Metabolic health is how well your cells make and use energy. It is the foundation of every function in your body: conceiving, holding or losing weight, the energy you have at four in the afternoon, and how well you age. For many women, the forties are when changes in that system first become impossible to ignore.

Why now?

Dr Mayoni Gooneratne, PHC's Chief Functional Medicine Officer, sees the same story often. Many of her patients come to PHC because they suddenly feel the difference. They are usually in their forties and high achieving.

Suddenly their clothes no longer fit. They cannot lose weight. They are not performing the way they used to. Many describe less energy, poorer sleep, slower recovery, more aches and pains and a general decline in how well they function.

The margin is narrower

When they were younger, many could get away with it. They ate inconsistently, did not always make the best food choices, slept too little, trained too hard and drank more alcohol than was good for them, and still felt they could function.

As they get older, in Dr Gooneratne's words, "the margin is much narrower."

This is not a personal failure

"This is not a personal failure," says Dr Gooneratne. It is not about a lack of willpower. It reflects real changes in muscle mass, recovery capacity, sleep, hormones and stress load.

The role of perimenopause

For women, perimenopause is a huge factor. Oestrogen has an important impact on muscle, bone, glucose regulation, sleep, mood and cardiovascular health. Oestrogen receptors are found across the organs of the body, which shows how far its influence reaches.

As hormones fluctuate, a routine that was once reliable can stop feeling reliable at all.

Men feel it too

Men go through their own midlife changes. Testosterone declines, sleep can worsen, and central adiposity (fat stored around the middle) can increase. Years of high stress can start to show up as lower energy and reduced resilience.

The answer is a better foundation

The answer is not simply to train more or train harder. It is about building a better foundation. As Dr Gooneratne puts it, it is about "rebuilding that house so it isn't crumbling again."

Understanding why your body has changed is the first step. From there, the work is to rebuild the foundations your metabolic health depends on, so that what you do starts working for you again.

Frequently Asked Questions

Why do I feel different in my 40s?

Many people notice less energy, poorer sleep, slower recovery, more aches and pains and weight that is harder to shift in their forties. This reflects real changes in muscle mass, recovery capacity, sleep, hormones and stress load. Habits that were once easy to get away with, such as irregular meals, short sleep and hard training, have a bigger effect because the margin is narrower.

Is midlife weight gain a lack of willpower?

No. Changes in weight, energy and performance in midlife are not a personal failure or a lack of willpower. They reflect shifts in muscle mass, recovery capacity, sleep, hormones and stress load. Understanding those changes is more useful than pushing harder with a routine that no longer suits your body.

How does perimenopause affect metabolic health?

Oestrogen has an important impact on muscle, bone, glucose regulation, sleep, mood and cardiovascular health, and oestrogen receptors are found across the organs of the body. During perimenopause, fluctuating hormones can make a previously reliable routine stop working, which is why many women feel the change so suddenly.

Why has my usual routine stopped working?

In midlife the margin for error narrows. Muscle mass, recovery, sleep and hormones all change, and stress often accumulates. For women, perimenopause adds hormonal fluctuation. A routine built on skipped meals, short sleep and hard training may have worked in your twenties and thirties, but it is far less forgiving now.

Should I train harder if I am gaining weight in midlife?

Not necessarily. Training more or harder is rarely the answer on its own. Dr Mayoni Gooneratne focuses on building a better foundation first, looking at the changes in muscle, recovery, sleep, hormones and stress that sit underneath how you feel.

Do men experience midlife metabolic changes too?

Yes. Men can experience falling testosterone, worsening sleep and increasing central adiposity (fat stored around the middle) in midlife. Years of high stress can also show up as lower energy and reduced resilience. As for women, the answer is a stronger foundation rather than simply more effort.