What happens when the woman who studies this for a living has to work it out in her own body?
I started HRT at 39, and two years on I want to give you an honest picture of what HRT and training in perimenopause have looked like for me. That includes the dose changes, the testosterone, the bone aches, the weight I gained and the races I finished smiling.
I'm a nutritional scientist. I'm also a curvy, fit woman in perimenopause who loves trail running and gravel riding. Since starting HRT I've had to relearn how to fuel, what to eat and when, and I've had to listen to my body when the data was telling me something completely different. It has been frustrating. There were plenty of days I wondered if I could pause the whole thing and opt out. You can't, so I've been working on finding some grace with myself in this new season.
If you're in the middle of it too, I hope this helps you feel less alone. This is my experience, not medical advice, and I'll say that more than once.
How did I know it was perimenopause?
I had a few night sweats from about 36 or 37, but looking back I can't say for sure they were perimenopause. It could have been my thyroid or something else metabolic, and I don't have the data to know.
The real tell for me was my brain. At work I'd be reading something on the screen and I couldn't think fast or sharp anymore. My mood started to tank, and waves of anxiety would wash over me while I was sitting at my desk or on my own. Nothing else in my life had changed, so I couldn't put my finger on it. My training felt flat too, and my body fat started to move around.
Then I looked at my cycle history. My cycles had stretched to 43 days, then 50, 54 and 58. The one that sent me to my GP was 83 days long. I told him something had shifted. I couldn't lose weight, I wasn't sharp, and I felt like a popped balloon.
At first I was told I was too young for HRT. I pushed back and explained my symptoms, and my GP agreed to start me on it while he referred me on for a second opinion. By the time that came back I was already feeling better, like a light had switched on, and I've been on it ever since. I'm grateful he trusted me with decisions about my own body. A lot of women don't get that.
And no, being a nutritional scientist gave me no special warning. It hit me out of nowhere. I help women and men lose weight for a living, and here was my own body refusing to budge. That was confronting. It's also why I believe experience is the best teacher. I need to know how this feels if I'm going to help other women through it.
Finding my dose: patch, gel, Utrogestan and testosterone
What finally made me say yes to HRT was the tiredness that never lifted and a libido that had gone completely out the window. I did have worries. We still don't have nearly enough data on women taking HRT long term, let alone combined with strength training, and there's very little research on women who stop once they've started. HRT changes your cardiovascular system, brain, bones and gut, so you have to give it time and accept it as part of the package.
I started on the patch, and it helped at first. When I started it I was living in a calorie deficit, struggling to make enough thyroid hormone and losing my hair. I reverse dieted back up to maintenance, and I think that restored some of my metabolic and ovarian function. Once I was eating properly, the patch became too much. I had swelling in my arms, legs, stomach and face, and just before each patch change I'd get massive migraines and heavy bleeding.
I moved to the gel, and a full pump was still too much for me. So I halved it and stayed there for about three months. Only now am I starting to increase it slightly, because my recovery is slowing again and there are other signs I need a little more estrogen.
Please hear me on this. Halving my dose is a decision I made for my own body, and I've taken on the risks of it. It is not a recommendation. Talk to your GP or a menopause specialist before you change anything.
Utrogestan
I still need progesterone to protect the lining of my uterus, so I make sure I'm taking enough Utrogestan to do that. I time it with where my luteal phase would naturally be, which supports the cycle I still have in the background.
Testosterone
Genetically I'm prone to low testosterone. After about eight months on HRT my energy was still in the toilet and my libido hadn't come back, so I had it tested. It came back at 0.7, which explained a lot. I now take testosterone, and my last test was 1.4. It could go higher, but 1.4 feels good for me, I haven't had side effects like oily skin, and it has made a huge difference.
How I track whether it's working
Sleep is always the first thing I watch. I've worn an Oura ring for almost five years, so I can follow my heart rate variability (HRV), temperature and recovery whenever I make a change. I get bloods done every three to six months, though hormone blood tests are a limited guide in perimenopause. I also pay attention to how my joints feel on a run and how quickly I recover.
Why can't I under-fuel anymore?
There wasn't one big moment when I realised my body was different. It was a slow shift. I didn't have the same energy in the tank, my joints and capacity felt different, and starting HRT didn't fix that straight away. It's really only been the last six months that I've understood how to fuel my body, and it's still a work in progress. As our bodies keep changing through perimenopause, we have to keep relearning balance. Some days that still irritates me.
My sleep has always been good, and I'm grateful for that, because in perimenopause sleep becomes everything. It's when we rebuild and recover. My HRV, though, started to dip and has been up and down since. Recovery takes longer now, even after a three or four kilometre run on the weekend.
The biggest change is that I can't get away with under-fuelling anymore. Perimenopause is a stressor on the body and cortisol goes up, so I need a lot more carbohydrate around my training. Before a run that might mean three scoops of collagen in my coffee and a whole banana instead of half, and I have to eat properly afterwards too.
The story underneath the fuelling
This one is personal. Growing up, I was told to hold my stomach in, and I absorbed the message that a bigger tummy or eating too much was bad. It's taken the best part of six years to unravel that. For a long time I under-fuelled without realising it. I'm a tall, dense, big-boned woman with a lot of lean mass, and my body was stressed. I did lose a lot of weight at one point, and I was lighter and faster on the trails. My hair was also falling out and my thyroid was a mess. It wasn't worth it.
When perimenopause arrived, it threw fuel on that fire, and I had to face it. Over the last two to three years I've gained weight, and I've also gained a lot of muscle, and my hair is growing back. That story is the backbone of why I do what I do, and why I'm so passionate about women fuelling themselves properly.
What training looks like on HRT
HRT, along with eating enough, has let me keep doing what I love. I'm a trail girl through and through: long runs and hikes on gravel, gravel riding, endurance. For a while I didn't think I could push my limits anymore. Now I'm lifting heavy again and pushing a bit more in my training, while keeping a close eye on recovery and sleep.
About two years ago, right as I was starting HRT, I completely tanked in an XTERRA triathlon. This year I ran the 22 km trail race at Tekapo, my first half marathon race. It was hard, I was broken afterwards and it took me three weeks to fully recover, but I was smiling at the finish and my body was happy the whole way. I can't tell you how much of that was HRT and how much was fuelling, because I threw everything at the wall. Either way, I believe in my body again, enough that I've signed up for my first ultra: the 54 km South Island Ultra on the West Coast in May.
I do still have a cycle of sorts, partly my own and partly shaped by how I take my HRT. These days I train by my HRV, readiness and temperature more than by cycle day, because for me they're more reliable. I check that my readiness and HRV are in a good place before any serious session.
Bone aches, a changing body and what the data can tell you
At one point I started getting really bad bone aches, and I still get them sometimes. There could be a few causes. Genetically I'm slow at making vitamin D, and I avoid the sun because I've had skin cancer. I eat very little dairy and no gluten, and for a long stretch I'd cut out several food groups without realising what that meant. In perimenopause, calcium and vitamin D matter more than ever.
Alongside the small increase in my gel, I now make sure any plant milk I drink is fortified with calcium. I eat a lot of salmon with the bones and skin, plus tahini and bok choy, and I've started having two Brazil nuts a day for selenium to support my thyroid. Your own nuances will look different, which is why this journey is so individual.
Learning to live in a bigger body
The thing that bugs me most is that my jiggly bits have become more jiggly. Since starting HRT I've noticed more cellulite on my arms and the insides of my legs. My body doesn't look the way I once wanted it to. It performs really well, though, and my bloods are the best they've been in three to four years. So I've had to weigh it up and ask what matters more to me. I'm at an age where that trade-off isn't such a big deal anymore. I'd rather be strong, fit and healthy. As Dr Stacy Sims says, thick thighs save lives.
Not all data is equal
I love data, and I think it's an important part of this journey, but you can't trust all of it equally. For workouts I use my Garmin rather than my Oura, because I find its algorithm better for exercise. Take wearable numbers with a grain of salt.
The measures I'd prioritise in perimenopause are the ones that tell you about bone density and visceral fat, and for those a DEXA scan is your best option. Even DEXA, the gold standard, can't give a perfect picture of body composition, but it's the closest you'll get. For things like VO2 max, lab testing is the most accurate. Many women can't access or afford that, so do the best with what you've got.
What I'd tell myself a few years ago
Start with your diet and lifestyle, whether or not you think you're in perimenopause. They are fundamental. See a qualified nutritionist with a tertiary education and experience in this area, sort out your food and your training, and treat your lifestyle like a job.
And go easy on yourself. The science is still developing, and whatever you decide today, we may learn more about it later. Do your best with what you've got right now.
If this sounds like you
I'm still learning and still adjusting, and I'm feeling stronger than I have in years. If any of this sounds familiar, don't sit with it on your own. Write down what you're noticing and take it to your GP. If you don't think your GP will be on board, there are specialist menopause clinics and menopause doctors who can help.
If you're an active woman training intentionally for more than 150 minutes a week and you need help with the fuelling side, start with my free Sérénité Plate, a personal meal plan built around your body and life stage. I've also built Sérénité Active, an app for active women in perimenopause that adjusts your fuelling targets as your body changes.
I'd love to hear your story too. Come and find me on Instagram at @mdeatswellness and tell me where you're at.
Listen to this story on the podcast: HRT and Training in Perimenopause: What It's Really Like Now (Part 2) https://open.spotify.com/episode/1uEgGQIPEpNSOovYqQwHwf?si=c0b46c4af17b4669
Read or listen to Part 1: Why I Started HRT at 39 and What It's Really like. https://open.spotify.com/episode/4vCPw21JficKb6F9UxerBr?si=G3ChyYliQ0S1ljTihakB9A
This post shares my personal experience and is not medical advice. Please talk to your GP or a menopause specialist about your own care.
About the Author: Combining professional expertise with personal insight, I am a nutritional scientist dedicated to changing the conversation around women's hormonal health. Having navigated the hidden complexities of HRT over-treatment myself, I bridge the gap between clinical research and real-world experience to ensure women have the tools they need to advocate for their health. If you're a woman in perimenopause struggling with metabolic health despite doing "all the right things," the missing piece might be understanding your unique internal landscape.
