Perimenopause Metabolism and Hormone Health: Nutrition, Sleep & HRT Insights for Midlife Women

When Long-Term Ketosis Meets Perimenopause

For more than five years, I lived in ketosis — truly therapeutic ketosis, eating fewer than 10 grams of carbohydrates per day. This approach transformed my digestion, skin, energy, and mental clarity.

But when perimenopause arrived in my early fifties, my physiology began shifting in subtle yet important ways. What had worked beautifully for years no longer supported the energetic, stable, resilient metabolism I wanted to maintain.

This is the story of how I adjusted my nutrition, supported my hormones, improved my metabolic markers, and found a more balanced approach to midlife health — all without abandoning the principles of metabolic therapy. health

The First Signs That My Body Needed Something Different perimenopause metabolism and hormone health

Even though I was still active, strong, and consistent with my lifestyle habits, I began noticing some changes in my health:

• Lighter sleep and early waking

• Feeling slightly “wired” without an obvious stressor

• Fasting glucose rising from 4.3 to 5.2 mmol/L

• LDL and total cholesterol increasing significantly

These weren’t failures of the ketogenic diet — hey were signals of a shifting hormonal landscape. Perimenopause had quietly re‑written my metabolic operating system.

Perimenopause, Metabolism & the Hidden Energy Deficit

Long‑term therapeutic ketosis had made my metabolism remarkably efficient — perhaps too efficient. As estrogen fluctuated, progesterone declined, and cortisol reactivity increased, that efficiency began working against me. I realized I was training and recovering in a low‑fuel state — not from lack of discipline, but from biology itself. It wasn’t burnout; it was a quiet, chronic energy deficit.

During perimenopause, shifting hormones reshape how the body accesses fuel:

• Estrogen enhances insulin sensitivity and helps muscles take up and store glucose as glycogen. When it fluctuates, those processes become less predictable — leading to blood‑sugar swings or reduced glycogen availability.

• Progesterone supports thyroid function and influences how we convert stored fat into usable energy. As it declines, resting metabolism can slow, making under‑fueling more taxing than before.

• Cortisol, the body’s stress hormone, becomes more dominant and reactive. Chronically low carbohydrate intake or excessive training can drive it even higher, deepening physiological tension and that “running on empty” feeling.

It wasn’t that my body suddenly needed a high‑carb diet — it needed flexibility. Metabolic adaptability keeps energy steady, muscles responsive, and mood grounded. My physiology needed:

• a bit more glycogen for strength and recovery

• moderate carbohydrates for nervous‑system steadiness and sleep quality

• enough total calories to align with the new hormonal rhythm

So I began eating with more intention, data, and compassion — fueling my midlife physiology rather than fighting it.

Evolving My Keto Approach: More Carbs, Same Quality Nutrition

I didn’t leave my diet — I personalized it. perimenopause metabolism and hormone health

I gradually increased carbohydrates to 80–150 grams per day, sourced from:

• fruits

• root vegetables

• squashes

• chestnuts

• raw honey

• high-quality dairy

I increased my protein and naturally reduced fat. Most carbs shifted to lunch and the evening meal to support:

• deeper sleep

• calming of the nervous system

• serotonin–melatonin production

• improved recovery from training

My calorie intake stayed steady, and my food quality remained high: whole, minimally processed, nutrient‑dense.

The Results

Stronger Workouts & Consistent Energy

Training felt powerful again. I no longer experienced post‑exercise restlessness or sudden fatigue.

Restored Sleep Quality

Nights became deeper and longer. My HRV improved by more than 10 points — a tangible marker of better autonomic balance.

Improved Metabolic Markers

• Average glucose ≈ 4.6 mmol/L

• Fasting glucose 4.2–4.3 mmol/L

• Post‑meal peaks mild and short‑lived

• LDL and total cholesterol normalized — nearly 50 % lower than before — stabilizing within a healthy range without medication or supplementation.

All this occurred while I was in late perimenopause — with fluctuating estrogen, low progesterone, and low testosterone — without HRT or supplements.

Where HRT Fits In — And Why It’s Not a Magic Pill

As a specialist in perimenopause, menopause, and metabolic health, I view hormone replacement therapy (HRT) as a powerful, evidence‑based tool. I am in favor of HRT when it is appropriate and individualized.

HRT can support:

• symptom relief

• sleep quality

• bone integrity

• cognitive and mood health

• cardiovascular protection

• muscle maintenance

• metabolic stability

But here’s the nuance: “Just start HRT — it will fix everything” is misleading.

HRT cannot replace the fundamentals:

• poor nutrition

• chronic stress

• unstable blood sugar

• under‑ or over‑eating

• lack of movement or excessive training

• insufficient sleep

• absence of meaningful connection

HRT works best on top of a well‑fed, well‑supported nervous system, not instead of it.

Fix the foundations first. Then, if chosen, HRT amplifies results rather than compensating for depletion.

The Missing Hormone: Oxytocin — A Metabolic Ally in Midlife

During the menopausal transition, one of the most impactful aspects of my rebalancing wasn’t merely biochemical — it was relational. Yet, those relationships did create real biochemical change. perimenopause metabolism and hormone health

Perimenopause heightens the sensitivity of the stress response system. With estrogen fluctuations and declining progesterone, the hypothalamic–pituitary–adrenal (HPA) axis becomes more reactive, allowing cortisol to dominate more easily.

Here’s where oxytocin — often called the bonding or connection hormone — becomes a crucial metabolic and emotional ally. Oxytocin is released from the posterior pituitary, but its effects extend throughout the entire body: it modulates stress circuitry, improves vagal tone, and counterbalances cortisol.

Seemingly simple moments evoke measurable physiological shifts:

• affectionate touch

• being held

• shared laughter

• sleeping beside a trusted partner

• eye contact, empathy, and emotional presence

These relational cues stimulate oxytocin release, which can, in turn:

• buffer the cortisol response to stress

• enhance parasympathetic nervous system activity (raising HRV)

• improve sleep regulation

• stabilize glucose metabolism by improving insulin sensitivity

• reduce blood pressure and ease internal muscular tension

Oxytocin doesn’t just make us feel connected — it literally shifts physiology toward repair, rest, and regeneration. It dampens the biochemical stress cascade (HPA overactivation), supports metabolic balance, and reinforces emotional stability.

Oxytocin is not “soft” or optional; it’s a biological necessity — particularly in midlife, when hormonal transitions can disrupt the delicate crosstalk between the endocrine, nervous, and emotional systems.

Connection is chemistry, too.

Key Lessons for Women Navigating Perimenopause & Menopause

1. Your body changes — your nutrition should adapt.

What worked at 40 may not work at 50.

2. The ketogenic diet is powerful, but not static.

Therapeutic ketosis often needs evolution in midlife (depending on other health paramteres, potential chronic diseases), by weighing risks and benefits.

3. Movement is essential — but only when properly fueled.

Match training intensity with recovery and nourishment.

4. Oxytocin is metabolic.

Connection is a hormone strategy, not emotional fluff.

5. HRT can be life-changing, but it is not your foundation.

Lifestyle, nutrition, and emotional wellbeing come first.

6. Data + intuition = clarity.

CGM trends, HRV, bloodwork, and your lived experience guide the way.

A Message to Women in Midlife

If your once-perfect routine stops working, you have not failed.Your body is simply asking for an updated strategy.

Perimenopause is not the end of vitality — it’s the re‑definition of it. Support that re‑definition with:

• real food

• balanced fuel

• strength and movement

• quality sleep

• connection and oxytocin

• and, if appropriate, individualized HRT

When nourishment, hormones, nervous‑system regulation, and connection align, midlife becomes not a decline — but an era of powerful metabolic intelligence.

References

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3. Lee H. The Yin and Yang of the Oxytocin and Stress Systems. Frontiers in Endocrinology. (2024).https://www.frontiersin.org/articles/10.3389/fendo.2024.1272270DOI: 10.3389/fendo.2024.1272270

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7. Endocrine Reviews. The Oxytocin System: Energy Homeostasis, Bone Health, and Well-Being. (2025).https://academic.oup.com/edrv/article/46/4/518/8030228DOI: 10.1210/endrev/bnad012

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9. Tang C, et al. Sleep Disturbances During the Menopausal Transition and Cardiometabolic Health. Healthcare (MDPI). (2025).(Same issue, complementary analysis).https://www.mdpi.com/2227-9032/13/17/2085

10. Contemporary OB/GYN. Hormone Therapy Associated With Reduced Insulin Resistance in Menopausal Women.(2024).https://www.contemporaryobgyn.net/view/hormone-therapy-associated-with-reduced-insulin-resistance

11. Moriyama T, et al. Effects of Resistance Training on Strength, Sleep Quality, and Vasomotor Symptoms in Perimenopausal Women. Menopause. (2024).https://journals.lww.com/menopausejournal/Fulltext/2024/03000/Effects_of_resistance_training_on_strength,_sleep,.9.aspxDOI: 10.1097/GME.0000000000002164

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