How menopause changes the body and how to manage symptoms today

Originally published on March 1, 2023

Menopause changes sleep, metabolism, mood, and long term health risk, and this article explains what is happening and what can help. In Episode 211 of the WHOOP Podcast, board-certified OB-GYN Dr. Jessica Shepherd joins Dr. Kristen Holmes, Global Head of Human Performance, Principal Scientist at WHOOP, to break down the biology of perimenopause, the clinical definition of menopause, and the habits that can improve how this transition feels.

Shepherd is chief medical officer for Verywell Health, founder and CEO of Sanctum Med + Wellness, and a member of the WHOOP Scientific Advisory Council. Their conversation covers symptom tracking, hormone therapy timing, sleep disruption, nutrition, strength training, and why menopause should enter the conversation well before the first missed period.

To listen to Episode 211 of the WHOOP Podcast, Women, Aging & Menopause with Dr. Jessica Shepherd, in full, head to the WHOOP Podcast on YouTube.

What is happening in the body during perimenopause and menopause?

Perimenopause is the transition leading up to menopause, and the hormonal changes usually start before the final menstrual period. Menopause itself is a clinical definition, not a vague feeling, and Shepherd argues that understanding that definition helps people recognize what is changing and when.

Shepherd explains that many women are taught to think of menopause as a switch that flips all at once. In practice, the process is gradual. Estrogen starts to downregulate, testosterone declines, and related neuroendocrine changes begin to affect energy, body composition, sleep, and metabolic health. Those changes often begin in the 40s, which is why Shepherd repeatedly pulls the conversation earlier instead of waiting until someone has already spent years dealing with symptoms.

Shepherd offers a useful way to organize the timeline. Perimenopause includes irregular cycles, skipped months, and fluctuating symptoms. Menopause is reached after a full year without bleeding. From that point forward, the clinical label is postmenopause. That framing matters for both symptom tracking and treatment timing because the physiology has been shifting long before the 12 month mark is reached.

In the discussion, Shepherd puts the definition plainly:

"Menopause means when a woman has not had menstruation, any type of bleeding, for 12 months consecutively."

If you want to hear Shepherd unpack the clinical definition of menopause and the timeline around hormonal change, listen to the full episode on Spotify.

What you should take away

• Perimenopause often starts before menopause is clinically reached.
• Menopause is defined as 12 consecutive months without menstruation.
• Hormonal changes that affect energy, sleep, and metabolism can begin in the 40s.
• Waiting for periods to stop completely can delay useful conversations about symptoms and care.

How can you tell whether symptoms may be related to perimenopause?

Once the timeline is clear, the next step is recognizing the symptom pattern. Shepherd says the classic list of hot flashes and night sweats is too narrow to explain what many women actually experience.

She describes a much broader cluster of changes: easier weight gain, shifts in fat distribution, sleep disturbance, anxiety, low mood, rumination, memory lapses, brain fog, lower libido, vaginal dryness, joint discomfort, and a general sense that the body feels different. Some symptoms show up before cycles become obviously irregular, which is one reason people can miss the connection.

That is also where self tracking becomes useful. Holmes points out that wearables can make subtle perturbations visible earlier, especially around sleep quality. WHOOP members may notice that sleep consistency, Recovery, or resting heart rate trends start moving before a problem feels severe enough to mention in a clinic visit. Paired with symptom notes, those shifts can help turn a vague sense that something is off into a more specific conversation.

Shepherd also raises another clinical point that often gets overlooked. Thyroid changes can overlap with perimenopausal symptoms, and thyroid dysfunction becomes more common in women starting around age 40. In other words, changes in mood, energy, sleep, and weight do not always come from one source, which is why a careful workup matters.

Her caution on symptom breadth is one of the most useful parts of the episode:

"Thyroid is the most common endocrine abnormality for women, especially starting at the age of 40."

For a broader overview of common physical and cognitive changes, see The Changes that Happen During Menopause.

If you want to hear Shepherd go deeper on the range of symptoms that can show up before menopause, watch the full episode on YouTube.

What you should take away

• Perimenopause symptoms extend well beyond hot flashes and night sweats.
• Weight gain, brain fog, joint pain, lower libido, and sleep disruption can all be part of the transition.
• Thyroid changes can overlap with perimenopausal symptoms and deserve attention in the workup.
• Trend data can make subtle changes easier to notice before symptoms become severe.

What helps with sleep disruption during menopause?

Sleep disruption during menopause is common, and the cause is often multi layered. Shepherd says the right response depends on whether the main issue is racing thoughts, hot flashes, hormonal depletion, or a behavior pattern that is making sleep more fragile.

She starts with the long view. Poor sleep quality and short sleep duration are tied to worse long term health, including higher risk for cardiometabolic problems and a lower quality of life. That is why she urges women to look beyond the bad night itself and ask what sleep changes may be signaling about overall health.

The physiology can work through several pathways. Some women struggle to fall asleep because of anxiety or cognitive overactivation. Others wake because of night sweats or hot flashes. Shepherd points to recently clarified KNDy neuron pathways as part of the mechanism linking falling estrogen to temperature dysregulation and sleep disturbance. She also emphasizes that sleep care has to be individualized. A person with hot flashes needs a different plan than a person whose mind races at bedtime.

Holmes adds the behavioral side of the equation. Stable sleep and wake times, a gap of roughly three hours between the last meal and bedtime, and lower alcohol intake can all support better sleep timing and next day recovery. The transcript stops short of turning those into rigid rules, but the direction is clear: reduce inputs that destabilize circadian rhythm and nighttime temperature regulation.

Shepherd is direct about the stakes:

"What we're seeing long term with decrease in sleep quality and quantity can show up in heart disease, it can show up in diabetes, it can show up in metabolic disorders later on in life."

If you want to hear Shepherd unpack how sleep disturbances connect to hormones, hot flashes, and long term health, listen to the full episode on Spotify.

What you should take away

• Menopause related sleep disruption can come from hot flashes, racing thoughts, hormonal shifts, or behavior patterns.
• Sleep problems during this transition are linked to broader health risks, not just tired mornings.
• Stable sleep timing, earlier meal cutoffs, and less alcohol can support better nights.
• Symptom tracking works best when it separates bedtime anxiety from temperature related waking.

When should hormone therapy enter the conversation?

After symptoms and sleep patterns are on the table, treatment timing becomes the next big question. Shepherd's view is that hormone therapy should be considered earlier and more individually than many people have been taught.

She references the historical effect of the Women's Health Initiative hormone therapy trial, which shifted practice sharply away from hormone therapy in the early 2000s. Shepherd argues that later interpretation has become more precise, especially around age, baseline risk, and timing relative to menopause. In her telling, the conversation should start with risk stratification, symptom burden, and the type of hormonal support a person may need, not with a blanket assumption that therapy is off the table.

One of her clearest lines in the episode is that everyone should be considered a possible candidate until a clinician identifies a reason to steer away. She also makes an important distinction between hormone therapy as a single category and hormone care as a tailored strategy. Depending on the individual, the useful intervention could involve estrogen, progesterone, testosterone, thyroid evaluation, or a combination.

Timing remains central. Shepherd says current evidence supports lower risk for healthy women younger than 60 and within 10 years of menopause, and she would often prefer to start the conversation even sooner, closer to five years from the menopausal transition. That does not mean everyone should start therapy. It means waiting for symptoms to become unmanageable is not the only model.

Shepherd sums up the timing issue this way:

"The risks of hormone therapy are low for healthy women less than the age of 60 and within 10 years from menopause, and I like to scale it back to even 5 years."

For a newer follow up on how Shepherd thinks about hormones, symptoms, and advocacy, read Podcast 328: Redefining Menopause and Building the Blueprint for Women's Health with Dr. Jessica Shepherd.

If you want to hear Shepherd go deeper on who may be a candidate for hormone therapy and why timing matters, watch the full episode on YouTube.

What you should take away

• Hormone therapy decisions should start with symptoms, risk factors, and individual goals.
• Shepherd argues that hormone therapy should be considered earlier than many people assume.
• Current evidence is strongest for healthy women under 60 and within 10 years of menopause.
• The useful intervention may involve estrogen, progesterone, testosterone, thyroid evaluation, or a combination.

Which lifestyle habits matter most for menopause symptoms and long term health?

From there, the conversation widens from treatment to daily habits. Shepherd gives a five part recipe for reducing risk and improving quality of life during and after the menopausal transition: informed hormone discussions, nutrition, exercise, sleep, and mindfulness.

Exercise is the anchor. As estrogen declines, the risks around bone density, lean mass, metabolic health, and future fracture rise. Shepherd recommends changing how training is distributed, with more emphasis on weight bearing work and strength training. That recommendation lines up with a later WHOOP conversation in How to Support Your Body Through Menopause with Dr. Jessica Shepherd and with broader training guidance in Episode 212: How to Train Through All Phases of Life.

Nutrition is the next lever, and Shepherd's language is practical. She is wary of short term dieting because restriction rarely holds. Instead, she pushes women to think about food quality, meal timing, and durable habits that support weight maintenance and metabolic health. Holmes expands that idea by distinguishing time restricted eating from generic intermittent fasting. The core point is simple: eating across a shorter daily window, biasing more calories earlier in the day, and leaving time between the last meal and sleep may help with sleep stability and metabolic control.

Alcohol also gets a clear mention. Both Holmes and Shepherd connect it to worse sleep and less stable physiology. WHOOP members often see this directly in lower Recovery, higher resting heart rate, and reduced sleep quality after drinking.

Shepherd's recipe is concise enough to quote in full:

"The recipe is looking at hormone replacement therapy differently, nutrition, exercise, sleep, and really mindfulness in the form of meditation, yoga, breathing techniques."

If you want to hear Shepherd unpack strength training, food quality, meal timing, and alcohol during menopause, listen to the full episode on Spotify.

What you should take away

• Strength training becomes more important as estrogen declines because bone and lean mass are at greater risk.
• Food quality and meal timing matter more than short term dieting during perimenopause and menopause.
• Alcohol can worsen sleep and recovery during this transition.
• Mindfulness practices can help lower stress load and support better sleep.

Why should menopause be a conversation for everyone?

Those daily habits matter most when the broader culture is ready to support them. Shepherd says menopause should be discussed by women, men, partners, clinicians, and researchers because the consequences of neglect have already shown up in women's health data.

Her example is heart disease. For decades, research leaned heavily toward male participants, which limited how well guidelines reflected female physiology. Shepherd argues that bringing men into the conversation is not symbolic. It is part of how research priorities shift, how support at home improves, and how taboo topics become easier to address in the clinic.

She also sees the future changing for a practical reason: better visibility. Wearables can make changes in sleep and recovery easier to spot, public conversations about menopause are expanding, and mainstream outlets such as The New York Times have started covering how women have been misled about menopause care. Shepherd expects demand for better answers to keep rising, which should push practice away from treating a narrow symptom list and toward treating the whole person.

That same life stage focus shows up across WHOOP content on healthy aging, including Podcast 258: Playing the Long Game: Embracing Aging with Dr. Vonda Wright.

Shepherd frames the research gap clearly:

"Women still die mostly from heart disease because we weren't really focusing the studies on women."

If you want to hear Shepherd go deeper on why men, partners, and clinicians all need to understand menopause, watch the full episode on YouTube.

What you should take away

• Menopause deserves wider attention because research gaps in women's health have had real clinical costs.
• Better public discussion can improve support at home, in clinics, and in study design.
• Wearable data can make symptom patterns easier to identify and discuss.
• Shepherd expects the next decade of menopause care to become more individualized and more visible.

The bottom line

• Perimenopause often begins before menopause is clinically reached, and symptoms can start while menstrual cycles are still changing.
• Menopause is defined as 12 consecutive months without menstruation, after which the clinical term becomes postmenopause.
• Sleep disruption during menopause can reflect hot flashes, anxiety, hormonal shifts, circadian disruption, or several of those factors together.
• Hormone therapy conversations are most useful when they start with symptom burden, baseline risk, and timing relative to menopause.
• Strength training, sleep quality, food quality, meal timing, and lower alcohol intake are central habits for supporting health during the menopausal transition.
• Declining estrogen is linked to higher risk around cardiovascular health, bone health, metabolic syndrome, and cognitive aging.
• Better menopause care depends on earlier conversations, better research, and more precise symptom tracking.

Frequently asked questions about things discussed in this episode

How does WHOOP help you spot sleep changes during perimenopause?

WHOOP helps make sleep disruption easier to see by showing trends in Sleep, sleep consistency, and Recovery over time, so a pattern becomes visible before it is easy to dismiss as a few bad nights.

What does WHOOP do for menopause symptom tracking?

WHOOP helps connect symptoms to physiology when you log behaviors and symptoms in WHOOP Journal and compare them with Sleep, Recovery, and resting heart rate trends.

How does WHOOP show the effect of alcohol during menopause?

WHOOP often makes alcohol's effect visible through lower Recovery, higher resting heart rate, and worse Sleep after drinking, which can help you decide whether alcohol is intensifying symptoms.

What does WHOOP show about late meals and bedtime?

WHOOP can help you compare earlier versus later meal timing by showing how Sleep and next day Recovery change across those nights.

How does WHOOP support strength training during menopause?

WHOOP supports strength training by helping you track Strain, sleep status, and recovery trends, which can make weekly training more consistent and easier to adjust.

What does WHOOP give you to bring into a menopause appointment?

WHOOP gives you objective trend data on sleep, Recovery, resting heart rate, and logged habits, which can make a menopause visit more specific and less dependent on memory alone.

During perimenopause and menopause, WHOOP can help turn changes in sleep, recovery, and daily habits into patterns you can bring to a clinician and act on.