This article was written by one of The Food Medic team; female health writer – Kelly McNulty
Unfortunately, there is little guidance for women when it comes to staying active during perimenopause, menopause and beyond. However, staying active during this time of your life is so important not only for the usual benefits that exercise provides – but also for additional menopause-related reasons, including improved symptoms, bone health, and heart health (just to name a few).
The time around the menopause can be divided into three main stages:
- Perimenopause: The time before menopause when female sex hormones (namely, oestrogen) start to decline and often, as a result, begin to fluctuate wildly. Typically, this occurs in your 40s, and lasts for an average of 4 to 7 years (1), although everyone is different
- Menopause: This is when you’ve not had a period for at least 12 consecutive months (for no other medical reason) During this time, ovulation stops entirely, and oestrogen levels decline significantly. The average age of menopause is 51 in the UK, but it can happen earlier or later (2)
- Post menopause: This is the time following menopause which we spend on average one third of our lives in (3)
Research shows that around 3 in 4 of us will experience symptoms during the time around menopause and beyond. Common symptoms experienced during perimenopause include changes in your ‘normal’ cycle, like more frequent or irregular cycles and heavier or lighter periods, as well as other physical and emotional symptoms, such as:
- Hot flushes and night sweats
- Muscle and joint pain
- Changes in metabolism resulting in weight gain
- Mood swings, including anxiety and irritability and other psychological symptoms
- Changes in memory or ‘brain fog’
Whilst the symptoms experienced during perimenopause might reduce as you reach menopause, a range of other symptoms and health conditions might be present post menopause because of low hormone levels, including (5):
- Increased risk of osteoporosis
- Increased risk of heart disease
- Issues with memory, including an increased risk of dementia
- Difficulty sleeping
- Urinary incontinence
- Sexual issues, such as reduced libido, vaginal dryness, and atrophy.
*Reminder: Tracking any symptoms you experience daily will be useful for discussing any concerns with your doctor/GP.
A role for exercise?
Whilst there are several treatments available to help with menopausal symptoms, such as hormonal replacement therapy (HRT), complimentary therapies (i.e., cognitive behavioural therapy), and antidepressants and other medications, it’s thought that there is a role for lifestyle changes (3).
For example, research shows that making healthy food choices, taking part in regular exercise, managing stress, and getting enough high-quality sleep can help with symptom management. With this in mind, let’s dive into our top tips for staying active during this stage of your life…
Beat the heat
Hot flushes, including night sweats, are one of the most common symptoms of menopause, with around 80% of women experiencing this symptom during this time (6). Whilst evidence investigating the influence of exercise on vasomotor symptoms, such as hot flushes is conflicting, there are a few studies that have found positive effects. For example, some research shows regular exercise (both cardio and strength training) can help to reduce both the frequency and severity of hot flushes by improving your thermoregulatory system control, lowering your core body temperature, and improving mechanisms for heat dissipation (7-10). Additionally, if you experience hot flushes during exercise there are several strategies you can adopt to prevent them from impacting your training.
For example, consider reducing exercise intensity and cooling strategies prior to exercise, stay well hydrated, wear breathable clothing, and keep your environment cool.
Optimise your bone health
Bone health is an important factor to consider around the time of the menopause, as bone turnover (aka the balance between bone resorption and bone formation) is modulated partly by our hormones. For instance, oestrogen plays a vital role in the development and maintenance of bone mineral density (BMD) (11). When oestrogen levels decline around menopause research highlights that women can lose between 2 to 3% of bone mass per year (3), which can result in reduced bone health making us more susceptible to conditions, such as osteoporosis (i.e., the thinning of the bones, causing them to become less dense and strong, which can make them more fragile and likely to break). Regular weight-bearing and muscle-strengthening exercise can help to reduce the risk of poor bone health and negative health conditions.
For instance, studies have shown that post-menopausal woman can not only maintain but increase BMD with rigorous strength and high-impact training (12-14). As such, taking part in high-impact and weight-bearing exercise, such as walking, running and bodyweight exercises is advocated to be one of the best tools to increase bone mass and prevent its loss (15).
Minimise strength loss
Research demonstrates that oestrogen plays a key role in mus cle function, maintenance, and overall strength (16). As such, when your oestrogen levels begin to decline around perimenopause so too can our muscle mass and strength (17-19), which can increase our risk of conditions, such as sarcopenia (20). Therefore, regularly partaking in muscle-strengthening exercises is essential to prevent muscle mass and strength loss. Additionally, oestrogen plays a vital role in muscle repair and recovery, and declining oestrogen levels around menopause might affect our body’s ability to respond, recovery and adapt to training (21). But further research is needed before accurate conclusions can be made and what this might mean for training.
*Bonus: Strength training also boosts your metabolism which could help you to avoid any weight gain during this time (21)
Strengthen your heart and blood vessels
Declining oestrogen levels around menopause can influence our heart and blood vessels which could increase your chances of cardiovascular disease. In fact, after the menopause cardiovascular disease is the leading cause of death in women in the UK (22). But it’s not all bad news, as we can reduce the risk and even strengthen our cardiorespiratory systems through exercise (23). For example, you should aim for at least 150 minutes (which equates to just over 20 mins per day) of moderate-intensity, aerobic exercise per week to help prevent heart disease, and if 150 minutes feels daunting at first, then start small and build up to it. Walking, cycling, running, or swimming are all good aerobic exercises, but importantly you should find exercise that you enjoy and fits with your life!
Bonus: In addition to improving our cardiovascular system, studies show that women who engage in regular aerobic exercise have fewer menopausal symptoms (24).
Protect your pelvic floor
Your pelvic floor muscles are located at the bottom of your pelvis and help to keep your pelvic organs (i.e., bladder, uterus, and bowel) in position. Whilst pelvic floor issues (e.g., urinary incontinence, urge incontinence, and a heavy feeling in your vagina) might not be the most obvious menopause symptoms they can be exacerbated during this time because of changing hormone levels. Importantly, this does not have to be an inevitable part of ageing, and there are things you can do to improve your pelvic floor health. For instance, keeping your pelvic floor muscles strong and active through pelvic floor exercises (i.e., Kegels) can help reduce the likelihood of dysfunctions.
*If you experience any pelvic floor issues, the best advice is to seek specialist advice from a pelvic health specialist ASAP.
Overall, the available research suggests that it’s important for women to stay active during perimenopause, menopause, and beyond to not only ease menopausal symptoms, but as an effective strategy to reduce the risk of negative conditions, such as osteoporosis, sarcopenia, and heart disease. Importantly, if you have any questions or concerns about your experience of menopause, you should speak with your doctor/GP so that you can decide what is best for you.
- Balance. (2022). What is the Menopause? https://balance-menopause.com/uploads/2021/09/What-is-the-menopause.pdf Accessed on 21st February 2022.
- FPA. (2020). Your Guide to Menopause.
- Kay, P. (2020). The M Word: Everything You Need to Know About the Menopause. Summersdale: UK.
- Rock My Menopause. (2022). Symptoms of the Menopause. https://rockmymenopause.com/portfolio-item/symptoms-of-the-menopause/ Accessed on 21st February 2022.
- Rock My Menopause. (2022). Life After Menopause. https://rockmymenopause.com/get-informed/life-after-menopause/ Accessed on 21st February 2022.
- Bansal, R., & Aggarwal, N. (2019). Menopausal hot flashes: a concise review. Journal of Mid-life Health, 10(1), 6.
- Bailey, T. G., Cable, N. T., Aziz, N., Dobson, R., Sprung, V. S., Low, D. A., & Jones, H. (2016). Exercise training reduces the frequency of menopausal hot flushes by improving thermoregulatory control. Menopause, 23(7), 708-718.
- Berin, E., Hammar, M., Lindblom, H., Lindh-Åstrand, L., Rubér, M., & Holm, A. C. S. (2019). Resistance training for hot flushes in postmenopausal women: a randomised controlled trial. Maturitas, 126, 55-60.
- Daley, A. J., Thomas, A., Roalfe, A. K., Stokes‐Lampard, H., Coleman, S., Rees, M., … & MacArthur, C. (2015). The effectiveness of exercise as treatment for vasomotor menopausal symptoms: randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 122(4), 565-575.
- Lindh-Åstrand, L., Nedstrand, E., Wyon, Y., & Hammar, M. (2004). Vasomotor symptoms and quality of life in previously sedentary postmenopausal women randomised to physical activity or estrogen therapy. Maturitas, 48(2), 97-105.
- Compston, J. E. (2001). Sex steroids and bone. Physiological Reviews, 81(1), 419-447.
- Engelke, K., Kemmler, W., Lauber, D., Beeskow, C., Pintag, R., & Kalender, W. A. (2006). Exercise maintains bone density at spine and hip EFOPS: a 3-year longitudinal study in early postmenopausal women. Osteoporosis International, 17(1), 133-142.
- Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2018). High‐intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research, 33(2), 211-220.
- Pruitt, L. A., Jackson, R. D., Bartels, R. L., & Lehnhard, H. J. (1992). Weight‐training effects on bone mineral density in early postmenopausal women. Journal of Bone and Mineral Research, 7(2), 179-185.
- Weaver, C. M., Gordon, C. M., Janz, K. F., Kalkwarf, H. J., Lappe, J. M., Lewis, R., … & Zemel, B. S. (2016). The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis International, 27(4), 1281-1386.
- Lowe, D. A., Baltgalvis, K. A., & Greising, S. M. (2010). Mechanisms behind estrogens’ beneficial effect on muscle strength in females. Exercise and Sport Sciences Reviews, 38(2), 61.
- Bondarev, D., Laakkonen, E. K., Finni, T., Kokko, K., Kujala, U. M., Aukee, P., … & Sipilä, S. (2018). Physical performance in relation to menopause status and physical activity. Menopause, 25(12), 1432-1441.
- Juppi, H. K., Sipilä, S., Cronin, N. J., Karvinen, S., Karppinen, J. E., Tammelin, T. H., … & Laakkonen, E. K. (2020). Role of menopausal transition and physical activity in loss of lean and muscle mass: a follow-up study in middle-aged Finnish women. Journal of Clinical Medicine, 9(5), 1588.
- Maltais, M. L., Desroches, J., & Dionne, I. J. (2009). Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact, 9(4), 186-97.
- Messier, V., Rabasa-Lhoret, R., Barbat-Artigas, S., Elisha, B., Karelis, A. D., & Aubertin-Leheudre, M. (2011). Menopause and sarcopenia: a potential role for sex hormones. Maturitas, 68(4), 331-336.
- Romero-Parra, N., Maestre-Cascales, C., Marín-Jiménez, N., Rael, B., Alfaro-Magallanes, V. M., Cupeiro, R., & Peinado, A. B. (2021). Exercise-induced muscle damage in postmenopausal well-trained women. Sports Health, 13(6), 613-621.
- Mishra, N., & VN Mishra, D. (2011). Exercise beyond menopause: Dos and Don’ts. Journal of mid-life health, 2(2), 51.
- Menopause Matters. (2022). Heart disease: What is CVD? https://www.menopausematters.co.uk/cvd.php Accessed on 21st February 2022.
- Nyberg, M., Seidelin, K., Andersen, T. R., Overby, N. N., Hellsten, Y., & Bangsbo, J. (2014). Biomarkers of vascular function in premenopausal and recent postmenopausal women of similar age: effect of exercise training. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 306(7), R510-R517.
- Moilanen, J. M., Mikkola, T. S., Raitanen, J. A., Heinonen, R. H., Tomas, E. I., Nygård, C. H., & Luoto, R. M. (2012). Effect of aerobic training on menopausal symptoms—a randomized controlled trial. Menopause, 19(6), 691-696.