Exercise and the menopause:
Time for a change
Sarah Bolitho, Fitness Wales
What is the menopause?
• Decline in key hormones
• Cessation of egg production (ovulation)
• Four key stages:
– Pre-menopause: the period of reproductive life up to
the last menstrual period
– Peri-menopause: the period leading up to menopause
and one year after, usually 2 – 6 years in length
– Menopause: cessation of menstruation, considered to
have occurred one year after the last menstrual period
– Post-menopause : the period after menopause
What is the menopause?
• Decline in hormone production leads to:
– Cessation of ovulation
– Cessation of menstruation
– Menopausal symptoms
• Average age in UK: 52 years
• Premature menopause: before 40 years
• Induced menopause: oophorectomy
Timeline of menopause
Premenopause
Peri-menopause
Menopause
Postmenopause
Main characteristics
Physical
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Hot flushes
Night sweats
Sleep disturbance
in metabolic rate
Urinary tract infections
Menopausal arthralgia
Vaginal atrophy
Dry skin
Psychological
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Depression
Mood disturbances
Anxiety / panic attacks
Irritability
Loss of childbearing role
Decreased libido
Poor memory and
concentration
Medications
Drug/Action
Side Effects
Hormone Replacement Therapy
long term effects of lower oestrogen levels
Hypertension, weight gain,
depression, thrombosis, headache
Anti-hypertensives
Decrease night sweats and hot flushes
Dry mouth, drowsiness,
depression, fluid retention
Selective Estrogen Receptor Modulators (SERM) Leg cramps, peripheral oedema,
Mimic action of oestrogen, vertebral # risk flu-like symptoms
Calcitonin
Decreases circulating calcium
GI upset, tingling hands/feet
Calcium and Vitamin D
Nutrient supplementation
GI upset
Bisphosphonates
Prevent re-absorption of bone cells, # risk
GI upset, nausea, abdominal pain
muscle and bone pain, headache
Benefits of activity
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Reduction in symptoms/severity of symptoms
Decreased CHD risk
Maintain/improve BMD
Weight control
Reduce stress incontinence
Reduce emotional symptoms
Improve wellbeing
Better sleep patterns
Exercise implications
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Decreased metabolism
Risk of cardiovascular conditions
Bone density
Menopausal arthralgia
Effects of symptoms
Depression
Anxiety
Mood swings
General exercise recommendations
• CV exercise
– Moderate intensity
– 30 mins a day
– 5 or more days a week
• Can be accumulated
• Active living and/or
structured exercise
• CMO At least 5 a week 2004
• MSE twice a week
– Resistance training
– 8 – 12 repetitions
– 8 – 10 exercises, WBA
• Bone loading activity
– Aerobics
– Skipping
– Jogging
Additional post menopause guidelines
• Include lower body strength exercises to help prevent
falls
• Perform upper body bone loading to help prevent OP
• Include walking with gradients or weighted vests
• Use balance and co-ordination exercises to improve
confidence
• Include mobility and flexibility to maintain range of
movement
ACSM/CMO
10
Types of exercise
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Any enjoyable activity that will be sustained
Moderate intensity
Bone loading activities
May be additional benefits from:
– Relaxation
– Yoga
– Tai chi
– Controlled pace breathing
Cautions
Avoid the following if osteoporosis is a risk:
• High impact
• Spinal flexion against resistance
• Unsupported spinal flexion
• Spinal hyperextension
• High compressive forces on the spine
• Rapid or uncontrolled torso rotation
Summary
• Exercise can alleviate many symptoms and
reduce risk of CVD etc...
• Start as early as possible – in your teens is
ideal!
• Keep it gentle to avoid making hot flushes
worse
• Work with the client to develop a sustainable
programme