If I had time machine, I think I would be tempted to go back to 2009 and have a stern word with myself. At the time, I was writing my dissertation on the “A Self-Determination Theory-Based Investigation Of Barriers to Exercise Faced By Peri- And Post-Menopausal Women”. Little did I know then at the age of 47 what was ahead.
Back in 2009, I was working as Personal Trainer (amongst many other things) and noticed an increase of women who wanted to exercise due to excess weight gained by going through or being in, the menopause. I thought it would be a good subject to study, and took the stance that the menopause provided a good opportunity to change, as in a driver to improve health, but without realising what the menopause really was. I could write a much better dissertation now that I am 59!
You have probably chosen to read this today as you are a) either going through the menopause and want to find anything that will help you manage the changes you are going through, or b) you love exercise and hope that this love of exercise will help you manage the menopause or maybe c), you wife/partner/colleague is going through the menopause and you hope you can find out something that will help them. Which ever one it is, then I hope that this next hour will give you some useful and practical information that will be of benefit.
All humans face a variety of barriers to exercising effectively and living healthily however, certain groups face more barriers than others, with important consequences for health and well-being. Peri- and post-menopausal women can be seen as a particularly susceptible group, and there is a need to identify and propose solutions to overcoming the difficulties of the menopause – especially if you are unable to take HRT.
Like many of you, I feel that menopause is almost like the dirty secret that was once mental health – but we know things can change and with a huge increase in the number of females over 50 now in the workplace, there is a growing need to be able to talk about these issues freely.
In 2015 a government statistical paper indicated that whilst only 16.9% of women over 50 were still in the workplace – this has now grown to 78.3%. Life changes mean that now women are more likely to be independent, alongside the more worrying lack of pension and having to work extra in order to be able to survive.
It is therefore becoming more of a topic of discussion – let’s face it, for many, menopause is tough. It is tough for the woman, for their partner (who also might be a woman of a similar age), families and work colleagues. There are currently around 3.5 million women in the workplace over the age of 50, and 1 in 4 experience such bad symptoms that menopause is soon to be classes as a disability - ACAS 2021
So, what is the menopause?
You might already be aware of the menopause and the effect it has on both your physical body and your mental health – and the menopause represents a key moment in the life of the human female body; a time when fertility comes to its natural end, and when significant body changes occur that can affect both your physical health and your psychological wellbeing.
The menopause is triggered by a gradual reduction of hormonal level due to the failure of the ovaries to produce sufficient oestrogen. This can be attributed either to natural causes or to external factors such as hysterectomy or chemotherapy.
Hot flushes are a common complaint of menopause and are distinguished by the sudden sensation of heat, ranging from warm to intense that is often accompanied a burning feeling and flushing to the face and chest, slight heart palpitations, and prickling skin - and we then sweat to cool down the heat.
Unfortunately, as these episodes can occur at any time of the day or night, sleep deprivation, fatigue and mood changes are common side effects of night sweats.
In addition to this, there can sometimes be a of loss of “femininity”, self-worth, and sexuality due to the lack of oestrogen and progesterone that can affect libido and comfort. It is one of the many symptoms that I felt no-one talks to you about and the “grief” you feel for the loss of your femininity.
The intensity and frequency of these perimenopausal symptoms not only affect women as the go through the transitional phase, but can often remain at a high level throughout the menopause phase which may last many years
Looking after your heart
In addition to regulating the menstrual cycle, oestrogen plays an important role in the cardiovascular system
Oestrogen stimulates prostacyclin which encourages our blood vessels to open up and help transport the oxygen around the body.
This opening of the vessels reduces the possibility of “hardening” or clogging of the arteries which can lead to coronary heart disease.
The effect of increased oestrogen on the our heart system can be seen in the as research indicates that there is up to a 50% reduction in the risk of coronary heart disease in post-menopausal women who take HRT.
Increased intra-abdominal fat, which is often seen in the menopause and sometimes referred to as “middle age spread” can also be linked to coronary heart disease.
As fat redistributes and the body changes shape, it is likely during the peri- and post-menopause, women can feel self-conscious and vulnerable, which leads to lack the self-esteem to take up exercise – but never fear, as there are ways to get around this. I have found online exercise to be fabulous as you can feel free to workout without having to worry about what you look like x
However, exercise can also diminish the physical symptoms and psychological distress associated with the menopausal transition
Women who were physically active in both the peri- and post-menopausal stage report less severe of symptoms, as well as improved psychological well-being and higher levels of self-worth.
If peri- and post-menopausal women can be encouraged to take part in exercise sessions, they should therefore experience direct benefits to their general health and a reduction in their adverse menopausal symptoms.
There should also be benefits to mood and improvements in quality of life that follows as a result of physical activity
Although mood can be affected by both lack of oestrogen and fatigue brought on by night sweats that disrupt sleep patterns, exercise can stimulate brain chemicals that elevate mood & alertness. For example, Attipoe et al. (2008) noted that stress levels reduced in menopausal women who partook in aerobic activity regardless of whether they were on HRT or not
Exercise has been shown to help ease the symptoms of menopause:
Baily et al 2015 found that exercise reduced the severity of the flush due to the body being more able to deal with the “heat” and “sweat” process that the body goes through – which is similar to what happens when you exercise. For sure, when you exercise this process is gradual so that you have time to get used to it (!) unlike a hot flush which can happen within 10 seconds and repeat 10 times a day – but, and it is a useful but, teaching your body to regulate heat is a good thing as it reduces the experience of the hot flush.
Protecting your Bone Mass
Osteoporosis is often described as the “silent crippler” or “silent epidemic”. Indeed, the scale of the ‘epidemic’ is set to grow as the world’s population ages. For example, it is expected that women in the over-fifty range will increase by 30 – 40 % between 1990 and 2025
In particular, the disease affects trabecular bone, which is a porous bone type forming the spine and articulating joints. The body continuously recycles bone mass throughout its life, although the rate of recycling peaks during youth and decreases after the age of 30.
Osteoclasts are responsible for the demineralisation of old bone cells, performing the important job of eliminating damaged tissue (broken bones) and dying cells. These processes, however, are age-related and degeneration outstrips mineralisation
This ageing effect a fragile bone structure, and loss of bone mass (osteopenia) and muscle mass (sarcopenia) brings about a loss of range of motion and strength. Due to the reduction in oestrogen, women become more susceptible to osteopenia and osteoporosis without intervention – and this needs to be both diet and exercise. Please see my other post for more information on this. x
The pelvic floor forms part of the group of muscles that make up the core. They fire alongside our main abdominal muscles and work with the diaphragm. When we hit the menopause, we lose the protective measure of oestrogen to support the body – basically we get loss of ligamentation strength to hold everything in place.
Childbirth, being overweight, doing high impact sport, having continuous coughing, menopause, and other surgery such as hysterectomy can all have a detrimental effect on our pelvic floor.
Sometimes, women will reduce their water intake because of problems with the pelvic floor, but this in the long run is not conducive to our overall health. So, there are great physical & psychological reasons to keep hydration - from improving our ability to process food, stop us being constipated, increasing the “plumpness” of your skin, helping you sleep better. Whichever way you look at it, drinking plenty of water is going to have a positive effect on your health.
During perimenopause and menopause, your oestrogen levels drop dramatically. This can cause your pelvic floor to weaken. Low oestrogen levels may also contribute to muscular pressure around your urethra - and also may lead to thinning of the bladder and urethral linings and possibly cause chronic dysuria (painful wee) and an increased incidence of urinary tract infections
Benefits of exercise
o Improved general health overall
o Protection against coronary heart disease
o Helps to lift your mood
o Heat helps you withstand hot flush
o Melatonin for improved sleep
o Dopamine – naturally reduces during aging, but speed up without oestrogen
o Even if on HRT, you still need to exercise
Buy bigger shoes – you are going to get hot, and your feet will swell, and they get hot too
Buy sport socks with arch support, do not let aching feet get in the way of your exercise
Buy a better bra – more bounce as you get older - declining oestrogen levels at the menopause make breast tissue dehydrated and less elastic, so your breasts lose their once rounded shape and begin to sag a little...
Take Iced water with you – shove it in your bra or on your head as well as drink
Do weights – there is increased risk of osteoporosis – fragility fracture, so weight bearing exercise can help.
Do flexibility - Pilates – joint pain Menopause may cause joint pain that can affect the knees, shoulders, neck, elbows, or hands. Old joint injuries may begin to ache. As time goes on, you may start to notice that you feel more aches and pains in those areas than you used to. That's because oestrogen helps to reduce inflammation
Depression – our neurotransmitters make us feel better when we exercise – and in one study, it was noted that women who were given anti-depressants during the menopause (but without depression) had no effect on improving “mood” – but exercise does.
Benefits of walking – exercise does not have to be “hard” and there are many studies to support low to moderate exercise
So, no matter at what stage of the menopause you are in, think about including some exercise to help you deal with the Menopause. I have a series of courses coming up in 2022 - short half day workshops about the affect of the menopause on physical and mental health, a course for Fitness Professionals to help with clients and then a 6-week Café
with structured exercise and advice.