WHAT IS THE MENOPAUSE?
Menopause is defined as the permanent cessation of menstrual periods (1) and is categorised into 3 main stages: premenopausal, perimenopause and postmenopausal. It’s diagnosed after 12 months without a menstrual period. Menopause can occur anytime between the age of 40 to 60 years old, but the average age is around 50 years old, meaning a third of the average woman’s life will be lived beyond the menopause. A female experiencing a persistent change in menstruation cycles for 7 days or more is likely in the early stage of perimenopause, with extended periods of 60 days or more without a cycle likely indicative of late perimenopause.
Most women will experience menopausal symptoms and some of these can be quite severe and have a significant impact on everyday activities. Common symptoms include hot flushes, night sweats, vaginal dryness and discomfort during sex, difficulty sleeping, low mood or anxiety, reduced sex drive (libido), and problems with memory and concentration. These symptoms can begin months or even years before periods stop and last around 4 years after the last period, although some women experience them for much longer.
Local GPs can offer treatments and suggest lifestyle changes for severe menopausal symptoms that interfere with day-to-day life including hormone replacement therapy (HRT) – tablets, skin patches, gels and implants that relieve menopausal symptoms by replacing oestrogen, vaginal oestrogen creams, lubricants or moisturisers for vaginal dryness, cognitive behavioural therapy (CBT) – a type of talking therapy that can help with low mood and anxiety.
However, it has been suggested that appropriate lifestyle changes during the pre and perimenopause period can also reduce menopause symptoms. These changes include physical activity and exercise. This blog will cover these areas of lifestyle change for women using scientific research and evidence. Starting with the broader area of physical activity which refers to all movement including during leisure time, for transport to get to and from places, or as part of a person’s work.
Physical Activity
It has been well established that physical activity (PA) reduces the symptoms associated with menopause (2). However, PA is a broad term and there are many inconsistencies linking the cause and effect in menopause studies. This is particularly relevant in the case of PA and vasomotor associated symptoms of menopause (hot flushes and night sweats), where some studies reported a significant association between the two, and others reported no association (3). It also appears that PA does not modulate the changes in most of the studied metabolic health indicators during the menopausal transition, although PA does associate with healthier blood lipid profile and body composition (4).
In general, the associations between PA and changes in indicators of metabolic health around menopause are understudied as only few longitudinal studies have been conducted using device measured PA (5). Moreover, these studies included only women transitioning from pre- or perimenopause to postmenopause and therefore could not address the contemporaneous aging-related changes.
Despite the difficulties in establishing a direct association between PA and menopause symptoms, there have been studies that have thoroughly searched the most prevalent chronic diseases such as obesity, investigating the prevalence, pathophysiology, diagnosis, management, and prognosis of such diseases in postmenopausal women. One such study was conducted by Knight et al 2022 (6), who concluded obesity is linked to hormonal, lifestyle, and environmental changes that occur during the menopausal transition, and it increases the risk for cardiometabolic disease. The utilisation of appropriate clinical evaluation methods to identify obesity in post-menopausal women, and the implementation of effective lifestyle, pharmacotherapeutic, and surgical interventions, have the propensity to reduce the deleterious effects of obesity in this population (6).
Studies have also suggested PA has a relatively positive impact on respective social and psychological health outcomes associated with menopause. Outcomes such as quality of life, depression, anxiety and self esteem all appeared to be positively impacted by PA, however most studies did not report any difference related to menopause status (7).
The type and intensity of physical activity on menopause symptoms has also been investigated. A study conducted by Da˛Browska-Galas in 2019 (8) suggested that moderate and high PA levels were associated with less severe menopausal symptoms, while the most inactive women had severe menopausal symptoms.
Exercise
Exercise is a subcategory of physical activity that is planned, structured, repetitive, and purposefully focused on improvement or maintenance of one or more components of physical fitness. As a non-pharmaceutical intervention for menopause symptoms, exercise is an attractive, alternative option for women. Having a regular exercise routine, has been shown to have significant health benefits and recent trials have suggested that exercise positively affects women’s health during the menopausal period (9), including osteoporotic women (10). Importantly, studies reported that menopausal women who did not participate in structured exercise programs reported high severity menopause symptoms compared to those who did participate in an exercise program (11).
It has been well established that aging is associated with a reduction in muscle mass, known as sarcopenia. Although primary due to the imbalance in protein breakdown and synthesis, menopause-associated decline in hormonal levels is thought to be implicated in this process (12). In postmenopausal women, some important factors contribute to the decline in muscle mass. It seems that physical inactivity, protein intake and oxidative stress contribute the most to sarcopenia in postmenopausal women (12). Since physical activity, especially resistance training, is a major determinant for maintaining muscle mass and reducing the accumulation of intramuscular fat mass, it makes sense for a woman during menopause to engage in some form of resistance training plan.
High blood pressure is also strongly associated with aging and exercise training is often considered the cornerstone of nonpharmacological therapy for postmenopausal hypertension. Moderate-intensity aerobic exercise is well tolerated on most days of the week by most people with postmenopausal hypertension and is not suspected to detract from exercise adherence. That being said, moderate aerobic exercise may be superior for eliciting cardiovascular benefits in hypertensive postmenopausal women and resistance exercise may offer desirable benefits. The beneficial outcomes of exercise training for hypertensive postmenopausal women include improvements in blood pressure, autonomic tone, baroreflex sensitivity, oxidative stress, nitric oxide (NO), bioavailability, and lipid profiles, as well as cardiovascular function and cardiorespiratory fitness. This partly explains the fact that exercise training programs have a positive effect for cardiovascular disease in hypertensive postmenopausal women (13).
During the menopausal period, sexual dysfunction is associated with the development or worsening of psychological conditions, causing deterioration in women’s mental health and quality of life. A review by Carcelén-Fraile et al in 2020 (14) studying the relationship between exercise and quality of sexual life, found aerobic exercises showed inconsistent results and resistance training did not seem to convey any benefits. The suggestion is that further studies are required in this area. This is further supported by Nguyen et al 2020 (15) who concluded that further well-designed studies are needed to confirm the effect of exercise on quality of life in women with menopausal symptoms.
Take Home
The reason for the differences in the severity of menopausal symptoms can be justified by racial differences, climate, genetics, geographic area and age for menopause. However, research shows both physical activity and exercise have a positive impact on associated physiological and psychological symptoms during menopause. Both aerobic training and resistance training have positive benefits on symptoms associated with menopause. The woman’s ability to choose their preferred physical activity increases the likelihood that they will adhere to exercise as a treatment method.
References
(1) NIH State-of-the-Science Conference Statement on management of menopause-related symptoms. NIH Consens. State-Sci. Statements 2005, 22, 1–38.
(2) Sternfeld, B.; Dugan, S. Physical activity and health during the menopausal transition. Obstet. Gynecol. Clin.N. Am. 2011, 38, 537–566.
(3) Sheila A. Dugan, Kelley Pettee Gabriel, Brittney S. Lange-Maia, and Carrie Karvonen-Gutierrez. Physical activity and physical function: moving and aging. Obstet Gynecol Clin North Am. 2018 December ; 45(4): 723–736.
(4) Karvinen S, Jergenson MJ, Hyvärinen M, Aukee P, Tammelin T, Sipilä S, et al.Menopausal status and physical activity are independently associated with cardiovascularrisk factors of healthy middle-aged women: cross-sectional and longitudinal evidence. Front Endocrinol.
(5) Matti Hyvärinen, Hanna-Kaarina Juppi, Sara Taskinen, Jari E. Karppinen, Sira Karvinen, Tuija H. Tammelin. Metabolic health, menopause, and physical activity—a 4-year follow-up study. International Journal of Obesity. 2021.
(6) Vuokko Kovanen Pauliina Aukee, Urho M. Kujala, Timo Rantalainen, Sarianna Sipilä and Eija K. Laakkonen, Michael G. Knight, Chika Anekwe, Krystilyn Washington, MD3, Eftitan Y. Akam, MD4, Emily Wang5, Fatima Cody Stanford. Weight Regulation and Menopause. Menopause. ; 28(8): 960–965.
(7) Hybholt, Maria. Psychological and social health outcomes of physical activity around menopause: A scoping review of research. Maturitas 164 (2022) 88–97.
(8) Magdalena Da˛browska-Galas 1, Jolanta Dabrowska, Kuba Ptaszkowski and Ryszard Plinta. High Physical Activity Level May Reduce Menopausal Symptoms. Medicina. 2019. 55. 466.
(9) Asikainen, T.M.; Kukkonen-Harjula, K.; Miilunpalo, S. Exercise for health for early postmenopausal women: A systematic review of randomised controlled trials. Sports Med. 2004, 34, 753–778.
(10)Tamara N. Filipović, Milica P. Lazović 1, Ana N. Backović , Aleksandar N. Filipović ,Aleksandra M. Ignjatović , Sanja S. Dimitrijević , Kristina R. Gopčević. A 12-week exercise program improves functional status in postmenopausal osteoporotic women: randomized controlled study. European Journal of Physical and Rehabilitation Medicine 2021 February;57(1):120-30
(11)Lily Stojanovskaa, Vasso Apostolopoulosa, Remco Polmanb, Erika Borkolesb To exercise,or,not to exercise, during menopause and beyond. 2014. Maturitas 77(2014)318–323
(12)M.L. Maltais, J. Desroches, I.J. Dionne. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact 2009; 9(4):186-197
(13)Yi-Yuan Lin and Shin-Da Lee. Cardiovascular Benefits of Exercise Training in Postmenopausal Hypertension. Int. J. Mol. Sci. 2018, 19, 2523
(14)Carcelén-Fraile María del Carmen Carcelén-Fraile, Agustín Aibar-Almazán, Antonio Martínez-Amat , David Cruz-Díaz, Esther Díaz-Mohedo, María Teresa Redecillas-Peiró and Fidel Hita-Contreras. Effects of Physical Exercise on Sexual Function and Quality of Sexual Life Related to Menopausal Symptoms in Peri- and Postmenopausal Women: A Systematic Review. Int. J. Environ. Res. Public Health 2020, 17, 2680;
(15) Thi Mai Nguyen , Thi Thanh Toan Do , Tho Nhi Tran and Jin Hee Kim. Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int. J. Environ. Res. Public Health 2020, 17, 7049.
Article written by our Better Body Trainer David Griffin
