and looked at the difference between fasted exercise on body composition. They kept calories constant between the two groups and either gave them a meal before exercise or had them work out fasted and fed them after the exercise was completed. Again, no significant difference was noted between the two groups in terms of body composition. They both demonstrated equivalent weight and fat loss.

Fed State

So here is where it gets interesting! Even though body composition seems to be agnostic to whether you are in a fed or fasted state, there's a significant difference in performance and repair of muscles when you are fed before exercising.

Specifically, when you consume carbohydrates and protein before a workout, this positively affects muscle glycogen stores. This is going to give you the oomph you need to maintain energy and execution during your lifts. It's also going to improve the repair of muscles and help to improve the short-term and long-term adaptations to training.

Said another way — being fed before a training session helps with the performance during that session and the repair afterward. I would argue that this speeds up changes in body composition over the long term because it is going to favor muscle tissue performance and repair. The faster you can put on muscles, the better your body composition is going to be.

For those of you wanting to go even deeper, check out this article on nutrient timing, and listen to one of the authors of the paper, Alan Aragon, on my Better! podcast.

HOW

If you want to try fueling before a workout and have been training fasted for years, start small!

Here is a short list of pre-training meals you can experiment with:

  • Add protein to your coffee. I often add a Core Power to my coffee, or I will blend Equip Foods or Schinoussa protein powder into my coffee.
  • Have a banana. It is light enough to avoid that “brick in the stomach” feeling.
  • Have a Protein Shake. (½ banana, scoop of whey protein powder and water)
  • My overnight oats recipe (check it out here)
  • Greek yogurt with some honey and walnuts
  • A few rice cakes with peanut butter and jelly

Personally, I am a creature of habit so it's either my overnight oats or I add one scoop of whey protein to oats and mix. I eat either one of these options before every lift. When it's leg day, I will also add a banana into the mix.

This clocks in somewhere between 350-400 calories, which is about right for the length and intensity of my workouts. I would say the bare minimum calories should be around 200, especially if you just starting to experiment with food intake early in the morning.

Many of you work out early, and I do as well. I eat my oats and protein of choice almost immediately after waking and then I get dressed and get to the gym. This buffer gives me about 30-45 minutes from the time I eat to the time I am in the weight room. Precisely about the time those glorious amino acids and glucose are spilling into the blood so I can drive them into my muscles to werk. Not work. WERK.

NOW

Decide on what small meal you are going to try. Tomorrow (or your next planned lift session), wake up and march into your kitchen to eat. Naked if need be — we're talking about better muscle performance and recovery here! Then go about your regular morning schedule and head to the gym.

Be patient with yourself. It may take a few weeks to adapt to eating on a new schedule. I would choose one food and just have that before your workout for two to four weeks to see if you notice a difference in your performance at the gym.

It may or may not work for you. Either outcome is fine. That you are willing to try different things is what makes you the champion you are.

In this article, I mentioned my two favorite protein powders. Take a look and choose the one that's right for you: Equip (use code DRSTEPHANIE to save 15%) or Schinoussa.

Question of the Week

Q: What does it mean when I'm spotting before my period?

Spotting outside your bleed week can be unsettling and there are a few explanations for it.

Before we dive in, consider your age, where you are in your cycle, and if you could be pregnant. And a word to the wise: I've had several friends in their late 40s get pregnant, so this is something to always rule out!

EVALUATING

Menstrual Cycle:  

  • Ovulation: Not all, but some women will notice some light pink blood mid-cycle around the time of ovulation. The pink color most likely is a mixing of the blood and cervical fluid. It should not be heavy enough to warrant a tampon, a cup or a pad, and this is considered uncommon, but normal.
  • Luteal Phase: This is most common in perimenopause when we see falling levels of total progesterone and estrogen. Lowered progesterone is unable to maintain the endometrial lining and premature shedding of the tissue can occur as it becomes ischemic and dies. Discussing hormone replacement with your provider might be in order here.
  • The spotting prior to bleeding might also be due to an estrogen deficiency or luteal phase defect where the luteal phase is shorter than the follicular phase. Typical diagnostic criteria consider 10 days as a luteal phase defect coupled with elevated FSH and LH. This can be confirmed on a blood test.

Hormonal Birth Control: If you have recently started on any kind of hormonal birth control like pills, patches, injections, or intrauterine devices, you may find you are spotting for the first few month as your body adjusts to its new hormonal environment.

Implantation Bleeding (Pregnancy): If you are pregnant, implantation bleeding often happens in the six- to eight-week mark of your pregnancy. This is right around the time you “should” be getting your period. The fertilized egg is burrowing itself into the womb and can cause noticeable spotting. This is normal, although you might mistake this for your period!

Sex: Penetrative sex can cause some spotting afterward, especially if you are experiencing vaginal dryness. This happens most commonly in perimenopause with declining levels of estrogen leading to reduced lubrication. The friction from sex can cause microtearing in the walls of the vagina. So, either ramp up the foreplay, grab some lubrication, or both.

You can also see some post-coital bleeding from cervical polyps. These are benign growths on the muscular wall of the cervix.

In all of these cases, keep a log of what is happening so you can discuss the specifics with your doctor. You'll want to note where you are your cycle, how much, how consistent, what colour, and duration of the spotting.

TESTING & NEXT STEPS

I love to run lab tests on myself and patients every six months. This is ESPECIALLY true in perimenopause when your sex hormones can drastically change from visit to visit.

YOUR TURN!

‘ll be answering your questions every week right here in the Mini Pause! Let me know what's on your mind. I'll be checking for both questions and feedback at support@drstephanieestima.com.

WHAT I RECOMMEND: Living Libations

As your hormones fluctuate in mid-life and your skin begins to change, you want products that deeply nourish.

Best Skin Ever-Rose is crafted to bring all skin types into balance and uses Rose Otto to replenish your skin. Use it as a cleanser, a gentle exfoliator, or a luscious face and body moisturizer.

It’s been a favorite face oil of mine for YEARS and for good reason. It is pure luxury. This is my “special” night oil when I want to up the glow and dewiness of my skin.

I also love the lightweight Rose Glow Serum that's rich with ingredients like jojoba, seabuckthorn, and geranium. It makes my skin feel silky soft while soothing and protecting.

Visit Living Libations link and save 15% off. (The discount is automatically applied at checkout.)

P.S.

MISSING LINK: In last week's Mini Pause, I included a link to a hand-held vacuum I like to use on my mattresses, but the link wasn't functional. Here it is!

HEALTH TOOLKIT: I've put together a toolkit for you on my brand new website. I designed these resources for my Bettys who are menstruating, experiencing perimenopause or have gone through menopause. There are commonalities between the categories and also specifics for each one. Everything I recommend, I use myself. That's my rule. I invite you to take a look!

Mini Pause #2: How Cold Plunge Benefits Women

Posted on by stephanie-estima

Welcome to the The Mini Pause!

This is your weekly roundup of the BEST actionable steps for women 40+ who want to gain control of their hormones during perimenopause and menopause.

Last week we looked at oats and how they can be effectively used as a pre-workout fuel. If you missed it, you can read it here.

Cold Plunge: Is It The Same for Women?

TL,DR (too long, didn't read)

Cold plunges are a great tool for recovering from muscle soreness post-exercise and there is some evidence it may help with the appearance of cellulite. There are a few considerations for women to keep in mind if you are jumping on this ‘cool' trend (see what I did there?). Irrespective of the temperature, you want to stay in the water until you start shivering. Interestingly, women may not need to cold plunge at extreme cold temperatures to reap the benefits on metabolism and immune function.

WHY

Cold plunging has myriad benefits and one of the ways it shines is as a recovery tool. When you submerge yourself in cold water, it triggers several physiological responses in your body, such as:

  • constricting blood vessels,
  • reducing inflammation (which helps with muscle recovery), and
  • reducing swelling.

Anyone with an autoimmune condition or an arthritide like osteoarthritis knows how “hot” joints and tissues can get during a flareup and how welcome the cold can be. Women who run hot in the luteal phase of the cycle, or those who suffer from hot flashes, also may find cold plunging a welcome relief and a help with thermoregulation.

Cold plunging aids muscle recovery. This is incredibly important if you lift weights!

  • In the short term, cold plunges help with recovery from high-intensity exercise and endurance activities.
  • In the long term, it helps with muscle strength, muscle power, and even jump performance.

Another benefit of cold plunging is its stimulatory effects on metabolism. While you are in the cold tub and immediately afterward as your body brings your core temperature back to normal, you will burn more calories to heat up. Cold plunging liberates stored triglycerides from your fat depots and uses them for energy as you are trying to warm up.

Now — a word of caution — some online influencers have claimed this is the “single best way to get fat off your body.” This is simply not true. We are all subject to the laws of energy consumption irrespective of whether we cold plunge or not! And frankly, I'd argue that building muscle tissue is the single best way to burn fat.

I've estimated using this calculator that I burn about 35 calories while in the cold plunge. Using this estimate, a 35-calorie burn (and then a bit extra to bring your core temperature back up) is going to burn about 3.6 lbs on an annual basis.

In aggregate, this can contribute to fat loss when calories are controlled in your diet.

And finally, cellulite. While harmless, it's often the reason women don't wear the short shorts, the short sleeves, or the bikinis. While I think life is too short NOT wear what you love, there's some emerging evidence that cold plunging can help with the appearance of cellulite.

WHAT

For those of you wanting to better understand the science of cold plunges, the process by which cold plunges impact metabolism is by activating brown fat.

When brown fat is activated, it generates heat by disrupting energy production. The technical term is called “uncoupling” oxidative phosphorylation. This uncoupling is being driven by Uncoupling Protein 1 (UCP1), which is present in the mitochondria of brown fat cells. UCP1 uncouples (or disrupts) the electron transport chain from creating ATP, causing the energy produced through cellular respiration to be dissipated as heat rather than used for ATP generation.

When heat is being created, your brown fat utilizes stored triglycerides as a fuel source. It breaks down triglycerides into fatty acids and glycerol. Then, those are transported to mitochondria to be oxidized for heat production. This process results in the release of energy in the form of heat and the consumption of stored fat.

For cellulite, during a cold plunge the cold temperature is absorbed by the fibrous connective tissue, leading to the collagen being more soluble. This solubilization promotes the removal of the tight, non-elastic network that often contributes to the appearance of cellulite. As a result, the skin’s pitted texture diminishes, creating a smoother and more even complexion. The activation of fibroblasts in response to collagen solubilization stimulates the production of new, more elastic collagen and further enhances the skin’s overall quality.

So at what temperature do you set your cold plunge and how long do you have to stay in to get these benefits? Like most things, there are sex differences when it comes to cold response.

Generally speaking, women are more intolerant to cold than men:

  • Women get colder faster
  • Women start shivering at higher temperatures
  • The neurotransmitter and immune benefits seem to be slightly lower for women. That doesn't mean you don't receive a benefit — it just means your response is smaller than what occurs in men.)

Where you are in your cycle also affects your tolerance to cold temperatures and how long you can be in cold water immersion.

  • Generally, women tend to run warmer in the luteal phase of the cycle — from ovulation through to the first day of your period. Cold plunging may be a welcome relief during this time.
  • In the follicular phase (bleed week through to ovulation), you're typically more resilient to stressors. This can be a good time to play with longer plunges or colder temperatures.

HOW

Here are a few ways you can incorporate cold plunges as a recovery tool. I've outlined strategies at different price points for you to consider:

Cold Shower: This where my cold plunging journey started. I would take my regular shower and then the last minute, I would turn off the heat and stand in the freezing water for a minute. I may or may not have been screaming, crying, or both.

Ice Bag Baths: The next step in my cold plunge evolution was my bathtub. I would fill it up with cold water then top it off with ice from the gas station to get it extra cold. This was a better solution for a while. I could immerse myself in the water completely rather than being limited to the size of my shower nozzle. Over time, I did find the trip to the gas station cumbersome, and it was hard to control the exact temperature this way. If I over did it with the ice, I had to wait for the water to warm up.

Coldture Cold/Hot Tub: I invested in a cold tub when I knew it was a recovery practice I wanted to do several times a week for help with muscle recovery from my training sessions. I know I sound like a broken record, but in perimenopause, it's all about the recovery!

For those of you wondering, I purchased the Coldture Classic tub with chiller. I decided on this tub because:

  • The tub is portable and I can move it outdoors in the summer if I want.
  • The tub DOUBLES as a hot tub! The temperature range on the chiller goes from 3C- 40C or 37F to 104F.
  • I can turn it on and off from my phone.
  • The chiller gets the exact temperature.
  • The two-step filtration system keeps my water clean.

There are other cold plunge options without a chiller. I went with this because I like to have control over the temperature. (If you decide to check out Coldture, use code DRSTEPHANIE to get a discount.)

I have the temperature set at 13C / 55F and I’m in there for 11 minutes, or until I start shivering. Depending on where I am in my cycle, this can be anywhere from 8 to 12 minutes. As I continue to build out cold tolerance, these numbers will change.

The main point is this: irrespective of your method or duration of cold water immersion — you want to stay in the water until you evoke a shivering response.

NOW

Choose your cold adventure (cold shower, ice bath in your bathtub, or cold plunge) and ignore the voice in your head telling you to avoid discomfort. That's where all the growth, grit, and resilience happens!

Research on women and cold plunging is almost non-existent (surprise, surprise), but here are a few general guidelines for you to follow. Also, let your intuition guide you.

  • Aim for 10-12 minutes per week to start. If you are plunging 3x/week, that will be anywhere from 3 minutes to 4 minutes per session. Stay in until you elicit a shiver response.
  • Aim for the temperature to be 10C-16C / 50F-60F to start.
  • Towel off when you get out, and if time allows, don’t get dressed right away. Let your natural shivering response warm you back up. Truthfully, I'm only able to do this on weekends when I have a bit more time. I usually find my shiver response to last anywhere from about 15-30 minutes after the cold.
  • Note where you are in your cycle (if you're still regular). You might find cold plunging a welcome relief in your luteal phase. That's when you tend to run hotter and your tolerance for longer sessions is lower. During follicular phase plunges, the water may feel relatively colder, and you may be able to tolerate longer sessions.

Question of the Week

Q: I'm in menopause and my cholesterol and blood sugar have both gotten worse. Why?

 

Excellent question!  Let's tuck into it.

EVALUATING

Menopause, from a strictly hormonal perspective, can and should be viewed as an estrogen deficiency. Estrogen has a direct effect on our lipids by directly acting on the liver to reduce total cholesterol, to reduce LDL cholesterol, and to increase HDL cholesterol.

In menopause and in perimenopause you have marked changes in estrogen levels. This means that in an environment of reduced estrogens, total cholesterol and LDL cholesterol will rise, and HDL cholesterol will lower. And the jump is significant — most women will see a 10-15% rise in their lipid levels in their post-menopausal years.

In my podcast with Ben Bikman, he called women “metabolic superheroes” prior to menopause because of of this lipid-balancing effect estrogen has. Once you're menopausal and not taking hormonal replacement therapy, you can absolutely see a rise in total cholesterol and thereby increase your risk for cardiovascular and cerebrovascular disease. In fact, the female risk of cardiovascular disease in women who are 10 years into menopause tends to square off with the risk in men!

Our blood glucose similarly has a similar fate through a different path — your muscle. Skeletal muscle is the largest organ in the body by weight and is one of the primary regulators of glucose balance and homeostasis. Skeletal muscle is responsible for 80% (not a typo) of the glucose that circulates post meal.

As you age, the muscle desensitizes to the insulin signal from the pancreas, which has a net result of increased circulating blood glucose. Now, pair this with menopause, where you have a lower concentration of anabolic hormones like estrogen and testosterone, and this insulin insensitivity is amplified.

NEXT STEPS

The good news here is that you can always do something about it.

Women with a healthy weight and normal to high muscle mass are much less likely to experience the glucose dysregulation and dyslipidemia I described above. Maintaining or building your lean muscle tissue can be achieved through dietary or mechanical means.

Consuming protein (at a minimum of 1g/lb of body weight) is ideal for stimulating muscle growth. (There's a lot more to say about what kind of protein, dosing of protein, and % of protein targets in the diet. Look for that in a future newsletter.)

Mechanical stimulation is what you might have guessed — regular resistance training! You have to give the muscle a reason to grow! Lift weight as heavy as you can with as close to perfect form as you can.

I will be diving into far more detail on form and type of exercises in coming newsletters and podcast episodes. I have spent the better part of 30 years mastering this and, as you might imagine, have a lot to say about it!

Nutrition plays a role here too — specifically your fibre consumption. Women who consume 25-35g per day will positively impact cholesterol levels, and can offset excessive weight gain.

YOUR TURN!

I'll be answering your questions every week right here in the Mini Pause! Let me know what's on your mind. I'll be checking for both questions and feedback at support@drstephanieestima.com.

What I Recommend: LMNT

Healthy hydration isn’t just about drinking water. It’s about water AND electrolytes. You lose both water and sodium when you sweat. Both need to be replaced to prevent muscle cramps, headaches, and energy dips. This is especially true in winter, when your hydration needs actually rise.

I'm loving the new LMNT limited-edition Chocolate Medley for hot drinks. All three flavors, Chocolate Mint, Chocolate Chai, and Chocolate Raspberry taste great on their own or swirled into my favorite recipes. And the Chocolate Caramel rounds out the hot-drink flavors.

Visit drinklmnt.com/drestima to receive a free LMNT Sample Pack with any order.