Why Ease Has to Come Before Energy in Bendy Menopause
Pacing, Hypermobility, Dysautonomia, and Nervous System Load
Important note:
This article is for educational purposes only and is not medical advice. It does not replace individualized care from a qualified healthcare professional. Always consult your own clinician before making changes to medical treatment, exercise, or activity plans.
For many people with hypermobility, dysautonomia, or sensitive nervous systems, menopause marks a clear shift. Things that once felt neutral—walking, social plans, exercise, even “good stress”—suddenly come with a cost. Rest helps, but it doesn’t reliably restore energy. Recovery takes longer. Symptoms flare more easily. Tolerance feels unpredictable.
This pattern is common in what I call Bendy Menopause. Not because bodies are weak, but because physiologic margin is reduced. When that margin shrinks, pacing stops being a wellness concept and becomes a core clinical strategy.
What Pacing Actually Means
Pacing is an activity management approach that aims to prevent symptom exacerbation by matching demand to current capacity. It involves breaking activities into smaller segments, limiting cumulative load, and building in planned recovery—rather than relying on push-through-and-crash cycles.¹
Pacing has been studied most extensively in conditions like postural orthostatic tachycardia syndrome (POTS) and chronic fatigue, where overexertion reliably worsens symptoms and delays recovery.¹ While menopause-specific research is limited, pacing is especially relevant for people with hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS), particularly during physiologic transitions when autonomic regulation becomes less stable.
Pacing is not avoidance.
It’s a way of protecting nervous system capacity so tolerance can rebuild.
Why Hypermobility and Dysautonomia Matter Here
Hypermobility conditions frequently overlap with autonomic dysfunction, especially POTS. Clinical guidelines now explicitly recognize this, noting high rates of orthostatic intolerance, fatigue, gastrointestinal dysmotility, and cognitive symptoms in people with hEDS/HSD.²
POTS is characterized by excessive heart-rate increase on standing and often includes exercise intolerance, brain fog, and post-exertional symptom flares.³ Its physiology is complex, involving altered hemodynamics, impaired autonomic control, and disrupted cerebral blood flow regulation.⁴
Many hypermobile people compensate for years—until menopause reduces the buffering that made that compensation possible.
Menopause as an Autonomic Stress Test
The menopausal transition is increasingly understood as a period of autonomic nervous system disruption. Fluctuating and declining estrogen levels are associated with shifts in sympathetic–parasympathetic balance, contributing to changes in cardiovascular regulation, stress responsiveness, and cognition.⁵⁻⁶
People with POTS often report symptom worsening during low-estrogen phases of the menstrual cycle.³ Although POTS becomes less common after menopause, many experience a temporary worsening during perimenopause, suggesting that hormonal volatility—not just hormone loss—raises autonomic workload.
In bendy bodies, menopause often removes the margin that once kept symptoms contained.
Musculoskeletal Changes Add to the Load
More than 70% of women experience musculoskeletal symptoms during the menopausal transition, with about one-quarter reporting significant functional impairment.⁷ These changes—sometimes called the musculoskeletal syndrome of menopause—include joint pain, muscle loss, and reduced connective-tissue resilience.
For people who already have joint instability or hypermobility, this increases the energetic cost of posture and movement, making pacing even more important.
Exercise Still Matters—But the Dose Changes
Exercise remains an important part of dysautonomia management, including POTS. Structured programs that start in recumbent or semi-recumbent positions, progress gradually to upright activity, and include resistance training have been shown to improve symptoms and quality of life in the general POTS population.¹
Pacing is central to these programs and typically includes:
minimizing orthostatic stress early
breaking activity into manageable chunks
alternating exertion with planned recovery
progressing only as tolerance allows
Aerobic training has also been shown to improve cardiovascular autonomic function in postmenopausal women, supporting the role of appropriately dosed movement during this transition.⁶
The question isn’t whether movement happens—but how and when it happens.
Using Wearables to Support Pacing (Real-World Tools)
For many people with dysautonomia or hypermobility, internal warning signals lag behind exertion. Wearables can sometimes provide earlier feedback about cumulative stress.
I personally use a Garmin watch with heart-rate variability (HRV) tracking, paired with the Guava app to look at trends over time rather than day-to-day numbers.
What I noticed was consistent:
On days I walked more than ~8,000 steps, my HRV reliably dropped
Lower HRV reflected higher physiologic stress
Those days were more likely to be followed by fatigue, irritability, or pain
The takeaway wasn’t “walking is bad.”
It was: there’s a threshold where this activity stops being neutral and starts being stressful—for my body, at this stage of menopause.
That insight let me cap walking on certain days, intentionally alternate movement with recovery, and reduce cumulative load without eliminating activity.
Other Wearables and Apps People Use
Apple Watch, Fitbit, Oura, Lief– for HR, HRV, sleep, and recovery trends
Visible armband – specifically designed for pacing in energy-limiting conditions
Guava, Bearable – symptom and pattern tracking
These tools are best used for pattern recognition, not performance optimization.
A Quick Word on HRV
HRV reflects autonomic adaptability and is influenced by sleep, stress, inflammation, illness, and cumulative activity load.⁴ It has not been validated as a pacing guide for hypermobile individuals in menopause.
When used longitudinally and without rigid targets, it can support awareness—especially for people who struggle with interoception. The goal is information, not control.
What “Brain Retraining” Actually Is
Brain retraining—sometimes called limbic system retraining—is an umbrella term for programs that use structured cognitive, behavioral, and attentional techniques to reduce threat-based nervous system responses.
Most programs aim to:
decrease hypervigilance to bodily sensations
reduce fear-based amplification of symptoms
improve autonomic regulation through repetition and reframing
leverage neuroplasticity to soften chronic stress responses
These approaches draw from principles found in cognitive behavioral therapy, mindfulness, exposure therapy, and interoceptive awareness, though they vary widely in structure, intensity, and messaging.
They are not treatments for connective-tissue disorders, hormone deficiency, or dysautonomia itself. At best, they may help reduce secondary nervous-system amplification layered on top of physiologic conditions.
What the Evidence Shows (and Doesn’t)
There are no published studies examining brain retraining programs specifically in people with the combined presentation of hypermobility, dysautonomia, and menopause.
However, adjacent evidence is relevant:
An ongoing randomized trial is studying Altering Dynamics of Autonomic Processing Therapy (ADAPT) for anxiety in joint hypermobility, targeting catastrophization and autonomic prediction error.¹ Results are not yet published.
A pilot study in women with hEDS/HSD found that combining physical therapy with cognitive-behavioral therapy improved daily function, reduced fear of movement, and increased strength and endurance.²
In menopausal populations, CBT and mindfulness-based interventions show moderate-to-large benefits for anxiety, stress, sleep, and quality of life.⁴⁻⁶
This suggests overlap in mechanism, not proof of cure.
How I Use Brain-Based Tools Personally
On a practical level, I use the Curable app myself. I find it helpful for calm, relaxation, and gently challenging negative or fear-based beliefs that often build up around chronic pain. What I appreciate is that the focus isn’t on ignoring symptoms or pushing through them, but on reducing background threat so the nervous system has more room to settle.
I explore similar themes in my individual hypnotherapy sessions, particularly around safety, predictability, and reducing the constant “bracing” that many bendy bodies live with.
Some patients also explore programs like Gupta or Primal Trust, which combine education, nervous-system regulation practices, and cognitive reframing. Response is highly individual. These tools work best when they are:
optional, not mandatory
paced and gentle
used alongside medical and physical care—not instead of it
They become harmful when framed as cures, moral obligations, or proof that symptoms are “all in the brain.”
Why Ease Comes Before Energy
Rest can lower symptoms temporarily.
Pacing reduces background autonomic strain.
Safety allows capacity to rebuild.
In Bendy Menopause, ease is not indulgence. It’s the foundation that makes energy possible.
Bottom Line
Evidence supports structured, paced activity for dysautonomia management and recognizes the autonomic and musculoskeletal changes of menopause. For people with hypermobility and sensitive nervous systems, pacing is a foundational, evidence-aligned strategy—not because bodies are fragile, but because physiologic margin is temporarily reduced.
Individualized care still matters. There is no single right tool—only patterns, feedback, and support.
References:
Peebles KC et al. Autonomic Neuroscience. 2024.
Aziz Q et al. Clinical Gastroenterology and Hepatology. 2025.
Bryarly M et al. Journal of the American College of Cardiology. 2019.
Fitzgibbon-Collins LK et al. Autonomic Neuroscience. 2025.
Schwarz KG et al. Journal of Physiology. 2023.
Souza HC, Tezini GC. Aging and Disease. 2013.
Wright VJ et al. Climacteric. 2024.
