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Navigating menopause through fitness


Image of a Semaglutide injection kit.

The blog is based on a panel discussion titled "Menopause & Health: Advice from the Experts" organised by UFIT in Singapore. The panel consisted of Tash Mirando (GP), Terri Forward (Fitness Coach), and Ellie Cheale (Dietician).


Menopause is a natural phase of life that every woman goes through. The hormonal changes that occur during this time can significantly impact various aspects of a woman's health and well-being.


In this blog, we will discuss what menopause is, what symptoms most women can expect to face, and the role of Hormone Replacement Therapy and/or lifestyle changes in managing those symptoms.


And, gentleman, if you've made it this far and are about to leave, consider reading on—this information's not just for the ladies. Understanding menopause and how you can help women manage it can better equip you to offer them empathy and support.



Understanding menopause

Menopause usually occurs in women aged 45–55 (the average age is 51). It's not an overnight event; it's a process that occurs in stages over time. These include:

  • Pre-menopause: The time between when a woman hits puberty and experiences the first signs of perimenopause.

  • Perimenopause: The transition between a woman's last regular period and when periods stop. It lasts around 3–5 years, but that can be shorter for some and much longer for others. This is when women will experience various symptoms, including irregular periods, hot flashes, poor sleep quality, mood swings, joint discomfort, and decreased fertility and libido.

  • Menopause: Menopause is officially diagnosed when a woman has not had a period for 12 consecutive months. The symptoms of perimenopause will often persist into menopause, however, the main change is that pregnancy can no longer naturally occur.

  • Post-menopause: The time after menopause has occurred.

A graph showing the stages of menopause

Menopause's impact on hormones

Menopause involves a significant reduction in the production of sexual hormones, including oestrogen, progesterone, and testosterone. These hormonal changes are primarily responsible for the symptoms women experience during the perimenopause and menopause stages.


Oestrogen plays a crucial role in regulating mood, bone density, and muscle mass. Its decline can lead to mood swings, increased risk of osteoporosis (causing bones to become weak and brittle), and changes in body composition (the proportion of fat and non-fat mass in the body).


Progesterone helps maintain the uterine lining (a specialised tissue of the uterus that thickens each month in preparation for a potential pregnancy) and contributes to emotional well-being. Its decline can result in irregularities in a woman's menstrual cycle as well as anxiety and depression.


Testosterone, a hormone commonly associated with men, is also produced in women and plays a role in maintaining libido, muscle mass, and energy levels. Its decline can contribute to muscle loss, and a decrease in sexual desire and energy.



Understanding and addressing these hormonal changes is crucial for managing the physical and emotional symptoms associated with menopause. Hormone replacement therapy and/or lifestyle changes are considerations to help restore hormonal balance, alleviate symptoms, and improve quality of life.


Hormone Replacement Therapy (HRT)

HRT is often misunderstood and surrounded by misconceptions. While it may not be necessary or suitable for everyone, it aims to supplement the sexual hormones that a woman's body naturally loses, it doesn't replace them entirely.


When prescribed and correctly administered as pills, patches, or creams by a healthcare professional, HRT is undeniably effective for most women in managing menopausal symptoms. While concerns around the use of HRT are often discussed, such as blood clots and an increased risk of certain types of cancers, there's little concrete evidence to support these claims.


The bottom line is that you should do your research before deciding whether or not HRT is right for you. If you cannot find a healthcare professional who can guide you through the process and adequately answer your questions, try to obtain accurate information from reputable resources or online communities of women who have been or are going through menopause.

The 6 pillars of lifestyle medicine

An alternative to HRT: Lifestyle changes

If you decide that HRT is not the right option for you, there are alternatives you can explore. Lifestyle changes can play a crucial role in managing menopausal symptoms as well as promoting overall well-being. These changes are based on the 6 pillars of lifestyle medicine, which are:

  1. Nutrition.

  2. Physical activity.

  3. Restorative sleep.

  4. Stress management.

  5. Avoiding risky substances.

  6. Mental and emotional well-being.

Nutrition

Diet is a critical factor in effectively managing the metabolic changes that occur during menopause, including the loss of muscle mass and a slowdown in metabolism. These changes necessitate adjustments to dietary habits, what worked for women pre-menopause may not work post-menopause.


Recommended strategies:

  • Increase or maintain an adequate intake of lean protein. Aim for at least 0.8 grams of protein per kilogram of body weight daily. This will help retain muscle mass.

  • Incorporate more calcium-rich foods, such as dairy products. Aim for 1,000–1,200 milligrams daily. This will help maintain bone health.

  • Consider following the Mediterranean-style diet, which incorporates whole, unprocessed foods and prioritises healthy fats, lean proteins, and an abundance of fruits and vegetables.

  • Don't demonise carbohydrates, they're the body's preferred source of energy. Consume moderate amounts to help maintain energy levels—do not exclude them.


Physical activity

As oestrogen levels decline, it becomes essential to adjust workouts to provide the body with the stimulus previously offered by this hormone. It's important women regularly engage in the right types of activities that will provoke positive physical adaptations.


Recommended strategies:

  • Prioritise high-intensity interval training (HIIT) and sprinting when participating in cardiovascular training. This will help decrease the risk of cardiovascular disease and help target visceral fat, which tends to increase during menopause.

  • Prioritise strength training and plyometrics (explosive movements) when participating in muscular training. This will help maintain muscle mass, improve muscle contraction, and safeguard bone health.

  • Aim for 1–2 cardiovascular training sessions, 2–3 muscular training sessions, and 1 plyometric training session per week to achieve optimal results. Plan for this to be a long-term commitment, not just for menopause.


Restorative sleep

As metabolic changes occur and testosterone levels start to decline, so will a woman's energy levels. This increases the importance of achieving good quality and quantity of sleep.


Recommended strategies:

  • Establish good sleep habits, such as reducing screen time before bed and going to bed at a time that allows you to get at least 7 hours of sleep.

  • Reduce caffeine intake, particularly in the late afternoon and evening hours.

Stress management

Stress management is crucial, especially during perimenopause, which is when cortisol (the "stress hormone") levels tend to increase. Elevated stress levels are often associated with belly fat accumulation, which will have an impact on body composition.


Recommended strategies:

  • Practise stress-reduction activities, such as relaxation exercises, mindfulness, and finding positive outlets for stress.

  • Avoid overtraining and prioritise rest and recovery in between moderate-to-vigorous training sessions.

Avoiding risky substances

It may go without saying, but at a time when the body is going through so much change, it's best to avoid or at least moderate any risky substances that could exacerbate menopausal symptoms.


Recommended strategies:

  • Avoid tobacco, excessive alcohol consumption, and non-prescription drugs.

  • A glass of wine now and again is fine, if not encouraged. Moderate alcohol consumption has been shown to activate a parasympathetic response, which can lead to a temporary reduction in stress and anxiety.

Mental and emotional well-being

Menopause can be a challenging phase of life and sometimes women can feel isolated in their experiences. Creating an open dialogue about these changes with partners, children, family, and friends is important. By fostering understanding and awareness, women can build a strong support network to help them navigate this transformative journey.


Recommended strategies:

  • Talk about menopause! Especially at work, modern women often remain silent about the immense professional and private pressure they're under.

  • Seek out counselling if you need it. Many women suffer from anxiety and depression during menopause, which can sometimes require the help of a trained counsellor or medication.

Conclusion

Taking a holistic approach to fitness and hormones is vital during menopause. By incorporating regular exercise, managing stress levels, and prioritising quality sleep, women can navigate all the stages with greater ease.


Remember, menopause is a natural process that every woman goes through. By taking practical steps to address lifestyle imbalances and prioritising well-being, women can not only address hormonal imbalances but get fitter and healthier in the process.


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