← The Peter Attia Drive

#378 ‒ Women's health and performance: how training, nutrition, and hormones interact across life stages | Abbie Smith-Ryan, Ph.D.

Jan 5, 2026 2h 11m 54 insights
<p><a href="https://peterattiamd.com/abbiesmithryan/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=260105-pod-abbiesmithryan&amp;utm_content=260105-pod-abbiesmithryan-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&amp;%20abbiesmithryan%20=referral&amp;utm_campaign=260105-pod-abbiesmithryan&amp;utm_content=260105-pod-abbiesmithryan-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=260105-pod-abbiesmithryan&amp;utm_content=260105-pod-abbiesmithryan-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Abbie Smith-Ryan is a leading researcher in exercise physiology whose work focuses on how training and nutrition influence body composition, metabolism, cardiovascular health, and women's health across the lifespan, with particular attention on perimenopause and post-menopause. In this episode, Abbie explains how early exercise and play help build the foundation for bone health, muscle development, and cardiorespiratory fitness in girls, as well as how puberty and menstruation shape athletic performance, motivation, and recovery. She also explores how women can tailor training and nutrition across the menstrual cycle through smart fueling, hydration, and inflammation management; examines the evidence behind supplements such as creatine, omega-3s, and magnesium; and unpacks the metabolic and body composition changes that accompany the transition into perimenopause and menopause. Finally, she covers practical exercise programming for busy women, training and nutrition considerations during pregnancy and postpartum, and the evolving role of hormone therapy alongside lifestyle-based, evidence-driven approaches that help women better advocate for their health.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>Abbie's background in distance running and her interest in studying women's health around exercise [3:00];</li> <li>The role of early-life exercise in building lifelong bone, muscle, and cardiovascular health in girls [4:00];</li> <li>Training principles for premenstrual girls, the risks of early specialization and delayed puberty from intense training, and how youth sport participation can shape bone and spinal health [7:15];</li> <li>Nutrition as fuel in young female athletes: supporting training, growth, and performance [11:00];</li> <li>Training and recovery across the menstrual cycle: recovery, nutrition, supplements, and practical strategies for performance support [16:00];</li> <li>The benefits of creatine supplementation and importance of protein intake across the menstrual cycle [27:15];</li> <li>How women should approach training intensity and volume across the menstrual cycle [33:00];</li> <li>How to identify and monitor the perimenopausal transition and why this phase represents a critical window for exercise and nutrition interventions [37:15];</li> <li>Case study: time-efficient exercise program for a busy, perimenopausal woman [42:00];</li> <li>Why improving body composition is a better goal than weight loss, and how to set realistic fat-loss targets in midlife women [53:30];</li> <li>How to preserve muscle and bone while using GLP-1 medications: resistance training, protein intake, and more [58:15];</li> <li>Designing a three-hour-per-week training plan for sustainable body recomposition [1:03:30];</li> <li>Abbie's insights from her 20+ years of self-tracking: nutrient timing, injury prevention, excessive training, bone health, and more [1:07:15];</li> <li>How pregnancy and the postpartum period affect body composition, and how consistent exercise and intentional nutrition can prevent a permanent shift in body fat or muscle mass [1:13:30];</li> <li>Changes in muscle quality and metabolic flexibility during perimenopause and menopause, and how exercise may counteract hormonally driven sarcopenia [1:21:45];</li> <li>The biggest open questions about women's health: combining menopause hormone therapy with exercise, GLP-1 drugs, minimizing injury risk, and more [1:32:00];</li> <li>How the training response differs between men and women, and the importance of type IIa muscle fibers [1:39:15];</li> <li>Training advice for the hypothetical 70-year-old woman who has never exercised deliberately [1:47:00];</li> <li>Misinformation about exercise and nutrition for women, injury risk, supplement hype, and the need for more nuanced messaging around hormones, recovery, and midlife training [1:53:30];</li> <li>Benefits of hormone therapy in midlife women and its interaction with exercise and lifestyle interventions [2:00:15];</li> <li>Peter's overall take on how women should approach exercise volume and intensity at various life phases and time constraints [2:03:00]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights

1. Start Exercise Early

Begin exercising early in life, treating it initially as play and gradually transitioning into various types of exercise, as this builds a strong foundation that makes it easier to maintain fitness throughout life.

2. Diversify Youth Sports

Encourage young girls to participate in a variety of different sports rather than specializing early, as this helps accelerate the development of diverse muscles and movement patterns.

3. Resistance Train for Injury Prevention

Incorporate total body resistance training (e.g., with bands, lightweights, plyometrics, or medicine balls) for young girls to prevent injuries, a crucial aspect often overlooked by coaches.

4. Prioritize Perimenopause Lifestyle Changes

Actively implement lifestyle behavior changes in exercise and nutrition during the perimenopause window (late 30s to 50s), as this period significantly impacts metabolism, muscle, bone, and fat distribution, with lifelong health benefits.

5. Focus on Body Recomposition, Not Just Weight

Aim for body recomposition (losing fat and gaining muscle) rather than solely focusing on weight loss, as weight may not change or even increase while overall health and body composition improve.

6. Prioritize Resistance Training with GLP-1 Agonists

If using GLP-1 agonists for weight loss, absolutely prioritize resistance training to maintain lean mass and improve muscle quality, as these drugs can accelerate muscle and bone loss if not managed proactively.

7. Maintain High Protein Intake with GLP-1 Agonists

When on GLP-1 agonists, target a high protein intake (e.g., 130-150 grams/day for a 150lb woman) and consistently consume protein (e.g., 30 grams evenly spaced throughout the day) to preserve muscle and optimize amino acid availability around workouts.

8. Track Menstrual Cycle for Empowerment

Monitor your bleeding patterns and hormonal changes (e.g., using at-home urine analyses) to understand what is normal for your body, identify when changes occur, and feel empowered to address any issues.

9. Adapt Recovery to Menstrual Cycle Phase

While women can train at any point in their menstrual cycle, be aware that performance and recovery may be impacted during certain phases (e.g., luteal phase), requiring more focus on recovery strategies and self-grace.

10. Utilize Omega-3s for Luteal Phase Inflammation

During the luteal phase, if experiencing severe inflammation or heightened anxiety/depression, consider increasing omega-3 intake (2-3 grams) to help down-regulate inflammation.

11. Supplement with Zinc and Magnesium

Consider supplementing with zinc and magnesium, particularly during the luteal phase, to assist with vasodilation, improve sleep, and support overall recovery.

12. Use Creatine for Fluid Management and Performance

Creatine (load with 20g/day for 5 days, then 5-10g/day maintenance) can help pull extracellular fluid into cells, potentially reducing bloating in the luteal phase and supporting performance.

13. Consider Caffeine for Luteal Phase Fatigue

Caffeine might be more effective in combating increased fatigue experienced during the luteal phase of the menstrual cycle.

14. Prioritize Consistent Protein Intake

Aim for adequate protein intake (around 1.6 g/kg or 1 g/lb of goal weight) consistently throughout the day, especially around workouts, to support muscle protein synthesis and recovery, particularly for aging muscle.

15. Eat Regularly to Maintain Amino Acid Levels

Avoid long gaps between meals without protein consumption to maintain a steady supply of amino acids in the bloodstream, which is crucial for muscle maintenance and overall metabolic health.

16. Get Regular Blood Work for Hormonal Changes

Starting in your 30s, get regular blood work (e.g., Day 5 FSH) to monitor hormonal changes as you approach perimenopause, providing individual baseline data for proactive health management.

17. Prioritize Consistency and Intensity (Limited Time)

For busy women with limited exercise time (e.g., 3 hours/week), prioritize consistency and intensity over high volume to achieve health benefits and improvements in cardiovascular fitness more quickly.

18. Integrate Exercise Snacks

Utilize ’exercise snacks’ – short periods of higher intensity training – to fit effective physical activity into busy schedules.

19. Prioritize Whole Body Resistance Training

For general midlife women, prioritize a few days a week of whole-body progressive resistance training (e.g., two 30-minute sessions at 60-80% of one-rep max, 6-8 reps, with 30-second rests between exercises).

20. Include Aerobic Exercise with HIIT

Alongside resistance training, incorporate two to three days of aerobic exercise, ensuring at least one (ideally two) high-intensity interval training (HIIT) sessions per week.

21. Structure HIIT Sessions Effectively

For HIIT, consider performing up to 10 sets of one minute on (at 90-110% of max effort, where you couldn’t sustain for 1:20) followed by one minute off, which can be completed in approximately 20 minutes total.

22. Set Realistic Weight Goals

When aiming for weight loss, set realistic goals based on body composition measurements (e.g., targeting a healthy body fat percentage) rather than arbitrary past weights that might necessitate unhealthy muscle loss.

23. Combine Calorie Deficit with Nutrient-Dense Foods

To lose fat, create a slight calorie deficit while prioritizing nutrient-dense foods such as fiber (for satiety), adequate protein, and complex carbohydrates.

24. Avoid Chronic Time Restriction

Be cautious with chronic time-restricted eating, as it can lower metabolism, negatively impact hunger hormones, and adversely affect protein synthesis and muscle in women, especially in midlife.

25. Eat Consistently for Leanness

To achieve and maintain leanness, prioritize eating more whole foods consistently throughout the day (e.g., 30 grams of protein, fiber, and vegetables evenly spaced) to stimulate metabolism and ensure sufficient macro/micronutrient intake.

26. Understand Personal Body Fat Set Point

Know your individual body fat set point, as going below it can increase your susceptibility to injuries like stress fractures, even if the percentage appears ’normal’ by general standards.

27. Address Under-Consumption Signs

Recognize signs of under-consumption, such as severe gastrointestinal distress or extended periods without eating, particularly in relation to training schedules.

28. Train for Birth as an Athletic Event

During pregnancy, treat birth as an athletic event and train for it by exercising consistently, prioritizing resistance training (e.g., squats, lats) up until delivery, and slowly increasing calories for a slight surplus.

29. Resume Exercise Gradually Postpartum

After natural delivery, start walking within a couple of days and light resistance training within a couple of weeks, gradually returning to normal exercise routines.

30. Prioritize Plant-Based Proteins During Pregnancy

If experiencing aversions to animal proteins during pregnancy, prioritize plant-based proteins to ensure adequate nutritional intake for both mother and baby.

31. Address Postpartum GI Distress and Hydration

Be aware of potential postpartum gastrointestinal distress (e.g., lactose intolerance) and prioritize liquid foods, protein shakes, omega-3, and creatine to aid recovery and maintain nutrition while nursing and managing sleep deprivation.

32. Prioritize Pregnancy Nutrition for Baby’s Development

Make nutrition a key priority during pregnancy, focusing on a variety of fruits and vegetables to support the baby’s neural development and gut health.

33. Exercise During Pregnancy

Exercise is crucial during pregnancy; if you haven’t exercised before, start with something, and if you’ve always exercised, continue, as current guidance supports this for better maternal and fetal outcomes.

34. Counter Sarcopenia with Resistance Training

Engage in consistent resistance training to combat sarcopenia, which disproportionately affects women, especially as muscle quality changes significantly during perimenopause.

35. Maintain Muscle Quality in Perimenopause

Focus on lifestyle changes, including exercise and nutrition, during perimenopause to maintain muscle size and quality, as this period is critical for preventing significant declines in muscle quality.

36. Exercise for Metabolic Flexibility

Regular exercise, particularly high-intensity interval training (HIIT), enhances metabolic flexibility, stimulating fat oxidation regardless of hormonal status or age.

37. Optimize Protein for Metabolic Flexibility

Consuming protein around training (as opposed to primarily carbohydrates) or opting for lower glycemic index carbohydrates can help optimize metabolic flexibility post-high-intensity workouts.

38. Combine Hormones and Lifestyle for Best Outcomes

If using hormone replacement therapy, combine it with lifestyle behaviors (exercise and nutrition) for synergistic benefits in relieving symptoms and improving overall health, as lifestyle changes are still crucial.

39. Exercise is Better Than Nothing

Avoid rigid, black-and-white thinking about exercise; doing any form of physical activity is always better than doing nothing, and women should be empowered to engage in activities they enjoy.

40. Apply Strength & Conditioning Principles

Leverage traditional strength and conditioning research (even if primarily based on male subjects) for women, as the female muscle responds similarly, with modifications for recovery, rest, or joint pain as needed.

41. Prioritize Power Training for Fall Prevention

Actively work to preserve power (e.g., through jumping, bouncing, or controlled explosive movements) at all ages, as it is crucial for regaining footing and preventing falls in daily life.

42. Address Joint Pain with Hormones

For perimenopausal and menopausal women experiencing joint pain, consider if hormone replacement therapy could be a solution, as pain can significantly impede the ability to train effectively.

43. It’s Never Too Late to Start Exercising

Regardless of age (e.g., 65-70 years old), it is never too late to begin an exercise routine; you can gain strength and muscle at any age, thereby taking control of your health span.

44. Hire a Personal Trainer for Older Adults

For older adults new to exercise, it is highly recommended to hire a personal trainer (seeking referrals and checking credentials) to teach proper form, safe progression, and build confidence.

45. Start Older Adults with Total Body Resistance

For older adults, begin with a total body resistance program focusing on glute activation, push-pull exercises for all major muscle groups, and calf work to improve stability and prevent falls.

46. Use Machines Initially for Older Adults

Start older adults with machine-based, controlled resistance training rather than free weights, and incorporate resistance bands for neuromuscular activation (e.g., glutes) to build foundational strength.

47. Aim for 3 Days/Week Resistance Training (Older Adults)

For older adults, aim for three days a week of resistance training (e.g., every other day to allow for recovery) and some form of movement or aerobic exercise on most other days.

48. Introduce Carries and Grip Strength Gradually

For older adults, once able to perform exercises deloaded safely, introduce low-resistance carries (e.g., with dumbbells) and grip strength exercises, using submaximal efforts (e.g., 1 minute on, 1 minute off).

49. Exercise for Mental Health

Recognize the profound positive impact of both resistance and aerobic exercise on mental health, including reducing anxiety, depression, and brain fog, and improving focus.

50. Be Wary of Black-and-White Rules

Be cautious of rigid, black-and-white rules about exercise or nutrition (e.g., ‘only do this,’ ’never do that’), as individual needs vary, and consistency is often more important than strict adherence to a single method.

51. Understand Supplement Limitations

While supplements like creatine can be helpful, understand they are not magical solutions and should not be the first priority, especially for midlife women; prioritize effective training and nutrition first.

52. Advocate for Your Health

Women should actively advocate for themselves, be informed about what symptoms are hormone-driven versus what can be overcome with lifestyle changes, and seek medical help when needed, especially regarding hormone therapy, without accepting invalidation.

53. Push Harder if Training Volume is Low

For individuals with limited training volume (e.g., a couple of hours a week), understand that workouts need to be pushed harder (closer to failure for strength, higher intensity for cardio) to achieve significant progress beyond initial adaptations.

54. Understand Zone Training Nuance

Be aware that many people mistakenly perform ‘zone two’ workouts at too low an intensity (zone one), resulting in minimal training effect; understand the precise intensity required for effective training versus recovery.