← BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
Should Women Train Differently? The Complete Guide to Cycle-Syncing Your Workouts
00:49:22
You're not failing at fitness programs—the programs are failing YOU. Women aren't "little men with pesky hormones," and it's time to stop training like we are. Learn how to modify your training across all four weeks of your cycle (yes, even if you're perimenopausal) using the golden rule of autoregulation. Watch the full episode at https://youtu.be/arKufo_-trE
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I feel like for most of my life, and I would gather maybe yours as well, we were not really taught to honor the menstrual cycle. It was just this annoying thing where we bled for three to seven days, you know, once every four weeks or so. And there was lots of cramping and there was lots of inflammation, there was lots of bloating. And I think that many women, myself included, have behaved in a way that would be best described as we are acting like we are little men with pesky hormones. Right? For too long, women have been following fitness programs designed for male physiology and then blaming ourselves when they don't work. But here's the truth. You have a 28 day infradian rhythm that men simply don't have. And it's time to start training in alignment with your actual biology. In today's solo episode, I give you my updated thoughts and thinking around a variety of topics that I know are very interesting for you. Today we're going to be talking about training, fitness training, and modifying our training over the course of your menstrual cycle, if you are someone who is still menstruating. And this will also include my peri menopausal women, however irregular your cycle may be. And we will talk about that today. And this was part of a talk that I had prepared for a recent visit to Europe, where I presented at the Health Optimization summit. Of course, if you know my work in any capacity, you know that we talked about this almost ad nauseam in the Betty Body book, which we'll have a link. If you haven't picked that book up, please do in the show notes. And I wanted to update a little bit of my thinking and thoughts around training for women in the Betty Body. We had talked about different hormonal environments and how we might train differently. And of course, all of those principles are still very true. And from the data that I get from every woman that I talk to who's read the Betty Body and does this kind of cyclical training is very, very useful for her equip. Collagen is simply the best of the best of the collagen products on the market today, with each scoop containing 15 grams of bovine collage. In perimenopause and menopause, we know that we see more joint pain, more arthritis like osteoarthritis, and painful conditions like frozen shoulder and bursitis. And collagen is one of the most important building blocks of the body. It makes up about 30% of the proteins in your body. So your hair Your skin, your nails, your connective tissue, your ligaments, your tendons, these are all made up of collagen fibers. Clinical studies have shown collagen strengthens your bones, joints, ligaments, improves gut lining and connective tissues as well as improves the condition of your skin. And your joints will preferentially take up collagen and concentrate it in the joint for healing and reparation. I put one scoop of equip grass fed collagen in my coffee every single morning and I absolutely love it. It's the best way to start my day. And equips 30 day happiness guarantee makes trying their grass fed collagen a no brainer. They will refund your purchase in full if you don't fully love it. Just head over to equipfoods.combetter and use code better for 20% off of your first purchase. That is equipfoods.com better and use code better at checkout. Starting with the obvious, of course men and women are not the same. And so whenever we are looking for fitness programs online or potentially with yours truly, men and women, very different, right? In terms of our hormonal landscape, certainly our reproductive cycle is one of the most obvious, you know, sexual dimorphic feet, you know, differences between the sexes. There are other things as well that I will maybe get into in other solo episodes like brain function. So there are certain nuclei in certain areas of the brain that are different in men and women, of course, under the influence of estrogen and testosterone and how that actually changes over the arc of a woman's life. We actually have other organs that function differently as well. Like our liver. There is sexually dimorphic behavior even in the female liver versus the male liver. So some really cool stuff there. But for the purposes of today, I really want to focus in on the reproductive cycle and that infradian rhythm or that, you know, 30 or so day rhythm that women have that men do not. And I outlined this in the Betty Body a little bit, but I feel like for most of my life, and I would gather maybe yours as well, we were not really taught to honor the menstrual cycle. It was just this annoying thing where we bled for five days or something, you know, three to seven days, you know, once every four weeks or so. And there was lots of cramping and there was lots of inflammation, there was lots of bloating. And then we had to make sure that we had tampons on on call with us at any time. And we weren't wearing white jeans, you know, like this kind of. That was like the extent of us, or at least myself, honoring the menstrual cycle. And I think that many women, myself included, have behaved in a way that would be best described as we are acting like we are little men with pesky hormones, right? It's like, ugh, you know, I'm just gonna do what all the guys do. I'm gonna do the diet, I'm gonna do the 75 hard. Worst thing, by the way, for women, don't ever do 75 hard. But I'm gonna do the 75 hard. I'm gonna fast for seven days. I'm gonna, you know, whatever it is. And then when we fail, right? When we fail on those programs, what do we say? We say, God damn it, why can't I ever do anything? Why can't I ever follow through on anything? Why can't I ever achieve the body that I want? Why can't I ever train the way that I had planned? Why does this stupid menstrual cycle or my mood or my affect or my weight, why can't I ever seem to take control of it? And I would offer that it's not you, it's them, right? It's like it's not you, it's me, it's not you, right? It's like we've been lied to, right? We've been told that cardio for fat loss, fasting until you know you're starving, caloric restriction forever. You know, one of the hills I will die on is 1200 calories is not enough for women. If you are one of those women who think that you need to restrict and restrict and restrict 1200 calories, 1100 calories, a thousand calories. Like, your body is not stupid. And your body will hold onto fat like it is an insurance policy, so it will not let go of your fat. And instead it will waste your muscles, it will waste your brain, it will waste your organs, and then you become correctly identified as tofi, right? So thin. T o f I thin on the outside, fat on the inside, you actually become relatively. You have a higher percentage of adipose tissue when you do that. Because when you are in a caloric restriction for too long a period of time, your body will sacrifice your skeletal tissue, your skeletal tissue, depending on where you are in the world, skeletal or skeletal. Some people have complained that I say it's skeletal, and I'm sorry, I will flip between the two. But skeletal tissue, skeletal tissue, we lose that when we calorically restrict for so long because your body's like, well, I gotta sacrifice something, and it's not gonna be the fat, because the fat is the last thing, right? So we've been lied to. And I talk about this in the buddy body a little bit in terms of how I really struggled with my menstrual cycle for ever, right? I struggled with it for decades, and it really wasn't until I actually went to Italy. There was a whole bunch of things that happened in my personal life and my professional life. My clinic burned down. I was going through a divorce with young children, which, if any of you have ever gone through a breakup of any kind, you know, how excruciating and stressful that might be. You know, I remember, like, having to almost bury some of the dreams that I had with this man that I was no longer gonna be with. And, you know, things like, well, I guess I'm never gonna have, like, a 50th wedding anniversary and all the. All the hopes and all the things that I had sort of over, like, put into that relationship. I had to let it go. And then you couple that with, you know, divorcing with young children and, you know, and, gosh, I mean, I feel myself even getting teary just saying this, you know, coming to the realization that I'm also breaking my children's hearts as well. Like, it's not only my heart that's shattered, but I've also shattered their hearts as well. And so you have that. And then in my case, when it rains, it pours. My clinic also burned down. So then I have all these lawyer spills and the pain of sort of splitting up a life with a man and a family. And so I ended up going to Italy with my. My boys for vacation, which fundamentally changed the trajectory of my life. I had the best period I'd ever experienced in my life there, and I learned a lot about what it means to live well and came back and started applying some of these principles in the temporary clinic that I set up. And it sort of evolved into the work that my book encapsulates with the Betty Body. And so for me, when we think about training around the menstrual cycle, this is. This is what I'd like you to consider. So this is for. We'll talk. The way that I'll structure this solo is that we'll talk with a regular menstrual cycle first, and then I'll give some considerations for perimenopausal women as well. So before we get into week one, week two, week three, week four, the overarching principle with a fitness regimen first is that you cannot, you absolutely cannot consider anything like fixing your period fixing, you know, menstruating like a goddess. That's how I like to think about it, because I remember in Italy, I felt like a goddess menstrual. I was like, gosh, this feels like a cleansing. I feel so good. It doesn't hurt. I'm not medicated. I'm still able to, you know, just put in a tampon and go into the sea, you know, like, no problem. Right? But we can't really have a conversation around fixing your period, let's say, or fixing your menstrual cycle without having a conversation around muscle. And this is something I didn't include in the book, but probably in the revised. I'm. I'm thinking about doing a revised, like a revision one, if you will, of the book is talking really about some of the effects that muscle has on the body. And I talked about this in the book, but there's three. Like, muscle starts with M, and so I like a good alliteration. So we're gonna go with three M's. Muscle serves three funct functions in the body. One is a mobility function, right? So muscles obviously help us ambulate, they help us get around, they help us walk. All the things. We don't really think about mobility too much in our 30s, our 40s, our 50s, even in our 60s. But if you are now postmenopausal and you are not lifting weights, which is gonna have a, you know, byproduct of helping you increase your bone density and keep your tendons really strong and ligaments really strong. The center for Disease Control last year reported 300,000 hip fractures that required hospitalization, and 95% of those hospitalized with hip fractures were from falls. So if you think about it, your grandmother, 65, 75, 85 years old, and maybe you trip on the corner of a carpet or coming down the stairs, you misstep, or your grandchild has Lego on the floor and you step on it and fall. Or if you live somewhere with winter, you might slip and fall on ice, let's say, on the sidewalk or something like that. So this is really important because as we are training, as we are strategically lifting weights, we are also driving up something called proprioception. And proprioception is, I like to call it, the sixth sense. It's not from the Bruce Willis, you're not seeing dead people. But it's. So we have all of our regular senses that are facilitated through the cranial nerves. We have sight we have so vision, we have auditor, we have hearing, we have taste, smell. And the sixth sense is proprioception. And so that is basically an unconscious sense. So if I were to ask you now to close your eyes. And so if I ask you to close your eyes and then if you're watching this on video, you'll see me doing this. You're going to bend your elbow to about 90 degrees and then open and see how close you are. I'm a little, little off there. Probably need an adjustment, but, you know, it's about 90 degrees. And so that's proprioception. That's actually your joint telling your brain where you are in space without your vision. Right. So your vision is one of the most dominant senses that we have. It's a great tool in the gym to watch for form. But over time, you don't want to rely on the squat rack having a mirror in front of it. You want to develop the proprioception in the hip joint, in the knee joint, in the ankle joint, in the toes, et cetera, to be able to feed back to the brain whether or not you're in the right position or not. And so there's actually some, just as a side note, there's some actually some really interesting chiropractic literature that supports the idea of neck adjustments. So that test that I just did, if you're watching me on video, I just did like a 90 degree angle with my joints. They would test pre. So they would get them to do that test that I just did and then adjust them and then get them to do it again. And their ability to approximate 90 degrees with the elbow was really awesome. That's with Dr. Heidi Havik. She's just an incredible chiropractic researcher for those of you that don't want look up her work. And clearly after doing that test on video, it looks like I am due for a neck adjustment. So I'm gonna be going to my chiropractor this week. Uh, okay, so back to, back to our functions on muscle mobility is one of them. I was saying 300,000 hip fractures last year, 95% from falls. Three quarters of that number. Female. Right. So that's the big, that's the big number. That's the big sort of data piece, data point that I wanted to get to you because women in those postmenopausal with, in that sort of sex hormone deficient environment, we are very susceptible to osteopenia, which is just the bones are becoming weaker and more frail. And that is sort of the precursor to osteoporosis, which is the disease state. That's the arthrotide where. Now, if you look at OA or osteoarthritis on film, let's say if you look at it on X ray, it looks almost like gray. So there's two types of bone. When you're. When you're imaging on X ray, we will look at the cortical bone, which is the shell, and then the. And then the cancellous bone, which is inside, and the cortical bone, we see a thinning of the cortices. So we will see the shell of the bone get thinner. And then inside the. That different type of bone, that cancellous bone inside the bone shaft itself almost looks like. It looks almost like teenage acne. It almost looks like pock marks, like Swiss cheese all the way through. And so that makes the bones incredibly brittle. And even though it might go contrary to, you know, what you're thinking in terms of, like, a strong bone is really stiff. Actually, strong bones are very bendy, right? So if you were to fall on your hip, you. Your bone should be able to absorb that impact. Right? By bending and not snapping. Right. It's kind of like, I think there's a pink song reference in there. Like, I'm bent. I'm not broken. Something like that. I'll find it and I'll put it in the. In the notes for you. But. So the women, we want to be thinking about weight training as a way to upregulate bone density. Okay, so that's the first m. If you've listened to me for any length of time, you know that I am not a fan of aggressive fasting. For most women in midlife, perimenopause and menopause is already a stress test. And piling on long fasts can leave you wired, tired, and, frankly, ravenous. But here's the nuance. I do love what fasting pathways can do. They help with cellular cleanup. They help with steadier, fewer cravings and better focus. And that's why I'm into mimeo. It's basically fasting in a pill. Mimeo is a biomimetic formula designed to support your body's natural restorative systems with ingredients that your body naturally elevates during a longer fast. And you can use mimeo in three ways. The first is with food as a fasting mimetic. So this is going to help activate fasting pathways even during a meal, and support less inflammation, brain fog, and sluggishness. And frankly, this is how I Use it. The second way is during a fast as a fasting enhancer. This will help to support appetite control, energy, mood and motivation. And finally you can use it before performance about an hour wherever you need to be on if it's a big presentation or a big meeting for sustained energy flow, state and recovery support. If you want the benefits of fasting without the fasting misery, go to mimeohealth.com better and use code esteema that's my last name at checkout to save 20% off of your first order. That's M I M I O health.com better and use code esteema E S T I M A at checkout mom that's class that was the reaction my son had when he tried Masa chips for the first time and I always know I found a winner when it passes the teenage taste test. Now Masa is a part of a growing movement to bring back real food. You know, the kind our grandparents ate before snacks were made in labs. Masa's chips contain just three organic corn, sea salt and 100% grass fed beef tallow. That's it. No mystery chemicals, just real food. And these chips don't only avoid all the bad stuff, they just taste incredible too. Snacking on Masa chips is nothing like eating regular chips. With Masa you feel satisfied, light and energetic. There's no crash and that gross, bloaty, sluggish feeling afterwards is not there. And because these chips are made with real food, they're more satiating. So you're not going to find yourself in the pantry again uncontrollably bingeing and still feeling hungry afterwards. My personal favorite of Masa is lime and their sister company Vandy Crisps have a herb de Provence chip that will make you proclaim mom that's class. If you are ready to give Masa or Vandy a try, use code better for 25% off your first order at masachhips.com better that's M A S A chips.com better for 25% off your first Order. Second, M is a metabolic function, right? So when we are thinking about the role that muscle has in the body, muscle is the primary site, so the primary site for insulin activity. Okay. It's also the primary site for glucose storage, glucose utilization and fat utilization. So your said another way your blood glucose and your blood lipids are heavily dependent on muscle metabolism and this is why a lot of women in their 30s, not so much 30s, but we see it more in perimenopause. A lot of women will Say, I don't know, what the heck, like doing the same thing, training the same way, eating the same way. And now my fasting blood glucose, like I've gone to do my blood work and my fasting blood glucose is off, my fasting is higher, my fasting insulin levels are higher. And now I'm starting to see my blood lipids go a little bit wonky. So things like your triglycerides and your LDL C number, so your LDL cholesterol number, your LDL particle number, total cholesterol, all of these things start to increase over time. If we are not being strategic with respect to keeping at least preserving the muscle tissue that we have, but ideally adding to it over time. And so muscle has a primary metabolic function and then of course, the last piece, the other last m is a menstrual benefit. Right. So every time that we lift weights, we are going to have a transient but significant rise in testosterone post lift. Depending on how fit you are and how long you've been lifting weights, that's going to look something like, you know, new lifters, you might have up to a 48 hour increase. More seasoned lifters like myself, it's a, it's a bit of a shorter window. So we might have a transient rise of maybe like 10 hours, 12 hours maximally of testosterone. So the fitter you are, the more you need to train, unfortunately, to get that testosterone bump. But newbies and all that newbie gains, you'll be able to sort of have a bump in testosterone that lasts anywhere from 24 to 48 hours after a lift. And so you can kind of see as you're mapping out your training week that you can keep through natural means, your testosterone elevated. Right? If your, if your testosterone's bumped up for two days after you train legs, let's say, you know, you can take the next day off and you're still gonna, you're gonna still profit from that elevated testosterone. And of course, the other benefit in terms of menstrual, if you're still cycling regularly and even if you're not, is that it does, lifting weights does seem to promote a healthy progesterone to estrogen balance, and that's in the second half of the cycle. So we haven't talked about the menstrual cycle quite yet, but if this is your first, you've never heard of the menstrual cycle, you're not tracking it. Basically, in the first half of the cycle, which we call the follicular phase, there's two sort of Main dominant hormones, one is estrogen, and that's an anabolic hormone, helps develop the follicle. And then the other one is testosterone that we mentioned. So testosterone, of course is famous for libido, but it's also really, really important in maintaining muscle mass. And it has other effects like having helping with cognition and clarity of thought and your confidence. Women in perimenopause will often say, like, I used to dominate the boardroom, like I used to walk into meetings and I used to be able to make all of these decisions and now I cannot. I feel like a shell of my former self. And so testosterone is very important for female cognitive function. Second half of the menstrual cycle is called the luteal phase. And then again two main hormones, progesterone and estrogen. So progesterone, I like to think of her, she only shows up once you ovulate. So the requirement for progesterone to show up is that you ovulate, which of course, again, in perimenopause, if you're not ovulating every month, you can see very quickly how you might not have that adequate release of progesterone every month, which is going to help with your anxiety, it's going to help with your sleep. It has many functions in the body. One of the more important things that it does in terms of our PMS regulation, I like to think of progesterone sort of showing up with her uterus ninjas to just beat the crap out of estrogen. She's kind of a bully with estrogen because she will down progesterone will downregulate not only the estrogen receptors in the body, making the body less like the receptors in the body which are throughout, like we have estrogen receptors everywhere, make her less susceptible or less sensitive to circulating estrogen, but also through positive feedback loops, will downregulate the production of estrogen. So I like to think of progesterone sort of showing up almost like she's like a, you know, Muay Thai or something with her other, you know, uterus ninjas and just like beats the crap out of estrogen to keep her in check. Right. In the second half of the cycle, if you are gonna experience any kind of PMS or any, any type of inflammatory if you're feeling inflamed, if you have issues with thyroid, you have issues with your metabolism, et cetera, the second half of the cycle is typically when you are going to start feeling it. Right? And part of the reason why so many women in Perimenopause, at least in those early stages of perimenopause, will report, like raging PMS is because that. That progesterone to estrogen level is not being kept in check in the luteal phase of the cycle. Okay? So that is the training why we need to be training, right? From a physiological perspective, right? So it has a mobility function, metabolic function, menstrual function. The other thing I do want to just mention, and this will be a separate solo episode, so I'll just sort of dangle the carrot for you here, is that in terms of muscle building, women actually need to train differently for men. You know, big, you know, big surprise there, right? It's like we don't want big chest and triceps, right? We want, you know, we want an hourglass figure, right? So we sort of want like a broad, you know, we want that beautiful top of the hourglass with. I always like to say I want glute sized delts, right? I want big ass delts. And I will train until my last day on this planet trying to go after my glute sized delts. And then we want glute sized glutes, right? We want, like, nice. We want like a sort of coming into a thin, thinner waist or a relatively smaller waist and then flaring out with beautiful glutes and hips. And so part of this, I mean, obviously aesthetic, right? Like, we all want to look good in our dresses and, you know, fill them out beautifully. But there's also a. There's also a health span and lifespan consideration here as well. The hourglass figure, right? So, and specifically, when I say hourglass, I'm talking about the waist being smaller than the hips. This is typically. It confers a longevity benefit. So when your waist is smaller than your hips, that is going to be associated with fewer risks, like cardiovascular disease, which number one killer in women. Ladies, it's not breast cancer. It is heart disease, cerebrovascular disease, so stroke and then metabolic diseases like Alzheimer's disease, type 2 diabetes, et cetera. So do you need expense? This is like one of the cheapest. I love this because it's cheap. Low cost to entry. All you need is a tape measure. You're just gonna take a tape measure. You probably have one already lying around in your home somewhere. And you're gonna measure the thinnest part of your waist. Ladies, if you've had babies, this is not where your belly button is anymore. Like myself, my belly button has migrated somewhat south. And so you are going to measure the smallest part of your waist. And then you're going to measure the widest part of your hip. So around sort of the, like the midpoint of the glute usually. And you'll if for most women, this is for me as well. This is right where the hip joint proper is. So it's kind of where the femur meets the, the ilia. So when you're measuring, it's probably right around that sort of bony socket on the side. And then you're going to take those two numbers. It doesn't matter if you do it in centimeters or inches or whatever. Just make sure that both are in the same measurement. And you're going to divide your waist number into your hip number. And the number that you should get is somewhere between 0.7 and 0.8, ideally. So said another way, your waist should be 70 to 80 maximally percent the width of your hips. Now, the other thing I'll say, which is actually interesting, not that we want to talk about the male gaze, but I will say that there have been studies that have asked both women and men. They've shown, you know, women pictures of women, and they've shown men pictures of women, and they've asked them to rate them in terms of their attractiveness. And interestingly, I think this is, I think this is interesting to note. Okay. Not that we're going to change our behavior around it, but it's just an interesting piece of information that may inform how women have such body dysmorphia and how we overemphasize leanness as something that, something to strive for. When they showed women pictures of women, they typically chose women who were thinner, right? They typically chose women who were smaller as the most attractive. Okay, so men, when they were choosing, when they showed the same pictures to men, what men would choose typically is a whim. A woman who, irrespective of size, had an hourglass shape and would get to and, and usually demonstrated that.07 waist to hip ratio. So I thought that that was interesting because what women tend to overemphasize in terms of health is leanness. Right? It's like the skinnier that we can get, the better looking we can become. But that's not at all what men find attractive, you know, irrespective of size. So they chose, you know, you know, quote unquote, bigger women. But as long as those proportions adhere to that 0.7 waist to hip ratio, they were deemed attractive. So I actually really like this because it's less about being skinny, which we've all been sort of. It's all been sort of beaten into our DNA to some degree. It's about your proportions. I really. I really like that. Okay. So I just wanted to sort of throw that in and I'll throw the study in in the show notes as well, if you want to look at it. Okay, so let's actually get into the weight training over the course of the month. And before I get into the specifics of each week, I will say that what overrides everything that I'm about to say is autoregulation. Okay. I want to talk to you about one of the most important molecules in your body to help keep your energy up as you age. I talking about NAD. High NAD levels help our bodies by creating energy, maintaining healthy DNA, and protecting our cellular health. But in our 30s, unfortunately, as young as our 30s, our NAD levels start to plummet. So you need to start supporting your NAD levels now. I absolutely love a formula that just came out within the last year called Qualia Nad. It is so unique because it has all three NAD precursors. So for my nerds, those are niacin, niacinamide, and nicotinamide riboside, which supports NAD production by boosting your NAD levels by up to 50%. It is vegan, non GMO, gluten free. And if you're over the age of 35, if you want to start taking it now, this will be one of the best things that you can do for your aging process. To learn more about how NAD can boost your energy, visit qualialife.com better and use code better to get 15% off. That's Q-U-A-L-I-A L I F E.com better and use code better at checkout. What does that mean? It means that I can tell you in week one, lift this much with this many weights. But if you don't feel like doing that and you feel like going heavier or you have a lot of energy or you're feeling particularly inflamed, you can do whatever the bleep you want. Okay? So you get to check in with yourself and say, how am I feeling today? How did I sleep? What are my stress levels? Like, how is my eating been? Has it been on point? All of these different things that would influence your ability to lift. So this is like a check in. Like I want you to check in before you say, oh, well, Dr. Stephanie says in week one, it should be eight to 12. You know, that might be true. It will be true most of the time. Okay. But there are going to be outliers, as there always are. And in my own life, there are outliers as well. Where in week one, I feel so strong and I feel so good that I push it as hard as I can. And I actually don't adhere to this program, but probably 70 to 80% of the time I am working through what I'm about to explain to you. But I just wanted to put a little asterisk and say if you feel like breaking the rules, you little rebel, you feel free to do so because I do the same thing all the time. Yes. Yes. Okay. Week one. So we are. Everybody knows when they're in week one, right? We're bleeding, right? So we're probably wearing some kind of cup, tampon pad, reusable underwear, something beautiful like that. This is when, you know, we're shedding of the endometrial lining. Bleeding is gonna last anywhere from three to seven days. Hormones are. This is. Obviously there's bio individuality for everyone. A lot of women, and I used to feel this way as well. First couple of days of your period, you kind of feel like crap, right? You sort of feel, ah, just not feeling it, right. Maybe your prostaglandins are particularly high. There's a lot of cramping as the uterine expel, as the uterus expels, the. As the lining. And so what I used to do, I don't do this anymore because I feel like I've really mastered my menstrual cycle. But if you are on that path and you don't feel like working out day one or day two, that's no problem. You can take a. You can totally check in with yourself, right. Autoregulation and say, actually, this is not the day for me. I'm gonna go for walks instead. Right? And when you're walking, a beautiful thing happens. Obviously, walking is great for a variety of reasons. I really feel it's like the unsung hero of cardio exercise. But in terms of pain management, every time you're walking, if you were to look at a 3D model of what's happening in the low back and the sacrum. So the sacrum sort of is nestled in between the hip bones. And in order for you to walk, it sort of has to do this like, 3D figure 8. And so when you're walking, you're gonna be obviously inciting that motion. And that can be very helpful for reducing pain. A lot of women who feel a lot of cramping and a lot of pain, those first couple of days. Walking is a great exercise to reduce low back pain, knee pain, that kind of thing. By day three, estrogen starts to rise right around day three, and it will kind of reach its peak a couple of days later, you know, somewhere around day 10, with the highest levels of estrogen that you will for your whole cycle. But around day three, most women are feeling like themselves again. So if you want, you can start training from day one. I always train kind of all through the cycle. I take days off where necessary. But just a little note, if you're someone who's really crampy, first one or two days walking is completely normal and acceptable and great for you. And then once you're kind of in the flow of things, pun intended. Intended, you can start weight training. So here's the other. Here's the other thing. You know, we talked about auto regulation, checking in with yourself. The other thing I'll say is all month long, you lift heavy, right? So you're lifting heavy within one or two reps of failure. So if you were to, you know, rate it on a scale to, of, you know, one to ten, you might say, yeah, that was like an eight. You know, that was like a seven. Eight or nine or ten out of ten. Okay. That's called RPE or rate of perceived exertion. The other way you can think about it is like, how many reps do I have left? Right? I typically do that. It's like, do I. How many reps do I have left? Probably one, maybe two. But I don't know if I could do two. Like full range of motion, right? So that's sort of how I want you to be lifting all month long. But when we are changing it for week one or week two or week three or week four, we're going to change the, the length of the set and the amount of weights. Because when we have shorter sets, that's going to require higher weights. When we have longer sets, that's going to require lighter weights. But in all cases you're moving, you're going to be lifting one to two reps from failure. And the other thing I'll say is you're going to be doing it in a range of motion that you can own. A range of motion that you can own. Okay? So as a doctor who has worked at restoring range of motion pretty much, you know, almost 20 years, I used to be like, team, full range of motion. If it's not full rom, it's not a rep. However, I have matured as, and maybe I've done it Slower than what I should have. But I would like to actually qualify that by saying it doesn't have to be full range of motion if you don't have that yet. And I say this because most of you, like me, grew up in the cardio section of the gym, right? We were on the elliptical, we were on the bike, we were on the treadmill doing cardio for fat loss. And so we were these cardio bunnies that grew up in that cardio section of the gym. And now I'm asking you to be a muscle mommy. Now I'm asking you to put down the elliptical handles and step over into the, the dumbbell section or the machine section or the, you know, free weight section of the gym. And that can be. There might not be the range of motion there, right? You might not have the range of motion in your spine or your hips or your knees or your ankle mobility might not be on point, or your shoulder mobility might not be there. Or, you know, if you're 40, 45, 50, 55, you might be dealing with an arthrotide, you might have osteopenia, you might have rheumatoid arthritis, you might be dealing with psoriatic arthritis, like some of these different arthrotides that basically destroy joints. And so if you are someone who a doesn't have the range of full range of motion because you're a cardio bunny, you know, formerly known as a card cardio bunny, and now you identify as a muscle mommy or you're dealing with an arthrotide, your primary job in both cases is going to be moving through a, a range of motion that is pain free and, you know, in that maximal range of motion for you. And then with time, you want to be thinking about increasing the range of motion. So I'm gonna do solos on the arthrotides on each one because they're so complex. You know, rheumatoid arthritis is its own beast. Psoriatic arthritis is its own beast. Osteoarthritis is its own beast. So I'll talk about each of the different considerations, but one of the through lines for all of them is maintaining range of motion. I'll say that heavy weight is less important for someone with OA or RA or PA or whatever than it is preserving the range of motion in the joint. So I'll say that. So all month long, we're lifting heavy all. If you don't have an arthrotite, okay, but you're going to one to two reps of failure, irrespective of the. Of the set size, and you're doing it in a range of motion that you can own. Okay, those two qualifiers out of the way. Let's get back to week one. I typically like a moderate rep range here, so 8 to 12 is what I really love. I wrote about this in the book. So you're going to train heavy, somewhere between 8 and 12 reps. So for me, what that looks like in week one, I'm typically. I typically choose about 10. I don't know why I just always settle on 10 in week one. It just feels right. But you can play and see what works well for you. I love to train at about 10. So if I did 11, I could probably punch it out. I could probably do one more. If I did 11 and 12 would be like, that's my limit, you know. And then at that point, I'm starting to make compensations in order to move the weight. All right, that's week one. In week two, this is. By the way, I don't know if I've said this before, but week two is my favorite week. I love week two. It almost feels so great in week two. This is week two for me, actually, as I'm recording this. So week two is really awesome because we have those two anabolic hormones peaking, right? We have estrogen and testosterone peaking. So in terms of outcomes for women, the other thing that I like to work on is strength and power. So obviously muscle hypertrophy, like muscle growth, should be a goal of yours if you're looking to optimize your cycle. You know, look good in the dress, avoid cerebrovascular cardiovascular diseases, metabolic diseases, et cetera. And we also want to be thinking about power and we want to be thinking about strength. And often the two are corollary with each other. So when you have someone with a lot of muscle, they're obviously usually very strong, but they're actually different outcomes in terms of training and sport. So when we are thinking about strength, we are thinking more about lifting as heavy as you can. This is one way to do it. Lifting as heavy as you can with as with the heaviest weight that you can for about five reps. Okay. Still builds muscle, right? So this is still within, you know, the literature is very clear on what is adequate set sizes for hypertrophy. Muscle hypertrophy, it's somewhere between five and 30 sets. So you can see that there's a big range there that you can sort of choose from based on your mood and based on your sleeping and when you're audio regulating and where you are in your menstrual cycle. But in terms of strength, we want to lift as much as we can somewhere between five and seven sets. If we actually borrow a little bit from the powerlifting world, they will actually do like one or, or two reps, right? This is like their one rep maximum or they'll do a double, right? So they'll do two reps of, of, of the heaviest weight that they can. Now, I'm not asking you to do doubles, I'm not asking you to do the one rep max, but I think somewhere between five and seven is a really nice compromise because you're still punching out, you're in that rep range that's going to build muscle, but you're also going to be developing that power, right, that strength outcome that we're looking at. So I, I really love that. And this is the week as well, because you're essentially firing on all cylinders from a, from a, you know, hormone aspect. Your coordination is better, your, your ability to recruit the mo, the, the motor unit like you, you'll, you'll be able to recruit more muscle. Your recovery is augmented so you're able to recover faster. And then you're just your balance, your coordination, your mental clarity, you know, it takes to lift a set. To have a set of five, you need to have a certain, you need to be in a certain, you know, mindset. Like you need to be in sort of a, you need to be able to initiate a certain psych, you know, you have to sort of psych yourself up for five, sometimes more so than I would say like a 15 rep set because the lights are, the weights are much lighter. So I really love week two to really push for this. If you're feeling like you have a lot of energy, that's completely the week to do so. And now I'll just be a rule breaker because, because I can. There are some women who, around ovulation actually feel quite tired. Instead of having all this energy and all this motor coordination and everything, they can experience something called middlesmerch, which is a German word for if you break it down, it means pain in the middle. By the way, the Germans always have the best words for everything. Schadenfreude is one of my favorite German words. This is not related to your menstrual cycle, by the way, but it just means, it means taking pleasure in someone else's pain. And of course the Germans would find this beautiful way to express this very natural, very common, not only exclusive to Germans, you know, feeling you know, anytime, if you've ever been on the highway or the freeway and you're going, and there's no traffic on the freeway, and then you look to the, you know, oncoming traffic or traffic going the other way, and you see that there's, you know, traffic jams, and you're like, huh, that's schadenfreude. Okay, so anyway, back to middle smirch. And I apologize for. To the Germans that are listening, my accent is terrible. But mittelsmirch means pain in the middle. And so there can be some cramping. Right? I actually, you're gonna probably think I'm a freak, but I can feel when I'm ovulating, I know which. I know which ovary it is. It's always like, oh, left one. Oh, right one. You know, I just know which one because one of them starts cramping. I could just. I just feel. I just feel it. So that's sort of. I would be on that spectrum as well. Like, I feel some pain. There's, like some pain when I ovulate. So if that's you, if you're feeling like, gosh, she's saying I should have all this energy, and I just feel like crap. I promise that is a normal outcome. There's nothing wrong with you. Some women are just. They have more of that interoception, meaning that you can kind of scan your internal environment and you can feel maybe your organs more so than, you know, maybe the. The general population. That doesn't mean that you shouldn't go for power. Right. And you shouldn't train. But if you are feeling like you don't have as much energy, then you might also consider like an 8 to rep range there, too, if you have a lot of pain surrounding ovulation. Okay, all right, week three. So now we ovulate, right? And the ovulation is sort of the middle. It sort of separates the two phases of the menstrual cycle. It ends the follicular phase. Now the follicle becomes a corpus luteum, or the artist, formerly known as the follicle. And that. That ovulation sets off the luteal phase. And for women in the luteal phase or luteal phase, she can feel it can. It can be a time where we don't feel our best. Right. If you're going to feel inflamed at all over the course of the cycle, it's probably going to happen in these last, you know, 12 to 16 days. And so what can happen for women is they can feel like decreased sex drive. Right. Week two, with testosterone peaking, you're probably more receptive to sex, probably more interested in sex. Your climaxes are probably stronger. You know, clitoral sensitivity is also heightened. But after testosterone kind of drops off a little bit and we ovulate, some women can notice a decrease in their sex drive. They can notice water retention. That's very common where you're. You feel more bloated, let's say breast swelling and tenderness. I wrote about this in the Betty Body. I always felt like my breasts were angry at me for like, two weeks out of every month. If you are over the age of 35, you know, you're 35, 45, you know, in your early 50s. You may also notice fibrocystic breasts. Maybe if you're doing mammograms, you've been told that you have dense breasts. Like, they'll sort of grade your breasts like A, B, C, D, E, F, G, et cetera. And you may be in the D, E, F, G, you know, kind of category. Or you might even when you're doing a breast examination, you might notice that your breasts are a little bit more lumpy again. That's because of progesterone not bringing in as many uterus ninjas and not beating the crap out of estrogen. So estrogen's running a bit of muck there. Headaches you can experience. I experienced headaches for years. I felt like I had migraines every single day in the, you know, five or six days leading up to my. My period. You know, Mood swings might be your form of cardio. I say that because. I say that because it's true. You know, it's like your mood swings are your form of cardio in the luteal phase. And then you might find, like, cold hands and feet, which is usually. That can be a symptom of thyroid dysfunction, hair loss, foggy thinking, memory loss, fatigue, trouble sleeping, all the things. Right. So we're not quite as on generally in terms of, like, our hormones like testosterone and estrogen sort of drop off a little bit, especially in week three. They come back. Or estrogen, I should say, comes back for. For seconds, sort of middle of week three to middle of week four. But here I actually, I revert back to that week one protocol, which is like eight to 12 reps, as heavy as you can do it within one to two reps of muscle failure in a range of motion that you can own. Right. This is a time for you actually, all through the cycle, all. All month Long, but particularly weeks one and week three, you can, instead of worrying about like the heaviest weight that you can lift, like you might be doing in week two, you focus in on your form and your technique. And you should, should really be doing this all month long, all the time, especially if you want to preserve your longevity in the sport. If you want to be someone who's lift weight, lifting weights for a long time, as I do, you don't want to get injured. So, you know, really dialing in your form and your technique, this reduces the, you know, the risk of injury. And it also accommodates like a longer rep range is going to accommodate for that loss and kind of strengthen that ability to really recruit the motor unit. It. But you're still approximating failure, as I said, within one to maybe three reps of failure in a range of motion that you can own in week four. I typically, I still run hot, man. Like my, I'm wearing my URA ring now and not to just knock on ura. I've actually reached out to them and asked them to modify their algorithm, and I think that they have. I think it's not just me who's, who's facilitated that change, but so many. I always get dinged. Like whenever I look at my readiness score, it's like twice a month I get dinged, right? So when I ovulate, I'm warmer. And then, you know, the week four, I'm usually warmer because progesterone's peaking that week. So it's like, are you okay, girl? Is everything okay? It's like, yeah, I'm okay. I, I get warm twice a month for, on repeat until I'm in menopause, you know, but for women who are feeling warmer, they're feeling, you know, all the, all the symptoms that I just described, the water retention, the brain fog, them, mood, mood swings as your form of cardio and sleep disturbances, et cetera, you're typically more inflamed. And so I like to elongate the set even more here. Okay, so I like a lighter weight because you're not as coordinated, you're generally feeling less amazing. And so I like a longer set. So 15 to 20 you can do, you can do up to 30. Like, you know, 30 is a really long set, guys. I don't like, I really do not like 30. I find that it is, it's very hard to get through 30 reps, but 20 I can do. And then maybe if I get to 20 and then I can't do any full, full range. I'll do like a long length partial. Like I'll do sort of partial reps for another five to ten just to like, kind of squeeze out the juice, whatever I have left. But 15 to 20, really great. And then you, maybe you can finish off the muscle by doing, you know, partials, long length partials, which will be another, another solo as well. I've written about it in the Mini Paws, but I do want to do kind of a bigger Nerdy dive into LLPs and how they stack up with range of motion. Okay, back to, back to my comment around inflammation. In week four, we are typically more inflamed. So generally a good strategy is to contract the muscle as often as you can. Right. So long walks are really great, but also longer sets in the gym when you're doing your resistance training, because that's going to release more myokines. These are the, they're the cytokines essentially that are, that originate in the muscle. So they're called myokines. It's a subset of the immune system. And these cross a blood brain barrier. They reduce systemic inflammation, they improve your mood, which tends to be generally lower if you're someone who suffer, you know, suffers from PMS in the luteal phase of the cycle. So it does activate areas of the brain that are involved in happiness, in hope. They're actually called the mol. They're often nicknamed the molecules of hope. And if you've ever had, in the luteal phase or otherwise, if you've ever gone into the gym and you just, you're hating everyone, you know, it's like your husband's chewing too loud, your kids are getting on your nerves, you hate your job, you don't even know what the point of life is. And then you, you lift some weights, you're like, faith and humanity are restored. You know, those are your myokines, right? Those are the myokines crossing the blood brain barrier and activating areas that I feel are uniquely human, which is hope. Right. I think that's a uniquely human quality, which I don't believe AI or anything else can ever replicate. So, so there you go. So week three, week four, still going to close to failure, right? But 15 to 20 reps, and then if you, if you feel, still feel like you got some left, you can do some partials to, to failure up to 30 reps or so. But if you're able to get to 30, that means that you're like, your weight's probably a little light, so you can, can, you can probably jack that up. A little bit. So that's how I like to think about training over the cycle. And that's if you're regular, right? So if you're irregular, if you're someone who's like, well, I'm 49 and I kind of get my period here and there, I don't know where I am, then you can certainly still follow this cadence, right? 8 to 12, 5 to 7, 8 to 12, 15 to 20. You can certainly still follow that because the principles in each week, week are consistent, right? It's like you're going one to two reps, three maximally from muscle failure in a range of motion that you can own. So you're still driving hypertrophy. So that's one option for you. The other option is just to auto regulate, right? It's like I wake up today and I feel like I have a lot of energy or I feel like I don't have a lot of energy. And therefore I will take one of these rep range sets and apply it to my workout today. And you can really just every day sort of figure out how you're feeling and then you can apply that. You know, based on, as I mentioned a couple times already, like your stress levels, how you slept last night, what your food has been like, what your recovery practices have been like, maybe you just need a day off. You know, women in our 40s and 50s and beyond, we need to really become recovery, like maximizers at recovery. We can no longer just hit the gym and do glutes eight days a week, right? We have to be thinking about doing legs and then allowing for appropriate recovery and then getting back and doing back or shoulders or whatever it is that we're training. So that's how I would apply. And that's how I, I still, I still sort of pair my workouts with my cycle because my cycle is still very regular at 46, 20, you know, it's 28 and a half days on the dot at this point. However, there are days where I break that pattern, as I mentioned, right? So there's days where I'll wake up and I'm supposed to feel, you know, if I'm, you know, if I'm week three, let's say. And like, I'm supposed to feel like, you know, I can't lift as heavy, but I really, I wake up and I'm like, gosh, I slept like a boss last night. I am going to really push it. I'm going to do that five. I'm going to go for five. Like, I'll do that. So it's like follow the pattern and also be willing to break it. So that's what I wanted to talk to you about, about training, certainly across the cycle and some perimenopausal considerations as well. So I hope that you enjoyed today's solo. Let us know how we did, let me know how I can improve, and we will see you next time. All right? All right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for general information only and the advice recommendations we discuss do not replace medicine, chiropractic or any other primary healthcare provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor and these conversations are meant for educational purposes only.