The menopause will affect every menstruating woman at some point in their life. It is an entirely natural and normal process, however the symptoms and side effects can be all-consuming and debilitating.
Women’s Health Physiotherapists Emily Russell and Tina Mason explain how women can best prepare for and manage menopause symptoms with simple lifestyle modifications and exercise.
Symptoms of peri-menopause can be vast, with some individuals experiencing none or only a few symptoms, and some experiencing them all. We always recommend individuals to speak to their GP or healthcare provider if they are struggling with symptoms, as there is a lot that can be done to help. In addition to this, one of the most important things you can do is exercise. Women should treat this transitional time as a reminder to take good care of themselves. Read on for our top tips on managing the symptoms of peri-menopause and menopause with exercise and lifestyle changes.
Why Exercise?
The World Health Organisation recommends all adults should complete at least 150 minutes of aerobic activity (eg brisk walking, running, swimming) and strength training at least twice each week. Research from Sport England on Women in Sport (2000) highlighted that 39% of adult women are inactive (not meeting these guidelines). We always recommend seeking advice from your GP, Physiotherapist or Health Professional when starting a new exercise regime, particularly if individuals have any health concerns or past medical history which might need to be considered.
Regular exercise at any point in a Woman’s life has many benefits, particularly around the menopause these include:
Helping maintain a healthy weight and improving fitness
Midlife weight gain, especially around the waist, is exacerbated by the decline in Oestrogen and Progesterone that the menopause brings. Regular exercise can help minimise weight gain, a common midlife complaint. Being overweight increases the risk of heart disease and type 2 diabetes.
Clinical guidelines advise a minimum of 30 minutes of daily moderate activity. This might be brisk walking where you are able to hold short a conversation, targeting a heart rate which equates to aerobic training (80-85% max heart rate). You can estimate your maximum heart rate by subtracting your age from 220. For example a 50 year old’s maximum heart rate would be 220-50 = 170 beats per minute. Exercising at this level should get your heart pumping but not leave you feeling excessively out of breath or exhausted.
Regular aerobic exercise can increase cardiorespiratory function, minimising the risk of high blood pressure, heart attacks and strokes. Being a healthy weight will also minimise these risks.
If you are starting from scratch and 30 minutes each day feels unmanageable, there is evidence to support starting with short intervals of training (eg 10 minutes) then gradually building up can be effective.
Strengthening muscles
As we age, there is a decline in muscle function and size. Again this is exacerbated by peri-menopause and into menopause, therefore the stronger our baseline in early adult life, the less we notice these effects of ageing.
Oestrogen and Progesterone protect the function of the nerves which control our muscles, meaning that when there is a fluctuation of these hormones it is harder to generate effective and maximal muscle contractions. This makes it harder to maintain and increase muscle strength and size, however it is not impossible. Although we can’t prevent ageing, our musculoskeletal system is clever at adapting to compensate and help counteract the ageing effect.
We recommend peri-menopausal and menopausal women complete three 30 minute strength training sessions each week. This doesn’t necessarily need to mean going to the gym or having lots of equipment. Exercises such as Pilates or using resistance bands to add challenge to your workout can be just as effective. Strength training should be progressive (it should gradually be made harder) so your muscles can adapt and strengthen in response.
Joint pain and muscle ache are common symptoms of peri-menopause and menopause. Aches and pains increase with increasing age, and this can be exacerbated during peri-menopause due to the gradual decline of Oestrogen. There are Oestrogen receptors in joints and Oestrogen plays an important role in keeping joint inflammation low. Joint pain often presents in the morning and improves with movement. During the peri-menopause joint pain may present just before a period and individuals often describe that old joint injuries become painful after years of no bother. Physiotherapists will often prescribe joint-protecting strengthening exercises to help minimise this often reported symptom. Individuals often describe that their body feels tight, or muscles feel tender. Oestrogen plays a key role in regulating the levels of cortisol (the stress hormone) in the body. When oestrogen levels are low, the stress hormone levels can rise which can commonly lead to muscles tensing up or becoming over-active. Oestrogen also affects magnesium levels (which is vital for normal muscle function and relaxation). Fluctuating and falling levels of progesterone also impacts on our ability to relax.
Strengthening bones
Strength training and impact exercise such as walking or running can help offset the ageing effect of declining bone mass and help reduce the risk of Osteopenia & Osteoporosis. Osteopenia is the start of osteoporosis and Osteoporosis is a condition where your bones lose density and therefore strength which leads to an increase risk of bone fractures or breaks. Osteoporosis is common, it affects women more than men: almost 25% of women age 60-64 and almost 40% age 70-75 are diagnosed with Osteoporosis.
You can minimise the risk of developing Osteoporosis by:
Maintaining a healthy weight (those with a BMI of less than 18.5 are at greater risk)
Not smoking
Not drinking excessive amounts of alcohol (the NHS recommends not drinking more than 14 units of alcohol in a week and having several alcohol free days each week)
Eating a healthy balanced diet, considering supplements to ensure you have enough protein, calcium and vitamin D
Being physically active during your 20s whilst your body is building strong bones
Completing 2 or 3 progressive strength training sessions per week (ideally combined with some impact or weight bearing exercise such as walking or jogging) can increase bone density in post menopausal women after 4-6 months. Bones are able to increase in strength (albeit slowly post menopause) if the muscles attaching to them are strong and robust.
Alongside these recommendations, maintaining a healthy body weight has also been shown to minimise vertebral (spinal) bone loss in early menopause which minimises the risk of Osteoporotic spinal fractures.
Improving mood and well-being
Combined with the reduction in the calming hormone Progesterone, the declining levels of Oestrogen can result in individuals feeling like they are in a constant state of pre-menstrual tension. These are commonly described as irritability, feelings of sadness, lack of motivation, anxiety, depression and panic attacks.
Alongside this, insomnia and sleep issues are common in menopausal women and tend to exacerbate or worsen many other symptoms.
During episodes of stress or anxiousness, our bodies switch on our sympathetic nervous system. This is also know as the “Fight, flight or freeze” state that allows us to escape danger. Our bodies are flooded with adrenaline and cortisol leading to increasing heart rate, blood pressure and releasing more sugar into the blood stream. This is essential if we were to be attacked by a lion but if adrenaline and cortisol levels are maintained at a high level for a long period of time, this increases the risk of heart attack and stroke, weight gain, insomnia and further anxiety. Oestrogen helps to keep cortisol in check but when oestrogen levels drop, cortisol levels rise.
Regular exercise has been repeatedly shown as an effective tool for improving mood and reducing stress and anxiety. Exercise decreases the levels of these stress hormones and stimulates the parasympathetic nervous system leading to the production of endorphins, the bodies natural mood elevators and pain killers.
Breath work, meditation, yoga or mindfulness are also good techniques to help decrease anxiety and stress. Checking in on your breathing helps to stimulate your vagal nerve, activating your parasympathetic nervous system, and allowing your body to relax.
A simple way to help stimulate your vagal nerve is to sit in a relaxed position, close your eyes and try to take a bring breath in through your nose for a count of 3 and then slowly release this breath out through your mouth for a count of 6. Repeat this until you feel your body and mind relax.
In Summary
It is never too late to start exercising. Although best practice tells us that all women should be preparing for their menopause years by maximising their fitness, muscle and bone strength in early adult life… it is never too late to make positive changes.
If you are new to exercise or not sure what is safe, seek help from a specialist Physiotherapist or Health Care provider. This is particularly relevant for those with medical history such as high blood pressure, heart problems or metabolic conditions and those who are at risk of Osteoporosis. Physiotherapists and other trained professionals will be able to safely prescribe and adapt exercises where necessary.
The key to successfully incorporating exercise into your life is to start safely and gently with activities you enjoy and can sustain. Women can and should enjoy a good quality of life after menopause. Exercise is a safe and effective method to help improve many of the common menopause symptoms.
Coming soon, a further blogpost on looking after your pelvic floor through peri-menopause and menopause.
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