Moving Beyond Menopause
Menopause gets painted with a pretty dirty brush. Hot flushes, mood changes, vaginal dryness, weight gain, pelvic floor dysfunction and incontinence, joint pain, muscle weakness, sleep disturbance, loss of libido. Despite the advice from those who have gallantly gone before us that reaching ‘The Menopause,’ (that point at which menstruation ceases, which can only be confirmed with certainty 12 months after the last period), will bring with it transformation and ‘peace,’ the journey to get there sounds pretty horrid.
So what to do? Is there a safe path through the mess that can be perimenopause (noting that many women seem to journey through fairly unscathed)?
There are some amazing resources and websites that discuss in detail all treatment options available to manage symptoms of perimenopause. One of my ‘go-tos’ is the website of the Australian Menopause Society. Do yourself a favour and check it out.
But. When it comes to musculoskeletal health during perimenopause and postmenopause, here at WHEN we do have some information that might be of use.
Menopause has a known and generally negative impact on overall muscle and bone health. It is associated with osteoporosis (bones become weaker and brittle), osteoarthritis (degeneration of joints leading to pain, inflammation and stiffness) and sarcopenia (think muscle wasting or thinning and loss of muscle function. Sarcopenia can happen regardless of your weight or size too. All of these issues are contributed to by the primary driver of menopause – loss of the hormone oestrogen. Poor musculoskeletal health can progress to frailty and an increased risk of falls and fractures which in turn is associated with increased risk of death and other disease.
Unfortunately studies have shown mixed results for management of menopausal symptoms with lifestyle changes. However, whilst exercise might not help your hot flushes or night sweats, it can help with building and maintaining muscle strength, reducing risk of falls, preventing or slowing bone loss, improving musculoskeletal function, supporting mental wellness and manage pain. Even better, regular exercise in middle age helps protect against muscle weakness later in life.
So what is best? There is some evidence providing guidance around the best type of exercises and movement to do and how often. There are four main types of exercise suggested:
aerobic activity for heart health:
flexibility based exercises or stretching
strength training
balance and posture exercises
Aerobic activity
There are so many options! Walking, cycling, gardening...just make sure that whatever you are doing feels right for your body. You may gain increased benefits if you include interval training or speed play, but this does not have to be running or sprinting! It can be as simple as picking an object ahead of you and trying to pick up your walking pace slightly until you reach that point then reducing back to a moderate walking pace. At WHEN we like to use the Borg’s talk test as a guide (link). Aim for at least a few times a week for around 30minutes (doesn’t have to be all at once!), but if you can fit in some form of aerobic movement in every day that is great!
Strength training
Around age 30 you begin losing approximately 1% of your muscle mass each year. Which is important because muscles have a role in burning fat and also in keeping your bones healthy. Strength training doesn’t have to be heavy weights! It can be as simple as body-weight exercises or resistance based training and should involve all major muscle groups (legs, arms, core (including tummy and back muscles), buttocks). As you get stronger you need to increase the amount of resistance to keep building strength.
Balance and posture
Balance and posture are so very important! A healthy functioning spine allows the rest of the musculoskeletal system to function well. Pilates, Tai chi and yoga are all great forms of exercise to support this. Or working with a physiotherapist or exercise physiologist. We suggest aiming for at least 1-2 sessions a week.
Stretching
This need not be onerous! Even a few brief stretch breaks every day can make a difference (especially if you are still working with a lot of time sitting down). Muscles and tendons in the bottom are prone to stiffness and tightness if kept in one position for too long and staying flexible is a task which requires active attention as we get older. In our 30s, my partner and I have taken to having ‘stretch chats’ after the kids are in bed – we make tea, hang out in the kitchen, catch up on the day and stretch all at the same time!
Remember: it is never too late to start! If you are beginning a new exercise program or have health concerns or haven’t exercise in a long time we strongly recommend you check in with your doctor first and try and start with supervised exercise sessions to ensure you are doing the exercises in the safest and most effective way. If you already know you have osteoporosis, keep to low impact exercise and avoid activities that risk falls.
Exercise and movement should come from a place of positivity and not obligation. If it doesn’t feel right, find a way to move that does feel right. Seek support or professional guidance. Find a friend to team up with. Don’t worry about what the person next to you is doing. Oh, and my last comment? Prioritise sleep! A tired body doesn’t move well!
REFERENCES:
MISHRA N, MISHRA VN, DEVANSHI. EXERCISE BEYOND MENOPAUSE: DOS AND DON'TS. J MIDLIFE HEALTH. 2011 JUL;2(2):51-6. DOI: 10.4103/0976-7800.92524. PMID: 22408332; PMCID: PMC3296386.
CALEJJA-AGIUS, JEAN & BRINCAT, MARK. (2014). MENOPAUSE-RELATED CHANGES IN THE MUSCULOSKELETAL SYSTEM, CARTILAGES AND JOINTS. 10.1007/978-3-319-03494-2_19.
WATT, F. MUSCULOSKELETAL PAIN AND MENOPAUSE. POST REPRODUCTIVE HEALTH 2018, VOL. 24(1) 34–43DOI: 10.1177/2053369118757537
PREVALENCE OF SARCOPENIA AND ITS ASSOCIATION WITH EXERCISE HABITS IN THE ELDERLY OF JAPANESE POPULATION-BASED COHORTS: THE ROAD STUDY, OSTEOPOROSIS INT, VOL. 2, SUPPL. 4, DOI 10.1007/S00198-013-2536-X
AUTHOR: DR RHEA PSERECKIS
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