How to prepare for menopause and perimenopause with Jessica Shepherd

Originally published on June 17, 2025

Perimenopause and menopause are easier to navigate when preparation starts before symptoms become disruptive. In Episode 328 of the WHOOP Podcast, board-certified OB-GYN, menopause expert, and Generation M author Dr. Jessica Shepherd joins Kristen Holmes, Global Head of Human Performance, Principal Scientist at WHOOP, to explain how earlier education, heavier resistance training, better protein intake, smarter lab work, and informed hormone therapy conversations can change the experience of midlife health.

Shepherd's central point is simple: menopause is a biological transition, not a signal that good health is behind you. The discussion turns a vague sense that something feels off into clear actions people can take with a clinician, at home, and with data from WHOOP.

To listen to episode 328 in full, head to the WHOOP Podcast on YouTube.

When should women start preparing for perimenopause and menopause?

Preparation should start in the late 30s or early 40s, before symptoms become intense. Shepherd explains that many people first notice subtle changes long before they would ever describe themselves as menopausal.

That early phase is perimenopause, the stretch before menopause when hormone levels begin to fluctuate. Clinically, menopause itself is defined by 12 consecutive months without a menstrual bleed. Shepherd says the problem in practice is that many women are taught to think about menopause only after symptoms become severe, even though the transition often starts earlier and shows up first as a feeling that something is off.

Those early signs can be broad and subjective. Shepherd describes cycle changes, heavier or lighter bleeding, skipped months, sleep disruption, mood changes, hot flashes, and night sweats as common entry points. She also makes the point that perimenopause is hard for clinicians to classify quickly because it is experiential, not a single number like hypertension or diabetes. That is one reason people can feel dismissed even when real physiological change is happening.

Shepherd gives the timing a clearer frame by separating the transition into a pregame, a main event, and an afterparty. The point of that reframing is to take menopause out of the category of something to fear and place it in the category of something to prepare for.

Before the article moves into training and nutrition, it helps to remember that this timing conversation is not new for WHOOP readers. Episode 211 on menopause with Dr. Jessica Shepherd covers the earlier foundation on symptoms, aging, and what menopause means physiologically.

Shepherd defines the timeline directly in the conversation:

"Perimenopause is that time frame which can last anywhere from 3 years to 10 years prior to menopause."

What you should take away

• Perimenopause often starts before many women expect it, usually in the late 30s or 40s.
• Menopause is a clinical definition of 12 consecutive months without a menstrual bleed.
• Early symptoms can be subtle, varied, and subjective, which makes preparation more useful than waiting for a single lab result.
• Learning the language of perimenopause earlier can make it easier to seek care before symptoms become disruptive.

If you want to hear Shepherd unpack early symptom patterns and why women often arrive late to care, listen to the full episode on Youtube.

Which training and nutrition habits help during perimenopause and menopause?

The most useful starting points are more resistance training, more protein, and more daily movement. From that early-preparation frame, Shepherd argues that women should stop treating cardio alone as the default answer for midlife health.

Her reasoning is practical. As estrogen declines with age, women lose muscle and bone more easily, and the body becomes more vulnerable to frailty, falls, and metabolic dysfunction later in life. Resistance training helps maintain muscle tissue and stimulates bone, which Shepherd describes as a living organ that responds to load. If the body does not get that signal, muscle and bone both trend downward.

She also connects muscle directly to metabolic health. Muscle is one of the body's main sites for glucose use. When muscle mass drops and training demand is low, glucose handling becomes less efficient, and the shift toward insulin resistance becomes more likely. Shepherd links that process to the abdominal fat gain many women notice during midlife.

On the training side, her recommendation is to build up gradually to four weekly resistance sessions. Not every session needs to be heavy from day one, but the goal is to work toward heavier loads than many women currently use. In the interview, she describes telling patients who think they are lifting enough with 8 or 10 pound dumbbells that the long-term goal may be 25 or 30 pounds, worked up safely over time.

Cardio still matters. Holmes and Shepherd are aligned that women need to challenge the heart and get out of breath a few times per week. Shepherd's model is balance: some days can be dedicated strength sessions, and other days can combine about 20 minutes of cardio with 20 minutes of lifting. She also encourages people to listen to the body, vary movement, and keep play in the process instead of turning training into punishment.

Nutrition follows the same pattern of gradual improvement. Shepherd says protein intake usually needs to rise, and that the shift rarely happens overnight. Many women are far below where they need to be for muscle maintenance.

She gives a concrete target in the interview:

"I want you at 1 to 1.5 grams per kg."

If that feels far away, the point is still useful. The number gives people a direction, even if the change takes months to build. For a broader training lens, this WHOOP episode on training through all phases of life and this WHOOP discussion of menstrual cycle training and sleep add more context on how female physiology changes training needs over time.

What you should take away

• Resistance training is one of the most important habits for preserving muscle, bone, and metabolic health in midlife.
• Shepherd recommends building toward four resistance sessions per week, with some sessions combining about 20 minutes of cardio and 20 minutes of lifting.
• Protein targets often need to rise during perimenopause and menopause, and gradual progress is more realistic than overnight change.
• Heavy weights, daily movement, and movement variety can all support better long-term function than cardio alone.

If you want to hear Shepherd go deeper on heavy lifting, protein targets, and why muscle changes glucose handling, listen to the full episode on Youtube.

Which labs and biomarkers matter in perimenopause?

Perimenopause is diagnosed more by symptom pattern than by a single hormone lab. Once the training and nutrition foundation is in place, Shepherd says the next step is asking for lab work that gives a clearer picture of metabolic and thyroid health.

She is careful here. Reproductive hormone panels can be useful for context, but they are often less decisive than people hope during perimenopause because estrogen, progesterone, and testosterone are still present and still fluctuating. A lab drawn on one day may not capture the whole picture. That is why Shepherd says clinicians sometimes hesitate to use estradiol, progesterone, testosterone, or follicle-stimulating hormone alone as the main answer in still-cycling women.

The more useful baseline often comes from other markers. Shepherd recommends asking about a full thyroid panel, not only a basic thyroid-stimulating hormone check. She also highlights hemoglobin A1C, vitamin D, vitamin B12, and a lipid panel. Her rationale is prevention: the goal is to spot drift toward insulin resistance, lower vitamin status, or worsening cholesterol before those patterns become harder to reverse.

Cycle changes still matter clinically. Heavier bleeding, lighter bleeding, skipped periods, and new irregularity can all help place symptoms in the perimenopause frame even when labs are inconclusive. In other words, the body can be changing before a lab offers an easy label.

For readers interested in why better data collection matters so much in women's health, this WHOOP conversation on the research gap in women's health gives additional background on how underrepresentation in research has shaped care.

Shepherd makes her case for A1C clearly:

"Hemoglobin A1C is one of those metabolic health markers that really is telling us most people are going to start to become insulin resistant."

What you should take away

• Hormone labs can add context in perimenopause, but they often fluctuate too much to act as a simple yes or no answer.
• A full thyroid panel, hemoglobin A1C, vitamin D, vitamin B12, and a lipid panel can offer a more useful baseline for prevention.
• Cycle changes are clinically useful signals, even when hormone numbers are difficult to interpret.
• The goal of lab work in midlife is earlier action, not waiting until disease is obvious.

For Shepherd's full take on which labs are worth asking about and why hormone panels can be tricky, listen to the full episode on Youtube.

When does hormone therapy make sense in perimenopause and menopause?

Hormone therapy can enter the conversation before a woman has gone 12 full months without a period. Building from the lab discussion, Shepherd argues that symptom relief and long-term health should not be delayed simply because a person is still in the fluctuating stage of perimenopause.

She separates a few issues that often get blurred together. Vaginal estrogen is local, low-absorption therapy used for dryness and tissue changes. Shepherd describes it as one of the easiest places to start because it acts at the site where symptoms show up and carries less of the fear attached to systemic estrogen. She also references an important 2023 study on vaginal estrogen use after breast cancer that found no increase in recurrence.

Systemic menopausal hormone therapy is a different decision. Shepherd says current practice is shifting away from the older standard of waiting until menopause is fully established. In her view, people with clear symptoms during perimenopause may benefit from treatment earlier, because the goal is not to recreate hormone levels from the 20s. The goal is symptom relief and enough hormonal support for better organ function.

She also spends time correcting the long shadow of the Women's Health Initiative study. In the interview, Shepherd says press coverage turned the study into a blanket warning that estrogen causes breast cancer. Her explanation is that later analysis pointed more specifically to the synthetic progestin used in the study, while several benefits of therapy received far less public attention.

Birth control belongs in a separate bucket. Hormonal birth control can still suppress symptoms and prevent pregnancy during perimenopause, while menopausal hormone therapy does not function as birth control. That distinction matters for women who are still ovulating intermittently or who stop hormonal birth control and assume the shift to menopausal hormone therapy will also prevent pregnancy.

Readers who want a shorter practical guide alongside this section can also see this WHOOP article on how to support your body through menopause.

Shepherd highlights how dramatically the older study changed care:

"The amount of prescriptions that were dropped from that time, 84%."

What you should take away

• Hormone therapy discussions do not always need to wait until 12 months without a period if symptoms are already affecting quality of life.
• Vaginal estrogen is a local treatment that can help with dryness and tissue changes during perimenopause and menopause.
• Menopausal hormone therapy aims to support symptoms and organ function, not to restore hormone levels to those seen in early adulthood.
• Hormonal birth control and menopausal hormone therapy serve different purposes, and menopausal hormone therapy is not birth control.

If you want to hear Shepherd unpack vaginal estrogen, the Women’s Health Initiative, and when therapy can start, listen to the full episode on Youtube.

How can women ask for help and use data to navigate menopause better?

Menopause care improves when symptoms, daily habits, and home support are all treated as part of the picture. After explaining training, labs, and hormones, Shepherd closes on two themes that make the advice easier to act on: self-advocacy and data.

On the support side, she says many women in midlife are carrying children, older parents, work, and household management at the same time. That can make exercise, rest, and medical follow-up feel unrealistic even when symptoms are severe. Her advice is to ask for help directly, even in small increments. A 14-year-old and a 16-year-old watching a younger sibling for half an hour, or a partner taking over one part of the evening routine, can create the time needed for training, rest, or simply being alone for a short stretch.

On the data side, Shepherd describes WHOOP as a way to make the invisible more visible between appointments. In the conversation, she says data gives people a picture of how alcohol, missed sleep, low movement, or better habits show up internally. Holmes adds that WHOOP trends can also help people see larger physiological shifts across the menopause transition. She notes that HRV tends to decline with age, that the drop appears sharper through perimenopause and menopause, and that resting heart rate rises as cardiovascular risk changes.

That is where wearable data becomes useful in a clinical discussion. Sleep, Recovery, Strain, HRV, and resting heart rate do not diagnose menopause on their own, but they can help structure a conversation that might otherwise start and end with, I just do not feel like myself. For readers who want more context on how WHOOP handles female physiology over time, this WHOOP episode on menstrual cycle training and sleep is a useful companion read.

Shepherd also places the whole topic in a longer frame:

"Because 40% of our lives are lived in the postmenopausal phase."

What you should take away

• Asking for help at home can be part of menopause care because time, rest, and training capacity are often limited in midlife.
• WHOOP data can help people connect symptoms with sleep, recovery, training load, alcohol, and other daily behaviors.
• HRV and resting heart rate trends can add context when women notice changes during perimenopause and menopause.
• Menopause planning is long-term work because a large part of adult life is spent after the menopause transition.

If you want to hear Shepherd go deeper on self-advocacy, family support, and what data can add to care conversations, listen to the full episode on Youtube.

The bottom line

• Perimenopause often begins in the late 30s or 40s, and waiting for severe symptoms can delay useful care.
• Menopause is defined clinically as 12 consecutive months without a menstrual bleed.
• Resistance training supports muscle, bone, and glucose handling, which makes it one of the most important exercise habits during midlife.
• Protein intake usually needs more attention during perimenopause and menopause, and Shepherd points women toward roughly 1 to 1.5 grams per kilogram as a working target.
• A full thyroid panel, hemoglobin A1C, vitamin D, vitamin B12, and a lipid panel can offer a better baseline than hormone labs alone in many still-cycling women.
• Vaginal estrogen and systemic menopausal hormone therapy solve different problems, and both require a clinician-guided discussion.
• Hormonal birth control can mask or manage some perimenopause symptoms, but menopausal hormone therapy does not prevent pregnancy.
• WHOOP trends in sleep, Recovery, Strain, HRV, and resting heart rate can help turn vague symptoms into clearer patterns for clinical conversations.

Frequently asked questions about things discussed in this episode

How does WHOOP help you spot changes that could line up with perimenopause?

WHOOP helps by showing long-term trends in sleep, HRV, resting heart rate, Recovery, and Strain. Those trends do not diagnose perimenopause, but they can show when physiology is shifting and give you better information to bring to a clinician.

What does WHOOP do for sleep tracking during menopause?

WHOOP tracks sleep duration, sleep stages, and night-to-night consistency so changes are easier to see over time. Sleep disruption is one of the most common complaints in perimenopause and menopause, and trend data can help connect poor nights with training load, alcohol, stress, or cycle changes.

How does WHOOP support strength training during menopause?

WHOOP supports strength training by helping you place lifting inside the larger context of recovery and total load. That makes it easier to see whether heavier lifting, better sleep, and consistent routine are lining up with better recovery patterns over time.

What does WHOOP measure that can support conversations about metabolic health?

WHOOP measures metrics such as resting heart rate, HRV, sleep, and strain that can reflect how daily behavior is affecting stress and recovery. Those signals do not replace lab work like hemoglobin A1C or a lipid panel, but they can add useful behavioral context.

How does WHOOP help you see the effect of alcohol or missed sleep during perimenopause?

WHOOP helps by showing how alcohol and short sleep can change recovery-related signals from one day to the next. That makes cause and effect easier to spot when symptoms already feel variable and hard to describe.

What does WHOOP do for long-term menopause trend tracking?

WHOOP makes long-term trend tracking easier because the same core metrics are collected continuously over weeks, months, and years. That consistency can be useful when symptoms develop gradually and when you want to compare lifestyle changes with what is happening in your body.

Tracking sleep, HRV, resting heart rate, recovery, and training over time can give menopause conversations a clearer starting point than symptoms alone.