I’ve spent years reading pathology reports, programming training plans, and teaching women to breathe properly on a yoga mat. All three jobs point to the same thing: normal on paper and normal in your body aren’t always the same conversation.
This week’s podcast episode is one I’ve been looking forward to for a while. I sat down with Dr Christina Enzmann, a board-certified OB/GYN, Certified Menopause Practitioner, and functional medicine physician, to talk about why so many women in midlife feel flat, foggy, wired-but-tired or just generally off, even when their doctor tells them everything looks “normal” [Episode [EPISODE #], listen wherever you get your podcasts].
Listening back to our conversation, I kept thinking about how much of it overlapped with the three very different hats I wear. I trained in biomedical science with a focus on pathology before I ever picked up a yoga mat or wrote a training program, and honestly, the three disciplines all end up circling the same question: what is actually going on underneath the numbers?
So I wanted to add my own layer to what Dr Enzmann shared this week, from the pathology bench, the gym floor, and the yoga studio.
The Pathology Lens: What “Normal” Actually Means on a Lab Report
Here’s something that doesn’t get explained often enough: a “normal range” on a pathology report is a statistical range, built from a population, not a promise about how you personally should feel. It’s usually the middle 95% of results from a reference population. That means being inside the range tells you that you’re not a statistical outlier, not that your particular biology is running optimally for you.
This matters enormously in perimenopause. Research from the long-running Study of Women’s Health Across the Nation (SWAN) found that fasting insulin levels can start climbing years before menopause, and that this early rise, well before it reaches the level doctors would call “insulin resistance,” is already linked to earlier and longer-lasting hot flushes and shifts in reproductive hormones (Reed et al., Journal of Clinical Endocrinology & Metabolism, 2026). A standard glucose test can miss this completely, because fasting glucose is often the last thing to move.
That’s the pathology lens in a sentence: the absence of a flag doesn’t mean the absence of a pattern.
The Training Lens: Why Your Body Responds Differently Now
As a personal trainer, the question I get asked most by women in their 40s and 50s is some version of “why doesn’t my training work the way it used to?” The honest answer is that your metabolic environment has changed, so the tool that changes it best changes too.
A 2023 randomised controlled trial in postmenopausal women with metabolic syndrome compared eight weeks of resistance training against high-intensity interval training, and found resistance training produced meaningful improvements in fasting blood sugar, HbA1c, blood pressure and body composition, alongside gains in muscle mass and strength (Shamlou Kazemi et al., Lipids in Health and Disease, 2023). Cardio still has its place, but resistance training earns a much bigger seat at the table in this decade of life than it usually gets credit for.
The Yoga and Meditation Lens: Stress Isn’t Just a Feeling, It’s a Measurable Signal
My yoga and meditation training taught me to take the nervous system seriously as a physiological system, not just a mood. A 12-week randomised trial comparing Hatha yoga, general exercise and a no-intervention control group in postmenopausal women found that only the control group showed a significant rise in cortisol over the study period, while the yoga group reported lower stress, fewer menopausal symptoms and better quality of life (Jorge et al., Complementary Therapies in Medicine, 2016). Cortisol dysregulation from chronic stress has wide-reaching downstream effects on metabolism and inflammation, so a genuine nervous-system practice isn’t a soft add-on, it’s doing real physiological work.
Bringing the Three Together
None of these three lenses replace the other, and none of them replace a proper clinical work-up like the one Dr Enzmann talked through on the podcast this week. What they do is explain why “your labs are normal” is often the start of a conversation about your health, not the end of one. If something in your body has shifted and the standard panel isn’t giving you an answer, that’s worth pursuing further, not dismissing.
Give this week’s episode a listen, and if any of it resonates, I’d love to hear which part landed for you.
Sarah 🌿
A note on this post: I’m a biomedical scientist by training and a personal trainer, yoga and meditation teacher by practice, but this post is general information, not personalised medical advice. If you’re noticing symptoms despite “normal” results, or you’re considering changing your training, supplement or exercise routine, please check in with your GP or an accredited specialist first, particularly if you have an existing health condition.
References
- Reed SD, et al. Insulin Levels Early in Perimenopause Inform Vasomotor Symptom Incidence Across the Menopausal Transition. J Clin Endocrinol Metab. 2026.
- Shamlou Kazemi S, Heidarianpour A, Shokri E. Effect of resistance training and high-intensity interval training on metabolic parameters and serum level of Sirtuin1 in postmenopausal women with metabolic syndrome: a randomized controlled trial. Lipids Health Dis. 2023;22(1):177.
- Jorge MP, Santaella DF, Pontes IMO, Shiramizu VKM, Nascimento EB, Cabral A, Lemos TMAM, Silva RH, Ribeiro AM. Hatha Yoga practice decreases menopause symptoms and improves quality of life: a randomized controlled trial. Complementary Therapies in Medicine. 2016;26:128-135.
