Estrogen and Women’s Health: What Your Hormones Are Trying to Tell You

Your sleep is off, your recovery is dragging, and workouts that used to feel great now feel a little flat. This month, F45 | Joi + Blokes is unpacking a question too many women never get a straight answer to: what is estrogen actually doing, and how do I find out what’s going on in my body?

Estrogen is a hormone that supports your bones, brain, heart, skin, and menstrual cycle.¹ During perimenopause, which typically starts two to eight years before menopause, estrogen and progesterone rise and fall unpredictably, and that can shake up your sleep, mood, recovery, and periods.³ The good news: there’s plenty you can do. A full health evaluation with a licensed clinician is a great first step, hormone therapy may be an option for some women, and strength training can support your muscle and bone health along the way.¹⁰ ¹²

Your Body Has Been Talking. Here’s How to Listen

If you’ve been told that your sleep, mood, and recovery are “just stress,” you’re not alone. Sometimes it is. But for many women, there’s another player in the mix: estrogen.

The conversation around hormone health is changing fast, and honestly, it’s exciting. In November 2025, the FDA announced it was beginning to remove its long-standing boxed warnings from menopausal hormone therapy products, a major shift after more than two decades.⁵ ⁶ That doesn’t mean hormone therapy is right for everyone. It does mean women have more reason than ever to ask better questions and expect better answers.

In this guide, we’ll cover what estrogen actually does, what changes during perimenopause and menopause, what the FDA update does (and doesn’t) mean, and how strength training fits in. We’ll also show you how our partnership with Joi + Blokes helps you swap guesswork for real data. *Joi + Blokes is available to the US only.

What Does Estrogen Do in a Woman’s Body? (More Than You Think)

Estrogen is best known as a reproductive hormone, and it absolutely is. But it’s also a serious multitasker, supporting your heart, bones, and brain.¹ It helps regulate blood sugar, bone density, cholesterol, circulation, and focus, and it plays a part in collagen production and moisture in your skin.¹

Your body makes different forms of estrogen over time. Estradiol is the main player during your reproductive years, and estrone takes over after menopause.¹ Because estrogen touches so many systems, a shift in your levels rarely shows up as just one symptom. It tends to show up everywhere: in how you sleep, how you feel, and how you bounce back.

What Is Perimenopause, and What Does Changing Estrogen Feel Like?

Perimenopause is the transition leading up to menopause, when estrogen and progesterone levels rise and fall unpredictably. Menopause itself is confirmed after 12 consecutive months without a period.³

Here’s the part that rarely gets talked about: the lead-up to menopause isn’t a smooth, steady decline. Estrogen and progesterone rise and fall unpredictably, and those swings, not just the drop, drive many symptoms.³ One OB-GYN calls it a roller coaster, with very high highs and very low lows in estrogen production.⁴

Perimenopause typically starts about two to eight years before menopause, and the average age of menopause in the US is 52.³ Harvard Health adds an important note: estrogen isn’t the whole story. Researchers have found no difference in estrogen levels between women who have hot flashes and women who don’t, and it can be tough to separate hormone effects from the effects of aging and midlife stress.²

Here are the signs women commonly report:

• Disrupted sleep. Waking up in the middle of the night more often.
• Cycle changes. Periods that are irregular or simply different.
• Hot flashes and night sweats.
• Mood changes. Harvard Health cites estimates that 10–20% of women experience mood symptoms during perimenopause.²
• Brain fog. Trouble concentrating.¹⁰
• Slower recovery. Workouts that leave you sore or flat for longer, plus joint discomfort.¹⁰
• Body changes. Vaginal dryness, dry skin, or shifts in sex drive.⁹ ¹⁰

None of these are diagnostic on their own, and that’s exactly the point. Many overlap with stress, thyroid issues, or simply not enough rest. Estrogen can also run low for reasons unrelated to age, including very low body fat, not fueling enough for your training, or overtraining.⁹ None of this means you’re doing something wrong. It may just mean your body is asking for support, and if symptoms are unexpected or severe, a healthcare provider is a great next call.⁹

Is Hormone Therapy (HRT) Safe? What the FDA Changed, and What It Didn’t

It depends on your age, health history, how long it has been since menopause, and the type of therapy, which is why it should be an individualized decision made with a clinician.¹⁰

Big news first: on November 10, 2025, the FDA announced it would begin removing the boxed warning from more than 20 hormone therapy products for menopause, including pills, patches, and creams.⁶ That warning had been in place for over two decades, based on findings from a large study published in 2002.⁶ The agency also approved a generic version of Premarin and a non-hormonal treatment for moderate to severe hot flashes, which gives women another option if they can’t or choose not to use hormone therapy.⁵ Label updates have continued into 2026, product by product.⁷

Here’s the nuance that matters:

• The endometrial cancer warning stays. A boxed warning remains on systemic estrogen-alone products, and women who still have a uterus are advised to take estrogen combined with a progestogen.⁶
• This is a labeling change. It doesn’t mean hormone therapy is right for everyone, and it doesn’t replace a conversation with your clinician.
• Not everyone agrees on how it happened. The independent drug-safety newsletter Worst Pills, Best Pills argues the change was based on opinion rather than new safety data.⁸

Meanwhile, Joi + Blokes points out that major medical organizations, including The Menopause Society, ACOG, and the Endocrine Society, recognize that for many healthy women under 60 or within 10 years of menopause, the benefits of hormone therapy often outweigh the risks when it’s appropriately prescribed.¹⁰

The takeaway: hormone care is getting more personal, and the smartest move is still an individualized evaluation, not a headline or a hunch.

Does Strength Training Help During Perimenopause and Menopause?

Research supports resistance training for muscle and strength in postmenopausal women, with clearer bone benefits after menopause than during perimenopause.¹² ¹³

Here’s where it gets fun for anyone who loves to train. Estrogen receptors are found in skeletal muscle and bone, which helps explain why changing hormone levels can show up in how you train and recover.¹⁰ The menopause transition is also when bone and muscle loss tends to be fastest, yet most exercise trials have historically left out women in perimenopause and early post-menopause.¹²

So what does the research say about lifting? A 2024 systematic review and meta-analysis supports resistance training as a strong starting point for healthy postmenopausal women, though there’s more debate about its effect on bone density.¹³ A 2025 systematic review focused on the menopause transition found that strength training improved bone density at all measured sites in early post-menopause. Results were less clear during perimenopause, and the authors say it’s still inconclusive which training method is best.¹²

The honest takeaway: strength training isn’t a substitute for medical care, but it’s one of the levers that’s fully in your control, and that’s empowering. Ready to build a routine? Start with our resistance workouts and this guide to strength training and muscle. Protecting your sleep and rest days matters too.

Should You Test Your Hormone Levels? Why Labs and a Clinician Matter

There’s no single test that confirms perimenopause, and because hormone levels swing, one number can’t tell the whole story. Clinicians typically look at your age, menstrual history, and symptoms.³ So why test at all? Because fatigue, brain fog, and weight changes can come from poor sleep, thyroid dysfunction, insulin resistance, chronic stress, or nutritional gaps like low iron, not just hormones.¹⁰ A broader evaluation helps rule those in or out and gives you and your clinician the full picture.

That’s the approach Joi + Blokes takes: looking at hormone health alongside metabolic function, thyroid health, inflammation, and key nutritional markers, followed by a conversation with a licensed clinician about your symptoms, history, and goals.¹⁰ And here’s a small step you can take today: start a simple journal of your sleep, mood, cycle changes, and energy. It gives your clinician valuable context.¹⁰

Want to keep reading? Explore Joi + Blokes’ guide to the hormones you need as a woman in your 40s.

F45 | Joi + Blokes: Training and Hormone Health, Better Together

Fitness and hormone health aren’t separate conversations. How you train, recover, and sleep is tied to what’s happening beneath the surface, and Joi + Blokes was built to help you understand it.

As an F45 member, our partnership gives you a direct path to:

• Comprehensive hormone lab testing that goes beyond a standard annual physical
• Clinician-guided evaluation, so every next step is based on your symptoms, history, and biomarkers, not assumptions
• Ongoing monitoring, because hormone health isn’t a one-time fix
• A team-based approach that pairs the training and community you already love at F45 with the clinical insight Joi + Blokes specializes in

The goal isn’t to add one more thing to your to-do list. It’s to replace guesswork with clarity, so the effort you’re already putting in, in the studio and outside of it, has the best chance to pay off. If you’ve been wondering whether your symptoms deserve a closer look, consider this your sign to start finding out.

Visit joiandblokes.com to learn more and access your exclusive F45 member offer.

*This article is for educational purposes only and is not a substitute for professional medical advice. Hormone therapy and any treatment for menopause symptoms should only be pursued under the guidance of a licensed clinician following appropriate evaluation.

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Sources:

1  https://my.clevelandclinic.org/health/body/22353-estrogen

2 https://health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause

3 https://health.stonybrookmedicine.edu/when-does-perimenopause-start-signs-and-when-to-seek-help/

4 https://obgyn.coloradowomenshealth.com/in-the-news/understanding-perimenopause

5 https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy-1

6 https://www.opb.org/article/2025/11/10/the-fda-removes-a-long-standing-warning-from-hormone-based-menopause-drugs

7 https://www.managedhealthcareexecutive.com/view/fda-approves-removal-of-black-box-warning-for-six-menopausal-hormone-therapies

8 https://www.worstpills.org/newsletters/view/1700

9 https://my.clevelandclinic.org/health/diseases/22354-low-estrogen

10 https://joiandblokes.com/women/estrogen-patches-and-hrt-what-every-women-should-know/

11 https://joiandblokes.com/women/do-estrogen-boosters-work/

12https://search.pedro.org.au/search-results/record-detail/84403

13 https://repositorio.ucam.edu/bitstream/10952/9803/1/2024_Resistance%20training%20effects%20on%20healthy%20postmenopausal%20women.pdf

14 https://nccih.nih.gov/health/providers/digest/menopausal-symptoms-and-complementary-health-practices-science

Written and published by F45 Training HQ, and reposted here for the F45 North Paramus community.