Women’s Health for the Long Run: Metabolic Health
Why muscle, insulin, and inflammation shape how women age.
I grew up thinking the safest thing I could do for my body was to eat less.
I knew about macros.
I knew exercise mattered.
What I didn’t know — not really, not in my bones — was that protein and muscle would be the difference between feeling like myself in perimenopause and feeling like a stranger in my own skin.
The Body Hierarchy I Grew Up In
My education about my body didn’t start in a doctor’s office.
It started at home.
My older sister is four years ahead of me.
Tall. Long black hair. Naturally thin.
She had the kind of body our culture quietly — and not so quietly — worshipped: slim, elegant, “model material.”
I was different.
Short. Curvy. Compact.
I wasn’t invisible.
I was smart, outspoken, friendly. I took up space in every room I walked into.
But the kind of attention my sister got was different.
My mother dressed her up.
She fussed over her outfits.
She paraded her — not literally, but emotionally — as the pretty one.
Boys noticed her first.
And I learned something I couldn’t yet name:
Slim meant desirable.
Slim meant chosen.
So my relationship with food and my body became about being acceptable. Attractive. Desirable.
Watching what I eat became a strategy.
I’d power through busy days — especially once I started running and scaling a business — barely eating.
Then I’d come home starving and binge.
The cycle was familiar:
Restrict.
Get overwhelmed.
Come home ravenous.
Eat everything in sight.
Feel guilty.
It’s not that I didn’t know what to do.
I did.
I’ve always been educated about nutrition, protein, exercise.
The deeper story was this:
I believed I needed to manage my body to be attractive and desirable.
I believed my worth in the romantic, feminine, “wanted” sense lived in how close I could get to that slim ideal I grew up watching.
That belief followed me straight into midlife.
Perimenopause didn’t care how educated I was
When my body began shifting, I wasn’t uninformed.
I knew strength training mattered.
I understood cardiovascular health.
I wasn’t living on fast food.
And yet things changed.
Sleep became fragile.
My mood felt subtly off.
The scale moved without obvious cause.
My clothes stopped fitting the way they once did.
Then there were the labs.
At 43:
ApoB: 115
LDL: 134
HDL: 70
Triglycerides: 146
Fasting insulin: 10.6
A1c: 5.0
Resting metabolic rate: 1123 calories
If you looked only at my A1c, you’d say I was fine.
But fasting insulin at 10.6 is an early signal of insulin resistance — the kind of metabolic drift that can precede diabetes by years.
Insulin resistance isn’t cosmetic.
It affects vascular health, inflammation, visceral fat accumulation, and long-term cardiovascular and cognitive risk.
Perimenopause exposed something uncomfortable:
I understood muscle mattered.
I wasn’t eating or training in a way that protected it.
Menopause itself shifts lipid profiles. It alters fat distribution. It accelerates muscle loss. It increases visceral fat even when lifestyle remains constant.
Lifestyle still matters deeply.
It just doesn’t override biology.
Muscle as Metabolic Infrastructure
For most of my life, muscle was about shape.
Toned arms. A firmer butt.
It was aesthetic. Optional.
But muscle is not decorative tissue.
It:
Improves insulin sensitivity
Regulates glucose disposal
Communicates with the brain through myokines
Protects bone density
Supports vascular health
Drives resting metabolic rate
Muscle is metabolic infrastructure.
As estrogen declines, fat doesn’t just increase — it shifts toward visceral fat around the organs, which drives inflammatory signaling and insulin resistance.
My DEXA estimated my visceral fat at 1.67 pounds — not catastrophic, but a reminder that direction matters more than any single number.
Chronic under-eating of protein no longer looked disciplined.
It looked metabolically naïve.
The Strategy I’m Using Now
This is where I want to be very clear:
I am not doing this perfectly.
But I am doing it intentionally.
~30g of protein per meal
I aim for roughly 30g at each meal to stimulate muscle protein synthesis.
I’m experimenting with eating closer to my bodyweight in grams per day (around 150g for me), but that’s a working target — not a universal rule.
Strength training 2–3 times weekly
Heavy enough that the final reps are difficult.
Not for calorie burn. For tissue preservation.
Creatine (5g daily)
As support for muscle and potentially cognition — not as a “bodybuilder supplement,” but as support for muscle, strength, and even cognition in midlife.
Zone 2 cardio
For mitochondrial and vascular health — not punishment.
Labs beyond A1c
Fasting insulin. HOMA-IR1. ApoB. Triglycerides. Blood pressure. Body composition.
Because metabolic dysfunction begins quietly. Over time, I’m looking for fasting insulin and HOMA‑IR to trend down, not up.
Medical tools without moral framing
Transdermal estrogen. Progesterone. GLP-1 therapy.
I used to judge GLP-1s harshly. I assumed they were shortcuts.
Used thoughtfully, alongside strength training and adequate protein, they can improve insulin sensitivity and reduce visceral fat, which lowers long‑term cardio-metabolic risk.
They are not risk-free. They are not magic.
They are tools. This is not medical advice; I’m sharing what I’m using under medical supervision.
What I wish someone had told me at 35
This isn’t only for women already in perimenopause.
If you are 30, 35, 40 — and still trying to eat as little as possible to stay small — this matters to you now.
Muscle loss doesn’t begin at 50. It accumulates gradually across years of insufficient protein and resistance training.
Menopause amplifies whatever foundation you built before it.
If I could speak to my 35-year-old self, I would say:
Stop trying to minimize yourself.
Lift.
Learn your fasting insulin baseline.
Build lean mass intentionally.
Don’t equate thin with metabolically healthy.
Menopause is not a surprise event.
It is a predictable metabolic transition.
Preparation is cumulative.
The Tension I’m Watching
I have a history of turning health into performance.
There is a version of this where “strong” simply replaces “thin.”
Where protein targets become another control mechanism.
Where lab optimization becomes its own obsession.
I am paying attention to that.
The goal isn’t domination of my body. It’s long-term cooperation.
If Your Body Feels Different
If your metabolism feels unfamiliar.
If weight gain feels disproportionate.
If labs look normal but you don’t feel normal.
It’s easy to interpret that as failure.
It isn’t. You are not broken; your operating system has changed.
Biology shifts.
But there are levers you can pull:
Ask for fasting insulin
Calculate HOMA-IR
Track ApoB
Strength train deliberately
Eat adequate protein
Consider hormone therapy or metabolic medication when appropriate
Just like with sex, this isn’t about willpower; it’s about understanding the physiology so you can stop blaming yourself and start making decisions.
The girl who didn’t feel desired growing up is learning:
To eat enough.
To get stronger, not just thinner.
The questions I’m holding:
How many of us could write a different story for our 70s and 80s if we stopped fearing food, started feeding our muscles, and treated menopause as a metabolic transition we can prepare for — instead of a personal failure we’re supposed to quietly endure?
xoxo💋
Paola
Homeostatic Model Assessment of Insulin Resistance. It’s a simple formula that uses two labs — your fasting glucose and your fasting insulin — to estimate how hard your body has to work to keep your blood sugar in range. It doesn’t diagnose diabetes; it shows you how insulin‑resistant you are getting, often years before your A1c ever looks abnormal.
This post is part of Women’s Health for the Long Run—a series grounded in lived experience, careful listening to experts, and shared learning. It is not medical advice.