How nutrition needs shift across the decades for women and men, and what every Pilates body should know about blood sugar, inflammation, and gut changes.

If you’ve been teaching or practicing Pilates for any length of time, you’ve probably heard some version of this conversation from the women in the studio lobby: “I’m doing everything I used to do, doing the same workouts, eating the same food, and my body just isn’t responding the same way anymore.”

This article focuses on the female hormonal transition because perimenopause and menopause are unique, universal experiences for women that deserve dedicated attention. But men go through their own gradual hormonal shift called andropause, which I’ll address as well.

The Big Picture: Hormones

Hormones are messengers. They send signals to cells throughout the body. We have over 50 major hormones that help us regulate mood, stress response, sleep, growth and tissue repair, hunger and fullness, metabolism and energy levels, reproductive cycles, bone strength, mineral balance, fluid balance, blood pressure, blood cell production, immune function, and more. Hormones run the background systems that determine how we feel, sleep, eat, grow, heal, and respond to stress every single day.

We are going to focus on four hormones: estrogen, progesterone, testosterone, and cortisol. It’s easy to think of estrogen, progesterone, and testosterone just in terms of reproduction. However, these hormones affect our whole body, including cardiovascular health, cognition, mood, temperature, inflammation, muscle mass, bone density, metabolic health, and gut health.

Estrogen helps regulate insulin sensitivity, how our cells respond efficiently to the insulin our pancreas produces. It also has anti-inflammatory properties, and it influences the composition of the gut microbiome, the trillions of bacteria living in our digestive tract. When estrogen levels are stable, these systems tend to run more smoothly. When estrogen starts to fluctuate and eventually decline, we feel changes in all three systems. This is why the same diet that beautifully nourished your body when you were 28 can feel like the completely wrong diet at 46. While the food has not changed, how our bodies interpret it has.

Progesterone has a calming, sleep-promoting effect on the brain, largely because it converts into a neurosteroid that supports the brain’s calming GABA system. Progesterone often begins declining in the late 30s or early 40s, before estrogen starts declining. That’s partly why some of the very first perimenopause symptoms noticed are changes to sleep and mood. Because ovulation becomes less predictable starting in the 40s, and no ovulation means no progesterone production that cycle, this decline can be erratic well before a woman’s period noticeably changes too.

Testosterone is best known as the male hormone, but women produce it too, primarily in the ovaries and adrenal glands. We think of testosterone’s role in libido, but testosterone also supports mental sharpness, helps regulate serotonin and mood, and plays a substantial role in muscle mass, bone strength, cardiovascular health, and energy levels. Women’s testosterone actually peaks in the mid-20s and can drop by roughly half by age 40. Levels tend to plateau gradually, and for some women the effects are barely perceptible, while others notice a real dip in libido, energy, and concentration.

Cortisol is the body’s primary stress hormone. Cortisol and blood sugar are directly linked. Cortisol can mobilize glucose for quick energy, which is what we need in an emergency. Unfortunately, modern life comes with a lot of chronic, low-grade stress that we often don’t get a break from, and that can have a direct effect on our blood sugar.

Chronically elevated cortisol also has a complicated relationship with inflammation: short bursts are anti-inflammatory, but sustained elevation is associated with low-grade, chronic inflammation. To add another layer, cortisol and reproductive hormones are produced via overlapping pathways. As a result, chronic stress during perimenopause can compound the hormonal turbulence already underway. While stress is not the cause of perimenopausal symptoms, sleep, stress management, and adequate (not excessive or insufficient) caloric intake belong in the same conversation as diet quality, not as an afterthought.

Decade-by-Decade: What’s Actually Happening

The 20s and 30s: Building the Foundation

This is our metabolic high season. Estrogen and progesterone follow relatively predictable cycles, insulin sensitivity is typically strong, and the body is forgiving of inconsistency in a way it won’t be later on. You can bounce back from a night out with little sleep, a few drinks, and late-night French fries.

That said, “forgiving” doesn’t mean “unimportant”. The 20s and 30s are actually one of the most important nutritional windows of a woman’s life. This is peak childbearing time for women, and peak bone mass is achieved by around age 25.

This is also the decade where under-fueling is most common and most consequential. Many women in their 20s and 30s chronically under-eat protein while training hard, which can quietly undermine muscle development at exactly the life stage when building muscle is easiest and needed to support bone health.

A cycle-aware approach to eating also starts to pay dividends here: in the follicular phase (the first half of the cycle), insulin sensitivity tends to be higher and the body handles carbohydrates more efficiently; in the luteal phase (the second half), metabolic rate rises slightly and cravings often increase, which isn’t a willpower failure but a hormonally driven shift in fuel demand. Leaning into protein and fiber can help stabilize those cravings.

Late 30s to Early 40s: The First Signals

This is where things get interesting. Perimenopause, the hormonal transition leading up to menopause, often starts here, years before most women expect it. As covered above, progesterone is frequently the first hormone to shift, which is why disrupted sleep, new anxiety, or a shorter fuse can show up before any change in the menstrual cycle itself. Research on the perimenopausal period shows that the odds of developing metabolic syndrome (a cluster including high blood pressure, high blood sugar, and abdominal fat gain) rise during perimenopause, independent of chronological age. In other words, it’s not just getting older, but perimenopause itself appears to accelerate certain metabolic shifts.

The earliest and most noticeable of these shifts often involves insulin. As estrogen begins its erratic decline, many women start noticing that carbohydrates that once metabolized cleanly now seem to land differently. It’s not uncommon to experience more bloating, more fatigue after meals, and a new tendency to store fat around the midsection rather than the hips and thighs, even in women who aren’t overweight or don’t gain weight during this period.

Weight loss resistance also tends to make its first appearance here, which is genuinely disorienting for anyone who’s relied on “eat less, move more” advice for years. That strategy becomes less reliable during this window because it doesn’t account for what’s actually happening hormonally, or for how the body processes different foods. A hundred calories of broccoli or chicken behaves very differently in the body than a hundred calories of a candy bar. Fiber and protein are filling, help keep snacking to a minimum, and stabilize blood sugar.

The practical takeaway for this decade is to start prioritizing protein and fiber at every meal now, before the blood sugar swings become more pronounced. It’s far easier to build the habit early than to overhaul everything at once later.

Perimenopause Deep Dive: 40s to Early 50s

Most women are deep into perimenopause by their mid-to-late 40s. Perimenopause can last for up to 10 years, with menopause being the single point, twelve months after a woman’s last period. Most women experience the most intense symptoms in the last several years of perimenopause. This is the stage where the three threads introduced earlier of blood sugar, inflammation, and gut changes become impossible to ignore.

Blood sugar stability. As estrogen fluctuates wildly before its eventual decline, insulin sensitivity becomes harder to predict day to day. Practically, this means the carb-heavy breakfast (scones, muffins, oatmeal, granola…) that was fine for years might now spike energy and then crash it. This can leave us reaching for a mid-morning and/or a mid-afternoon pick-me-up. Building meals around a protein anchor (aiming for roughly 25-30+ grams per meal), filling your plate with colorful vegetables, a reasonable portion of fiber-rich carbohydrates, and healthy fats. Pairing this with resistance training and movement is some of the most evidence-supported ways to blunt these swings.

Inflammation. Estrogen has long been recognized for its anti-inflammatory effects, which is part of why cardiovascular risk markers shift so noticeably around this time. This is when women start feeling muscular skeletal effects of hormone loss such as frozen shoulder, osteoarthritis, muscle aches, and tendinopathies. Research comparing pre- and postmenopausal women found that postmenopausal had measurably higher levels of TNF-α, an inflammatory marker, even after accounting for other factors. While an elimination diet can be an effective tool for reducing some inflammatory symptoms, it is not necessarily the best place to start. Begin by adding, not eliminating. Adding foods rich in omega-3 fatty acids, more colorful plants rich in polyphenols and fiber, and reducing ultra-processed foods might be all you need.

GI changes. This is often the most surprising shift for women in this decade. Women who pride themselves on tolerating every food they eat suddenly notice new bloating, new food sensitivities, and slower motility during perimenopause. As estrogen and progesterone decline, the gut microbiome begins to change. Research comparing pre- and postmenopausal women found that postmenopausal women had measurably lower gut microbial diversity, and that their microbiome composition shifted to more closely resemble the male gut microbiome. This suggests that the loss of female reproductive hormones is a driver of these gut changes. A note for Pilates instructors here: the core and breathwork practice central to Pilates genuinely supports circulation and gentle digestive motility, along with addressing these underlying hormonal and dietary factors.

Sleep. Sleep disruption deserves its own conversation here rather than a passing mention, because it’s one of the most common and most underestimated perimenopausal complaints. Self-reported sleep issues affect as many as 47% of perimenopausal women, rising to roughly 60% during menopause itself. Two mechanisms tend to drive this. First, declining and fluctuating estrogen affects the body’s temperature regulation, which can lead to hot flashes during the day and night sweats during sleep. Second, as discussed above, the earlier decline in progesterone removes some of its natural calming, sleep-promoting effect, which can show up as trouble falling asleep or waking in the middle of the night with a racing mind. Poor sleep directly worsens blood sugar regulation and amplifies inflammation, which means the three pillars of this article aren’t really separate at all; they reinforce one another. Practical support includes a cool, dark bedroom, a consistent wind-down routine, and limiting caffeine after midday.

Menopause: 50s and Beyond

Menopause is officially marked by twelve consecutive months without a period, and in the United States, the average age is 51-52. Women are considered postmenopausal after that one day. This is when estrogen settles into a consistently low baseline, and several of the shifts that began in perimenopause become more pronounced and more permanent.

Protein needs increase significantly. This is one of the most consistent and well-supported findings in aging research, and it’s frequently underemphasized. The standard RDA for protein (0.8 grams per kilogram of body weight) was established using research on young, healthy men and is now widely considered insufficient for midlife and older adults. Several expert panels now recommend 1.0–1.2 g/kg per day as a baseline for healthy older adults, moving up to 1.2–1.5 g/kg for those who are highly active or want extra protection against age-related muscle loss, and 1.5–2.2 g/kg for those already showing signs of muscle loss (sarcopenia) or who are losing weight intentionally, including those on GLP-1 medications.

This matters because sarcopenia, or muscle loss, affects an estimated 5–13% of adults in their 60s, climbing to 11–50% of adults over 80, depending on the diagnostic criteria used. For a 150-pound woman (about 68 kg), the old guidance suggested about 55 grams of protein a day; the updated baseline guidance suggests closer to 70–80 grams, with 100+ grams appropriate for someone actively working to maintain or rebuild lost muscle. That’s a meaningful difference, and protein recommendations should be personalized to the individual rather than applied as a flat rule.

Bone health becomes urgent. The years immediately surrounding the final menstrual period are when bone loss accelerates most sharply. Most women do not have their bone density tested until years later, and are unaware of their own bone loss until they have a fracture.

Estimates vary by study and skeletal site, but several large longitudinal studies including the Study of Women’s Health Across the Nation (SWAN) found that women lose roughly 1.8–2.5% of bone mineral density per year at the spine and hip during the few years spanning menopause, before the rate slows to a more gradual 0.5–1% per year in the years that follow. Cumulatively, that adds up: one large cohort found about a 10% loss in bone density over the ten years surrounding menopause. The clinical stakes are real. Roughly one in two postmenopausal women will experience a major fracture in her lifetime as a result of bone loss. Calcium, vitamin D, vitamin K2, magnesium, weight-bearing and resistance movement, and hormone replacement therapy (if applicable) all work synergistically here.

Magnesium deserves a seat at this table, and it’s usually left out of the calcium-and-vitamin-D conversation. With roughly 60% of the body’s magnesium stored in bone, it plays a critical, direct role in bone density. Magnesium is also essential for glucose metabolism, and deficiency has been linked to insulin resistance, tying it directly back to blood sugar. The RDA for women in this age range is roughly 310–320 mg per day, ideally from food such as leafy greens, nuts, seeds, legumes, and whole grains.

The gut microbiome continues to shift. Building on the changes that began in perimenopause, postmenopausal women show further reductions in microbial diversity and a depletion of certain bacteria involved in what researchers call the estrobolome, the subset of gut bacteria involved in metabolizing and recycling estrogen. Declining estrogen and progesterone may also increase gut permeability, allowing more microbial material to cross the gut lining than would otherwise occur. This is where the bloating, new food sensitivities, and irregular motility that started in perimenopause often become a daily reality rather than an occasional annoyance. Fermented foods, a fiber-rich diet (25 grams for women and 38 grams for men, or more), and a diet rich in colorful plants are supportive. Here is where an individualized protocol and working with a medical provider may become relevant.

Inflammation management becomes an ongoing practice. The inflammatory shifts that began in perimenopause don’t reverse after menopause, and if anything, the cardiovascular risk associated with elevated inflammatory markers becomes more clinically significant in this stage. Cardiovascular disease is the number one killer of women, and it rises notably after menopause. The good news is that the same anti-inflammatory strategies that include a diet rich in omega-3 fatty acids, colorful plant foods, and rich in fiber, along with exercise and quitting smoking, continue to be supported by research at this life stage, and are not a one-time fix but sustained practices.

60s and Beyond: Sustaining Strength, Mobility, and Balance

By this decade, the nutritional priorities established in the 50s don’t change so much as they become non-negotiable. Protein intake in the 1.2–2.2 g/kg range described above (or higher, for those managing existing muscle loss) remains essential for preserving function, mobility, and independence. Continued attention to vitamin D, calcium, magnesium, and omega-3 intake supports both bone and muscle health. Testing and looking at what you are actually eating over a week is the best way to determine your actual nutrient needs.

Digestive resilience also matters more here. Diversifying fiber sources, staying genuinely well-hydrated, and for some, shifting toward smaller, more frequent meals can ease the digestive load.

Diet and lifestyle go hand in hand. Consistent and regular movement such as Pilates, supports the kind of functional strength, mobility, and balance that keeps women active and independent well into their 70s and 80s.

What About Men? Andropause and Hormonal Aging

A note about the male hormone transition. Men experience a gradual decline in testosterone that typically begins around age 30-40, at a rate of roughly 1-2% per year for total testosterone, with free (biologically active) testosterone often declining slightly faster due to age-related increases in a binding protein called SHBG. By the time a man reaches his mid-70s, circulating testosterone levels are typically around 30% lower than they were at 25.Roughly 20-30% of older men have clinically low testosterone, and one large U.S. study found that about 24% of men show some degree of testosterone deficiency, though only a small fraction of symptomatic men actually receive treatment.

Where men and women differ most is in how quickly that decline happens. Menopause is a relatively defined transition that unfolds over a few years and ends with a clear hormonal floor. Andropause is a slow, decades-long slope with no equivalent “finish line.” In fact, many men never notice a dramatic before-and-after the way women often do.

That said, several of the same nutritional themes apply. Declining testosterone is associated with reduced insulin sensitivity, increased visceral fat accumulation, and accelerated muscle loss, meaning the blood-sugar-stabilizing and protein-prioritizing strategies outlined throughout this article are just as relevant for men in their 40s, 50s, and 60s. Strength training remains one of the most effective tools available to men for supporting healthy testosterone levels and offsetting age-related muscle loss. Like women, men can talk to their doctors to see if they are a good candidate for hormone replacement.

One notable difference between men and women during this transition is that the intensity of GI symptoms many women report do not have a clear male equivalent. Andropause is more dominantly experienced through fatigue, mood changes, and gradual muscle and strength loss than through new digestive symptoms. Stay tuned for my nutritional toolkit to balance blood sugar, fight inflammation, and support digestion, along with suggested foods to focus on in each decade

All ideas and assertions expressed in The CORE are those of the individual contributors, offered to spark conversation, enrich understanding/inspire growth and share diverse perspectives within our community. They may not necessarily reflect the views of Balanced Body®.