Perimenopause and Physical Therapy: The Nervous System is Supreme

Written by:
Dr. Lisa Harlan
June 3, 2025

How can PT’s support women through perimenopause, menopause, and beyond? Physical therapists are educators and education is a key component of supporting women through Menopause. Learning how to optimize our bodies and minds to move into this transition in a strong and healthy way can help make the difference between smooth sailing or a bumpy path.

Where does one start when thinking about how to help women through Menopause?

I am currently taking a Menopause/ Permenopause course through the Integrative Women’s Health Institute, whose motto is “Don’t chase symptoms, optimize systems.” Where should we start?... With the Nervous system. Regulating our nervous system is the way to begin because nothing else will work well, unless our nervous system is regulated. With regards to our nervous system, we should be living most of our life in a Parasympathetic Ventral Vagas activation mode. If we are in this state, our body is calm, we are able to rest and digest well. In a dorsal vagus state, we tend to freeze, think deer in headlights. In a Sympathetic mode, we are in fight or flight, which causes chronic inflammation. When we consider nervous system problems: things like headaches, mild cognitive deficits, anxiety, depression, chronic, fatigue and poor sleep, are all signs that our nervous system is living in a state of sympathetic activation.

How do we assess the state of our Nervous System? Parasympathetic nervous system is our “rest and digest” mode. So taking a look at your rest and your digestion can give you a clue about how you are doing. I’m going to discuss 4 simple ways to assess the state of your nervous system.

1.Track your sleep: There are many wearables on the market now that track sleep and can give you information on sleep quantity and quality. Quality is just as important as quantity as our body repairs itself during deep sleep periods. 

 

2. Another is to analyze your digestion. Women’s health therapists don't shy away from talking about poop. So how are your bowel movements? There is a whole scale of types of stool that you can compare yours to. Bristol #4 is what we are going for: smooth and soft like a snake. This means that we are hydrated and our body is getting nutrients it needs from our food. 

3. Heart rate variability is a score that measures the variation in the time interval between heart beats. The higher, the better, this means that you have a low resting heart rate, but also increase your heart rate through healthy stress like exercise. Apple watches can track our HRV through the heart app. Inside the heart app, click on browse and scroll to heart where you’ll see HRV.

4. Respiratory rate and heart rate are also easy measures of our nervous system. Normal respiratory rate is between 12- 20 breaths per minute. The average heart rate for women is between 60 - 100 beats per minute. Specifically, the average heart rate or pulse for women in their 40’s is 75.3 and women in their 50’s is 73.9.

How can we change the mode of our nervous system? Simple strategies such as deep breathing, meditation, exercise, prioritizing sleep, improving our gut biome through nutrient dense food, and taking time to find joy and pleasure in life are ways that we can optimize our nervous system.

 If you live in Atlanta, Georgia and need support getting started with any of these strategies, make an appointment today! To get started contact me at Activcore Druid Hills

Disclaimer:  The views expressed in this post are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

Dr. Lisa Harlan

Physical Therapist
Lisa Harlan is a Doctor of Physical Therapy (DPT) and Nationally Certified Pilates Teacher (NCPT) who specializes in orthopedics, women's health, and cancer rehabilitation. As a former professional ballet dancer, she has a passion for helping dancers and other individuals recover from injury and move well without pain. She works at Activcore in Atlanta, Georgia, located just 2 miles from Emory University.
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