Field notes for the long lift.

If you wake up stiff, your knees complain on the stairs or your hands ache in the morning, you're far from alone. Joint and muscle aches are among the symptoms women report most often around menopause, yet they rarely come up in the conversation, which tends to stop at hot flushes.

In 2024, a group of researchers proposed the name 'musculoskeletal syndrome of menopause' to describe this cluster of joint pain, muscle loss, bone loss and stiffness. Their review suggests musculoskeletal symptoms affect a large share of women in midlife, and that for some they are disabling. It's a useful name, because it recognises something many women have been told is 'just age'.

It isn't only hormones

Oestrogen plays a part. It influences connective tissue, muscle and bone, and inflammation. But joint pain in midlife usually has several contributors at once: less muscle to support the joint, changes in weight and how load moves through the body, poorer sleep (which makes pain feel worse), stress, previous injuries and the early stages of osteoarthritis.

That matters, because it means there are several things you can work on, not one.

Why strength training helps

For osteoarthritis, NICE guidance recommends therapeutic exercise, including strengthening and general activity, as a core treatment, because it can reduce pain and improve everyday function. Stronger muscles share the load with the joint, and regular movement keeps joints mobile.

The research on menopause-related joint pain specifically is still developing, so we can't promise exercise will make every ache disappear. But resting sore joints for long periods tends to leave them stiffer and weaker, and building strength gradually is one of the best-supported things you can do.

• Start lighter than you think, and build up week by week.
• A little discomfort that settles within a day or so is usually fine. Pain that's sharp, or worse the next day, is a sign to ease back.
• Warm up properly. Our sessions open with breathing and joint prep for this reason.
• Choose a range of movement that feels comfortable, and widen it over time.
• On a sore-joint day, use the check-in. It will suggest a gentler session rather than nothing.

The rest of the picture

Enough protein supports the muscle that protects your joints. Sleep matters too, because pain feels louder when you're tired. And daily movement, such as walking, keeps things moving between sessions.

If a joint is hot, swollen, very painful or stops you sleeping, or pain comes on suddenly, see your GP rather than putting it down to menopause. If you're considering HRT, it's worth mentioning joint symptoms to your doctor too, so you can weigh up your options together. Whatever you choose, strength work can sit alongside it.

Few women talk about it, and fewer are asked about it. Yet urgency, frequency, getting up in the night, leaking when you cough or jump, and urine infections that keep returning are some of the most common changes of the menopause transition. They are not an inevitable part of getting older, and you do not have to put up with them.

In 2014 the North American Menopause Society gave these symptoms a proper name: genitourinary syndrome of menopause, or GSM. It replaced older terms like 'vaginal atrophy' because the changes are not only vaginal — the bladder and urethra are affected too.

Why oestrogen matters to your bladder

The bladder, the urethra and the vaginal tissues all carry oestrogen receptors. Oestrogen keeps that tissue thick, well supplied with blood and elastic, and supports the healthy, slightly acidic vaginal environment that keeps harmful bacteria in check.

As oestrogen falls, the lining thins, the tissue loses some of its support and the vaginal pH rises. The result is a urethra that seals less well, a bladder that becomes more irritable, and a door left open to the bacteria that cause infection. Unlike hot flushes, which often ease with time, these symptoms tend to progress unless they are treated.

What the research shows

The evidence for local (vaginal) oestrogen is strong and consistent. A 2014 systematic review in Obstetrics & Gynecology found it improved urgency, frequency, night-time waking, stress and urge incontinence, and reduced recurrent UTIs. A 2025 meta-analysis pooling the newer trials confirmed it: women using vulvovaginal oestrogen were markedly less likely to report each of these urinary symptoms, and their vaginal pH moved back towards a healthy range.

For urine infections, the evidence is rated moderate quality. In one nine-month trial a daily low-dose antibiotic prevented more infections than a twice-weekly estriol pessary — but long-term antibiotics carry their own costs, and many women and clinicians prefer to treat the underlying tissue change first. The UK's NICE menopause guideline recommends offering vaginal oestrogen for genitourinary symptoms, including to women already on systemic HRT.

What you can do

Bladder symptoms respond best to a combination of approaches. None of these replace a conversation with your GP, but all of them are worth starting.

• Ask about vaginal oestrogen. It is low-dose, applied locally, and is one of the most effective treatments we have for GSM.
• Train your pelvic floor. Daily, consistent pelvic floor work improves both stress and urge leaks — and it's woven through every Long Lift session.
• Breathe and brace without bearing down. Exhaling on effort protects the pelvic floor during lifting, jumping and carrying.
• Use non-hormonal moisturisers if oestrogen isn't right for you, or for mild symptoms.
• Keep drinking. Cutting back on water concentrates urine and irritates the bladder; reduce caffeine and alcohol instead.
• Don't ignore blood in your urine, pain, or sudden changes. See your GP promptly.

The bottom line

Leaks, urgency and repeat infections are a direct, well-understood result of losing oestrogen — not a personal failing and not something to quietly manage with pads for the rest of your life. They are treatable at every stage, from perimenopause well into post-menopause. Ask for help, train the muscles that support you, and expect to feel better.

A Boxlife profile making the rounds this month describes Jennifer Aniston, at 56, training with Pvolve for thirty minutes a day — low-impact, functional, resistance-led — and her trainer calling the resulting core "bulletproof." It's easy to scroll past as celebrity content. It shouldn't be. Underneath sits one of the first proper trials of resistance training across the full menopause transition, and the result is worth paying attention to.

The study, in plain English

The research was led by Professor Francis Stephens at the University of Exeter Medical School and published in Medicine & Science in Sports & Exercise (2025) — the flagship journal of the American College of Sports Medicine. Seventy-two healthy, active women aged 40–60, none on HRT, were randomised into two groups: one followed standard physical activity guidelines (150 minutes a week), the other completed a 12-week, whole-body, low-impact resistance programme from Pvolve, four 30–35 minute sessions a week, using resistance bands, light ankle and wrist weights, and dumbbells, paired with single-leg balance, hip hinges, planks and rotational work.

It's the first trial to compare the effects of a resistance programme on strength, balance and lean mass before, during and after menopause in the same study — and to ask whether the menopause transition itself blunts the response to training.

What they actually found

After 12 weeks, the Pvolve group — compared to women following standard activity guidelines — saw measurable, repeatable improvements:

• 19% increase in hip function and lower-body strength.
• 21% increase in full-body flexibility.
• 10% increase in dynamic balance, mobility and stability.
• An increase in lean muscle without increasing total body mass, with some markers shifting after just four weeks.

The finding that quietly matters

The headline result isn't the percentages. It's that the improvements were comparable across pre-, peri-, and post-menopausal groups — and on some balance measures, post-menopausal women actually gained the most. That is the first direct evidence that the menopause transition does not blunt your ability to respond to well-designed resistance training. The body still adapts. The stimulus just has to be right.

That matters because the dominant story women are told in midlife is one of inevitable decline: bone thins, muscle slips, balance goes. This trial pushes back on that story with numbers. Strength and balance are trainable through menopause, not despite it.

Why 30 minutes, four times a week, was enough

The Pvolve sessions in the trial weren't long, and they weren't brutal. They were short, progressively loaded, and consistent — four times a week for twelve weeks. The protocol is closer to what Aniston describes in her own interviews ("you can get as good, if not better, of a workout in 30 minutes") than to the high-intensity, sweat-soaked aesthetic that still dominates a lot of midlife fitness marketing.

The mechanism is unglamorous: enough mechanical tension to signal muscle and bone, enough balance and rotational work to defend joint integrity and proprioception, and enough frequency that the nervous system actually learns. None of it requires you to crawl out of the gym. It requires you to show up.

What we take from this at The Long Lift

We're not endorsing a brand. We are endorsing the principle the trial validates, because it is exactly what The Long Lift is built on: short, consistent, progressively loaded resistance work, paired with balance, mobility and pelvic-floor-aware cueing — three to four times a week, in 30–40 minute blocks — is enough to defend strength, bone, and balance through and beyond the menopause transition.

• Consistency beats intensity. Four 30-minute sessions a week, done for twelve weeks, produced measurable change. A perfect 90-minute session you skip half the time does not.
• Progressive resistance is non-negotiable. Bands, ankle weights and dumbbells worked because the load went up over twelve weeks. Light forever is not a stimulus.
• Balance and rotation belong in every week. Hip hinges, single-leg work and multi-planar movement are what protect you from the falls and fractures that decide how the second half of life actually goes.
• Post-menopause is not too late. The women furthest into the transition responded just as well — and sometimes better — than those earliest into it.

The bigger point

Jennifer Aniston gets the magazine cover. The quieter, more useful story is the one underneath: a peer-reviewed trial showing that the right kind of training — modest in duration, intelligent in design, sustained over weeks — measurably changes the trajectory of a midlife body. That is the work The Long Lift exists to support. The science is finally catching up to what your body has been asking for all along.

Reference: Stephens, F. et al. "A novel low-impact resistance exercise program increases strength and balance in females irrespective of menopause status." Medicine & Science in Sports & Exercise, 2025.

Menopause is not a disease. It is not a decline. It is, as Dr Stacy Sims PhD describes it in her book Next Level, reverse puberty — a single calendar date that marks the end of one hormonal chapter and the beginning of another. Before it lies perimenopause: the long, unpredictable transition where oestrogen and progesterone begin their erratic descent. After it lies postmenopause: the rest of your life, lived in a body that no longer has the hormonal buffer it once relied on.

The problem is not menopause itself. The problem is that we have been trying to navigate it with advice written for twenty-five-year-old men.

What is actually happening in your body

Oestrogen is not merely a reproductive hormone. It is a master regulator — of bone turnover, muscle protein synthesis, insulin sensitivity, vascular health, and neuroplasticity. When it falls, the body does not gently coast into decline. It enters a state of adaptation to absence.

Your brain, dense with oestrogen receptors, keeps searching for a signal that is no longer arriving. Hot flushes, night sweats, mood volatility, brain fog — these are not character flaws or weakness. They are neurochemical and thermoregulatory symptoms of a brain rewiring itself in real time. The body is not broken. It is reorganising.

What changes most profoundly is how your body responds to the things you used to do. Fasted cardio, calorie restriction, long slow distance running, and the eat-less-move-more prescription that worked in your thirties may not serve you in the same way. For many women, they can make it harder to hold on to muscle, recover well and keep energy steady.

The old rules — and why they stop working

For decades, fitness culture has sold women a single script: burn more, eat less, leaner is better. That script was never designed for a body in hormonal transition. Without adequate oestrogen, the protective effects of that advice simply vanish.

Hard training on an empty stomach, for example, may feel tougher than it used to, and many women find a small snack beforehand helps. Heavy calorie restriction can make it harder to keep muscle. Lots of long, exhausting cardio on top of poor sleep can leave you feeling more drained than refreshed.

Researchers increasingly recognise that women are not small men. Their physiology is not a scaled-down version of male biology. It is different in its hormonal architecture, its response to load, its recovery demands, and its nutritional requirements. Training advice works best when it takes that into account.

The new prescription: train for the body you have now

Dr Sims's research, distilled in Next Level, suggests a different approach. The goal is no longer aesthetics or arbitrary performance. The goal is preserving the four pillars of healthy ageing: muscle mass, bone density, metabolic health, and cognitive resilience.

• Heavy resistance training, 2–3× a week — compound lifts with progressive loading. Resistance training is one of the best-supported ways to help maintain muscle and bone. Build up gradually from lighter weights, keep good form, and progress steadily.
• Sprint interval work instead of chronic cardio — short, sharp efforts that may support heart fitness and blood sugar control, built up gradually. Think hill sprints, not marathon sessions.
• Protein earlier, and more of it — the dose-response curve shifts upward in midlife. Aim for 1.6–2.0g per kilogram of bodyweight daily, distributed across meals. Including protein at breakfast is an easy way to spread it out.
• Consider a small snack before hard sessions — many women find they train and recover better with some protein and carbs beforehand.
• Sleep as a non-negotiable training variable — 7–9 hours, protected. Poor sleep amplifies every negative symptom of menopause: hot flushes, mood disruption, insulin resistance, and cognitive fog.

The small levers that compound

Beyond the big structural shifts, a handful of smaller interventions produce outsized returns. Cooling the core — a cool bedroom, a chilled pillow, or simply sleeping with fewer layers — reduces the severity and frequency of night sweats. Limiting alcohol, which disrupts sleep architecture and thermoregulation, often produces more benefit than any supplement.

L-theanine, magnesium glycinate, and creatine monohydrate (3–5g daily) have solid evidence for sleep, mood, and muscle support in women at this life stage. They are not magic. They are scaffolding.

What this means for the next forty years

The deepest insight from the research is not about menopause at all. It is about the body that remains. Women in postmenopause are not inhabiting a diminished version of their former selves. They are inhabiting a body with different rules, different sensitivities, and different capacities — and those capacities are still trainable.

Bone density responds to load. Muscle responds to protein and tension. The brain responds to movement, sleep, and social connection. The cardiovascular system responds to sprint work and daily walking. None of this stops at fifty, or sixty, or seventy.

Menopause is not an ending. It is a recalibration. The fire is not going out. It is asking to be tended differently — with heavier weights, more protein, better sleep, and the quiet discipline of listening to the body you have now rather than mourning the one you had then.

The science says it plainly: the next forty years can be built on more strength, not less. More clarity, not more fog. More autonomy, not more limitation. The training just has to match the biology.

Longevity has become a noisy word. Cold plunges, peptides, red light, fasting windows, twelve supplements before breakfast. It's easy to feel that unless you're optimising every hour, you're falling behind.

The truth, for women in their second spring, is quieter and far more reassuring. The interventions with the strongest evidence for extending healthspan — the years you live well, not just the years you live — are almost all free, deeply unsexy, and entirely within reach.

Healthspan, not lifespan

The goal is not to die later. The goal is to stay strong, mobile, sharp, and independent for as long as possible — and then to compress the decline at the end into as short a window as we can. The science calls this healthspan, and it's the only longevity metric worth optimising for.

Almost everything that matters for healthspan in midlife women comes down to protecting four things: muscle, bone, brain, and metabolic health. Get those right and the rest tends to follow.

The five levers that actually matter

If you do nothing else, do these five. They are the foundation; everything else is decoration.

• Strength training, 2–3× a week — the single best defence against frailty, falls, and the loss of independence that drives most late-life decline.
• VO2 max work, once a week — short, hard cardio sessions. VO2 max is the strongest predictor of all-cause mortality we have, and it is trainable at any age.
• Protein, 1.6–2.0g per kg of bodyweight daily — the raw material for muscle, bone, immune function, and stable mood.
• Sleep, 7–9 hours, protected like a meeting — the master regulator for hormones, cognition, insulin sensitivity, and recovery.
• Connection — strong relationships are as predictive of longevity as not smoking. Loneliness in midlife is a clinical risk factor.

Why midlife is the leverage point

Between 40 and 60, the body recomposes more than at any time since adolescence. Oestrogen falls. Bone density drops. Muscle quietly slips away. Visceral fat creeps in. Sleep architecture changes. None of this is failure — it's biology renegotiating its terms.

The decisions you make in this window compound. A woman who maintains her muscle mass through her fifties walks into her seventies with an entirely different body — and an entirely different range of life — than one who doesn't. The midlife decade is where most of the long-term variance is decided.

What we'd quietly skip

Most of the longevity industry is selling answers to problems you don't have. Be sceptical of anything that's expensive, branded, or asks you to take its word for it. Cold plunges are pleasant; they are not a cardiovascular intervention. Continuous glucose monitors are interesting; for most healthy midlife women, the readings will tell you to eat more protein and walk after meals — which you already knew.

Supplements are a small lever. Vitamin D3 in winter, creatine (3–5g daily) for muscle and brain, magnesium glycinate for sleep if you need it, and a B12 check if you eat little meat. That's most of it. The rest is marketing.

What to do this month

Pick one lever and build the habit before adding another. If you're not lifting, start there — two sessions a week is enough to change a decade. If you are lifting, audit your protein for a week and notice where you fall short. If both are handled, protect your sleep with the same seriousness you'd protect a doctor's appointment.

Longevity is not a product. It's the unglamorous accumulation of ordinary days done well. The body you want at 75 is being built, quietly, by the choices you make this week.

If we could prescribe one free, daily intervention for every woman in her second spring, it would not be a supplement or a workout. It would be this: step outside within an hour of waking, and again as the sun is setting, and look toward the sky without sunglasses for a few minutes. That's it.

It sounds almost too small to matter. The research says otherwise.

What low-angle sunlight actually does

When low, warm-spectrum sunlight hits the specialised melanopsin cells in your retina, it sends a direct signal to the suprachiasmatic nucleus — the master clock in your brain. That signal sets the timing of cortisol (your wake-up hormone), melatonin (your sleep hormone), and the cascade of downstream hormones that govern hunger, mood, body temperature and recovery.

In perimenopause, when oestrogen and progesterone are already fluctuating, an anchored circadian rhythm is one of the few stabilising forces you still control. Women who view morning light consistently report deeper sleep, steadier moods, fewer night sweats, and easier mornings — not because the light is magic, but because a well-set clock is.

Why no sunglasses (for these few minutes)

The melanopsin cells need light to actually reach the eye. Sunglasses block the very wavelengths that carry the timing signal. Prescription glasses and contact lenses are fine — they don't filter the relevant spectrum meaningfully. Sunglasses, by design, do.

You are not staring at the sun. You're facing the general direction of the sky for two to ten minutes, eyes open, blinking normally. Never look directly at a bright sun — especially once it's higher in the sky.

And the vitamin D question

Here is where we have to be honest: morning and evening sun are not your vitamin D source. Vitamin D synthesis requires UVB radiation, which only reaches the skin in meaningful amounts when the sun is high — roughly between 10am and 3pm in summer, and very little at all in northern winters.

So the protocol is really two separate things, often confused:

• Morning and evening light, no sunglasses — for circadian rhythm, sleep, and hormone timing.
• Midday sun on bare skin (arms, legs, face), 10–20 minutes a few times a week in summer — for vitamin D.
• Most women in the UK and northern climates need a vitamin D3 supplement (1000–2000 IU daily) from October through April regardless.

Why this matters more after 40

Circadian disruption hits midlife women hard. Sleep fragments. Cortisol rises at the wrong times. Insulin sensitivity drops. The same protocol that does almost nothing noticeable for a 25-year-old can transform energy, sleep, and mood for a 48-year-old whose hormonal buffer is thinner.

Vitamin D, separately, matters for bone density (already under pressure from falling oestrogen), immune function, and mood. Getting both right — light for the clock, vitamin D for the bones — is a quietly powerful midlife foundation.

What to do this week

Tomorrow morning, before you check your phone, put on whatever clothes you can and go outside for two minutes. Face east. No sunglasses. Just look toward the sky and breathe. Do the same as the sun sets. Test it for seven days and notice what shifts — usually it's sleep first, then mood, then everything else.

Somewhere around 40, the body starts quietly renegotiating its contract with you. Oestrogen begins to fluctuate, then decline. Bone density edges down. Lean muscle — the tissue that keeps you metabolically alive — starts to slip by roughly 3–8% per decade if you don't train it. None of this is catastrophe. All of it is reversible.

The single most powerful intervention we have is strength training. Not pink dumbbells, not endless reps — real, progressive resistance with weights that genuinely challenge you. Here's how to begin.

Why strength matters more after 40

Three things change in midlife that strength training directly addresses: bone loss accelerates as oestrogen drops, muscle protein synthesis becomes less efficient (a phenomenon called anabolic resistance), and joint integrity depends increasingly on the muscles surrounding them.

Cardio is wonderful for your heart. But cardio alone cannot maintain bone, cannot rebuild lost muscle, and cannot protect you from the loss of independence that drives most quality-of-life decline after 60. Strength is the keystone.

Where to actually begin

Start with the six movement patterns that cover almost everything a human body needs to do: squat, hinge, push, pull, carry, and rotate. Two sessions per week is enough to start. Three is better. Four is plenty for a lifetime.

• Squat — goblet squat, then back squat
• Hinge — Romanian deadlift, then conventional deadlift
• Push — incline dumbbell press, then overhead press
• Pull — single-arm row, then chin-up progressions
• Carry — farmer's walks with heavy dumbbells
• Rotate — Pallof press, cable chops

How heavy is heavy enough?

Heavy enough that the last two reps of a set feel genuinely hard. If you can chat through it, the weight is too light to drive adaptation. A good rule: work in the 5–8 rep range for compound lifts, leaving one or two reps in reserve.

This sounds counterintuitive at midlife, but it's the science. Mechanical tension is the signal that tells your body to keep its bones dense and its muscle fibres recruited.

Recovery is not optional

In your thirties you could train hard and sleep four hours and feel mostly fine. In your forties and fifties, that arithmetic stops working. Sleep, protein (aim for 1.6–2.0g per kg of bodyweight per day), and a true rest day between heavy sessions are the difference between progress and burnout.

If your cycle is still arriving, expect the week before your period to feel heavier. That's not weakness — that's physiology. Plan the deload, don't fight it.

What to do this week

Pick two days. Pick three of the six patterns. Do three sets of five to eight reps. Add a little weight next session. Repeat for ten years. That is, essentially, the whole secret.

A pattern we see constantly: a woman in her late 40s, fit and disciplined, running four or five times a week, eating reasonably well — and watching the scale creep up, the energy dip down, and the recovery from a long run take three days instead of one.

She has done nothing wrong. She has simply hit the limits of what cardio alone can do for a midlife body.

What cardio is brilliant at

Aerobic exercise is unmatched for cardiovascular health, mood regulation, insulin sensitivity, and stress decompression. Walking is one of the most underrated longevity interventions in existence. Zone 2 cardio — the conversational pace, two to three sessions a week — should be a permanent fixture in your week.

What cardio cannot do

Cardio does not meaningfully build or maintain muscle. It does not load bones in the way required to maintain density. And in excess — particularly when paired with low energy availability — chronic cardio can actually accelerate the loss of both.

If you're running an hour a day and not lifting, you are likely getting steadily smaller, weaker, and more fragile. Not because running is bad. Because running is incomplete.

The balanced midlife week

We programme our members around a simple template that covers all the bases without overwhelming the week:

• 2× strength sessions (45–60 minutes, full body)
• 2–3× zone 2 cardio (30–45 minutes, conversational pace)
• 1× short, hard session — sprints, hill repeats, or a spin class (15–20 minutes of work)
• 1× mobility, pelvic floor, or yoga
• Daily walking — aim for 7,000–10,000 steps

Why this works

Strength preserves the tissue that defines how you age. Zone 2 keeps your mitochondria — your cellular engines — running clean. Short hard sessions maintain VO2 max, the single best predictor of longevity we have. Mobility keeps you free in your body. Walking does the quiet, unsexy work of metabolic health.

Together they are far greater than the sum of their parts. Each one alone is, after 40, not quite enough.

The single most-impactful nutrition change a woman can make in her forties is also the simplest: eat more protein, more consistently, across the day.

This is not a fad. It's a response to a real, measurable shift called anabolic resistance — the reduced efficiency with which an ageing body turns dietary protein into muscle. The fix is straightforward: give the body more raw material, and give it earlier in the day.

What the research suggests

Older nutrition guidelines (0.8g per kg of bodyweight) were derived from young, sedentary men and are almost certainly too low for active women in midlife. Current research on muscle protein synthesis in women over 40 points to a target closer to 1.6–2.0g per kg of bodyweight per day.

For a 65kg woman, that's roughly 105–130g of protein daily. Most women we meet are eating 50–70g.

What 120g a day looks like

Aim for 30–40g of protein at each main meal, and a 20g snack or post-workout option. A practical day:

• Breakfast — Greek yoghurt with berries and a scoop of whey (35g)
• Lunch — Chicken or tofu salad with quinoa, plus olive oil (40g)
• Snack — A handful of edamame or a protein shake (20g)
• Dinner — Salmon or lentil dahl with roasted veg (35g)

Why this matters beyond muscle

Higher protein intake in your 40s and beyond is correlated with better sleep, stabler blood sugar, fewer cravings, and protection against the dreaded "meno-belly" — which is not a moral failing but a predictable response to insulin resistance, cortisol shifts, and muscle loss.

Protein is also remarkably satiating. Women who hit their protein target tend to eat less of everything else without having to think about it.

One thing to try this week

For the next seven days, front-load protein at breakfast. Aim for 30g before 10am. Notice the energy stability, the reduced mid-morning hunger, and the quiet steadiness it brings. Then build from there.

If your stomach feels tight and swollen by mid-afternoon and your jeans fit differently from morning to evening, you're not imagining it. Bloating is a common complaint in perimenopause and menopause, and it's often dismissed.

Hormones are part of the story, but rarely the whole of it. Digestion in midlife is shaped by fibre and fluid, how much you move, stress, sleep, medicines, and the bacteria living in your gut. The good news is that several of those are things you can change.

What might be happening

Changing levels of oestrogen and progesterone can affect fluid balance and how quickly food moves through the gut. Many women notice bloating that comes and goes, especially in perimenopause when hormones fluctuate.

Your gut bacteria are involved too. Some of them help process oestrogen, a group of genes researchers call the 'estrobolome'. Studies suggest the gut microbiome may change around menopause, but this research is young, and nobody can yet tell you how to 'rebalance' it to fix symptoms. Be wary of anyone who says they can.

Stress and poor sleep also affect digestion, and both are common in midlife. And slower bowels, or constipation, is one of the most common reasons for a bloated tummy at any age.

What the evidence supports

None of this calls for detoxes, cleanses or cutting out whole food groups. These are simple, sustainable habits.

• Fibre, built up gradually. UK guidance is 30 g a day from vegetables, fruit, pulses, oats, wholegrains, nuts and seeds. Jumping up quickly can make bloating worse at first, so add a little each week.
• Drink enough water, especially as you add fibre.
• Move after meals. A short walk after eating can help things along.
• Eat regularly, and don't skip meals then eat a very large one.
• Notice your own triggers. Fizzy drinks, alcohol and some foods (often onions, beans or certain fruits) can produce more gas. A food diary helps you spot patterns.
• Look after sleep and stress. Breathing, walking and restorative sessions all count.
• Probiotics may help some people, but the evidence is mixed. If you try one, give it about four weeks and stop if nothing changes.

Strength training and your gut

Regular exercise supports healthy bowel habits, and building muscle helps your body manage blood sugar. Strong core and pelvic floor muscles also help you feel more supported. It isn't a cure for bloating, but it's part of looking after your whole body, not just one symptom.

When to see your GP

Bloating that's persistent, happens most days, or comes with weight loss, a change in bowel habits, bleeding, pain, feeling full quickly or needing to wee more often should always be checked by your GP. Persistent bloating can occasionally be a sign of something more serious, including ovarian cancer, so don't put it down to menopause without getting it looked at.

Your body isn't broken. It's changing, and it may need different support now: more fibre, more movement, more rest and a little patience.