Menopause – Every Woman’s Reality

Most women will live 1/3 of their lives in menopause. If we want to be able do all the things we have been used to doing, and feel great doing them, we must make some changes to our current routines. Decline and disability in older age is avoidable, even though it seems that nature has programmed our bodies otherwise. 

Before this finality, our bodies go through changes over years. Technically, menopause is when your period stops. Perimenopause is when your body starts reacting to that gradual change or loss in egg production. Some women are hit with irregular periods, and it could be 7 to 10 years before menopause. Some women, like me, just go directly into menopause. Ovarian failure. Eggs are gone. Postmenopausal woman. Periods done.  So, think about it. A lot of complaints through the years (late 30s to 40s) that we go to see a doctor about are most likely perimenopause (hormone) related. Ding, ding, alarms to let us know the natural (body processes towards aging aka decline) are happening. A call to action to support better health via our lifestyle choices. Are we listening?

As women, our endocrine systems age faster than the rest of our body. This is because this is where sex hormones are made, and at a certain age, these come close to depletion. Basically, our biological raison d’etre is for reproduction. When that window closes, our bodies begin cascade of changes and historically we are just told, well that’s aging for women. We live, we mother/ nurture, we die. 

Aging for women, declining and eventual loss of estrogen production can wreak havoc in all areas because every organ in our bodies has a receptor for estrogen. Estrogen is a natural anti-inflammatory. Estrogen affects serotonin and dopamine, which affect our mood. Estrogen loss affects every organ in our bodies and our brains are an organ. Given this, you can see why this estrogen loss is responsible for sleep disturbances, mood dampening, foggy thinking, gut and bone health, even joint issues like stiffness, frozen shoulder, and hip and back issues. The threat of chronic inflammation is naturally buttressed by estrogen production before we begin this last stage of our bodies journey through life. Up until then, we can count on our body’s natural functioning to keep us healthy and feeling great. Losing our ovary monthly production is a big deal. This is why it’s so important to do the lifestyle things that support our body’s health.

We know that estrogen, progesterone, and testosterone are reproductive hormones. They are produced in the ovaries. When we no longer need our ovaries, not only estrogen but also progesterone and testosterone levels are also affected. This is our ability to do everything from breathing to repair, drinking, eating, and even cognition is affected. You should also know that research into menopause and how it affects women’s bodies is far less than research into reproductive health. There are no complete menopause function tests for all our organs. If we aren’t doing preventatives in our lifestyle’s, changes are happening inside our bodies through the years that just don’t become apparent until those menopausal years hit. We really need to be advocates for our own health as we age and at every age.

So, my point thus far is that if you just go through your life living on your body, allowing nature to take its course, menopause and its aftermath has the potential to be life altering in a negative way.  During perimenopause, when these changes are happening, you can support your body and slow down these natural processes. There are medical interventions like estrogen and progesterone replacement available, but how you manage your body through lifestyle choices can make a huge impact on how the final 1/3 of your life goes. 55+ for some women looks vastly different today than it did 40 years ago. Women today who make those changes to their lifestyles to support better aging of their bodies, age easier. Whether you are perimenopausal or post menopause, you can improve the function of your body. If you have any symptoms, they can be made better.

If we don’t do these things? The statistics are around 50 percent for women before they die will have an osteopathic break. Due to these hormonal changes, our bones break down faster and they no longer remodel as well or as quickly if we don’t intervene to help them. When I meet a woman in her 50’s who has never strength trained, and she tells me she has osteoporosis my heart breaks for them because they could have avoided that by making them stronger pre and peri menopause. 

Remember that even though you may have made it through to post menopause unscathed, your bones are still deteriorating, your risk of cardiovascular and neurodegenerative disease is still increasing, because your hormones are declined. Your systems, without support, will continue to fail. This is where we have the control through our lifestyle choices to make this process as pleasant or unpleasant as its going to be. I have a client in her mid 50’s that came to me in post menopause because her lack of strength was causing pain in her feet and hips. She looked of average good health on the outside. Not overweight. By her posture and midsection flaccidity I could tell she had a weakened core. Her urgency was very low, as she was given orthotics for her feet, and physio was keeping her feel just well enough to function. So, she saw me very sporadically and didn’t do any exercise on her own besides walking the dog and very light activities. No purposeful exercise. Her progression understandably was very minimal.  Six months in, she had a bone density exam, and it came up pre-osteo. Then she had her blood sugars assessed and was diagnosed prediabetic. This is an excellent example of a lot of women 50 and older who do not ,and have not integrated the few things into their lifestyles through those years before perimenopause and menopause hit. These changes can be preventative. She became very motivated at that point, started training regularly and eating a better diet and has made great progress. 

This does not have to be your menopause story. It was not and is not mine, or any other’s I know who live a lifestyle that includes strength training, moderate to intense cardiovascular work, a diet that focuses on proteins, fruits, and vegetables first, and includes healthy fats and complex carbs in ratios to support their activity levels. Developing a sleep routine and ways to deal with stress that don’t cause long term adverse effects are also ways to end up with a healthier body into and beyond menopause. These lifestyle factors can greatly influence your menopause story.

Strength training- In good alignment, using the core and joint integrity and with enough stimulus, it will increase muscle mass as well. 2 to 4x a week. Muscle mass is one of the greatest drivers of metabolic health, and lack of it as we go into the menopausal years increases risk of weight gain and metabolic disorders. Not only that but as you’ve come to learn, these hormonal changes in our bodies leave us susceptible to sarcopenia. That is age related muscle loss in people who have not been doing preventative resistance training. Simple functions like walking, getting up and down off chairs and in and out of vehicles deteriorate. The future has a cane or a walker in it when strength, ability to produce power, and muscle mass is lost. Also, it’s important to not just lift weights, but to include producing power when lifting weights. Lift heavier weights faster. Its overcoming that resistance with speed that improves reaction time and ability to exert force quickly. These translate into better outcomes in preventing falls and improving overall function. 

a well-known consequence to strength and muscle loss is losing the ability to do everyday activities that we take for granted. But did you know strength and muscle loss also greatly affects your pelvic region? Those esthetic postural changes that no woman wants to see- dowagers hump, loss of glute muscle, rolled forward shoulders and caved chests. Incontinence or embarrassing flatulence at inopportune times. All consequences of loss of strength. Foundational strength. Those are not normal aging occurrences. They are due to loss of strength, and they happen quicker and sometimes to a greater extent in postpartum women who have not restored their core function after childbirth.

The type of strength training program that one chooses is also important to consider. As we have learned, the changes in hormones that happen during the menopausal years can affect elasticity of connective tissue. Considerations to controlled mobility, progression of exercises, type of exercises chosen, conditioning level, all should be taken into consideration. It’s not a matter of just exercising. The way one exercises as well as programming of exercise matters.

 Menopause can make what has slowly been deteriorating in the body more apparent. In many cases, it’s not only menopause, but also decades of lifestyle come to the surface in these years that is the confounding problem. Perimenopause or menopause can be a wakeup call to improve your overall health, quality of life and longevity.

Nutrition- Things change. Just like being able to get through the workday on 4 hours of sleep after a party in our 20’s would no longer be feasible today, the foods you regularly eat might not cut it to keep weight off anymore. As mentioned above, this could be due to the muscle loss because of not doing resistance training in a manner that spares muscle. But it’s not only about weight. It’s also about energy levels, and general health of the body. Micronutrient delivery to support biological processes. We get our micronutrients from highly nutritious foods.  How we feel, how our bodies react can be influenced by the foods and drinks that we ingest. I’m not suggesting that adverse symptoms are because your diet sucks. I am suggesting that there are a few changes that you can start to make to see if they make a difference in how you feel and how your body functions. Adapting the attitude of bringing in rather than taking away is always going to make the process of change feel less harsh. Nutritional changes as well as resistance training can make huge changes. Midlife is an awesome time to do some reinventing of oneself! 

What else? Focus relentlessly on the few basics. 

Forget counting calories and obsessing over what you eat. Instead, always focus on making a lean protein the star of your plate. Protein becomes more and more important as we age because it helps us to retain our muscle mass. We need it to build more muscle. Gaining muscle can become harder to do as we go deeper into this stage of our lives, but it can be done. 1 or 2 palmfuls is considered a serving. Aim for your body weight in grams of lean protein a day. Make it, and a minimum of 5 servings of colorful vegetables a day plus a couple pieces of fruit as the centre of your diet.

Good fats are critical to body function. consider making salmon one of your lean protein choices often. Pumpkin seeds, walnuts, almonds, all nuts and seeds in moderation, a thumb or two at a time. Avocadoes, avocado and olive oil are all great sources of fat.  An omega 3 supplement daily is also one of the few supplements to add in that has high health benefits. 

 Complex carbohydrates like lentils and legumes are a carbohydrate that are also an excellent source of protein. They are also high in fibre, and fibre consumption is very important during these years as we have learned that decreased hormones affect all organ systems. These resistant starches don’t digest like other starches do. Instead, they aid in creating a better gut environment, aid in lowering cholesterol levels and improve glycemic control.  Eating other types of high fibre foods like your 5 servings of vegetables, in the form of dark leafy greens, and oats and bran for complex carbs can assist in cholesterol management.  Gut health can also be improved with the addition of probiotics and probiotic foods like Kombucha, sauerkraut, Kefir, low sugar yogurts, kim che. It’s important to increase diversity of your gut biome, so investigating a supplement to include is also of value. 

Always try to increase your nutritive value with foods, but there are some supplements that are of value as well. Magnesium is a support for the musculoskeletal system, nerve function, aids in protein synthesis, blood glucose control and blood pressure regulation. It can also aid in sleep. and a glycenate form is good for quick absorption. Vitamin D is another supplement to include as it helps our bodies to retain calcium and phosphorous, important for our bone health. B- complex vitamins have been shown to assist with mood and energy levels. Life transitional times are stressful. Checking with your health professional to do a bloodwork panel will put you in the right direction for what supplements would be most beneficial for you.

You can’t go wrong by eating mostly whole foods prepared simply, cutting back on processed foods and bought sweets. Fats and carbs are energy sources. How active you are and how often you include moderate to intense exercise that utilizes energy should be your guide for general daily amounts. Use these types of exercise to train your body to utilize sugars more effectively. Avoid alcohol. Even 1 glass of wine can be disruptive. 

Cardiovascular work- aka cardio – walking is the best form of exercise but including exercise that takes your heart through all the zones is most effective for both your cardiovascular health as well as metabolic health. The great thing about lifting weights is that it raises the heart rate. If you are new to strength training, you will have to build your motor control first which is not taxing in this way. Using a piece of cardio equipment or the stairs is a great way to elevate the heart rate and to keep it up for an extended period. Start with zone 2 training, that is elevating your heart rate to 60 to 70 percent of its max and keep it there for 20 mins to start a few days a week. Increase up to 45-minute sessions a few days a week. This will build a good aerobic base that you can then work up from. After that, including intense work in 10-to-15-minute blocks a couple times a week is sufficient. Maintaining these exercise intensities is important because having the aerobic base means endurance to do harder activities like strength work and getting the heart rate into the higher ranges which improve outcomes in cardiac, metabolic, and neuro health. Because menopause can cause a decrease in muscle power, that is displaying strength quickly, this loss can be prevented by including some exercise modalities like high intensity training, remembering that high intensity is built from an aerobic base and the joint integrity that mobility and strength training modalities provide.  Bottom line- build a balanced exercise program. There are benefits to all exercise modalities, and just like medicine, the magic is in the dosing. 

Plyometrics – jumping, hopping, bounding, can all signal gene change that make improvements in power production and muscle building and function. They improve muscle growth and the muscle’s ability to contract. Not only does this improve your strength levels, your ability to react quicker, but it also improves your cellular function and insulin sensitivity keeping your body more metabolically stable. This type of exercise is done off of a stable base, so it’s important to be addressing your core and mobility needs to do these types of activities safely.

Sleep – hormonal changes in menopause do affect sleep. I have never met a woman that has said otherwise. With loss of estrogen and progesterone, its inevitable. There are things that we can do to improve our quality of sleep though. The common ones like no electronics in the bedroom and creating a sleep routine can help. Alcohol wreaks havoc at this stage of life as we just don’t process toxins the way we did in our younger years. If you are still drinking alcohol, particularly daily and close to bedtime, that will be your low hanging fruit change to make. Adding in moderate to intense exercise earlier in the day may also assist with sleep. Making our bodies work hard so that they need to rest, and recover is also a low hanging fruit, but this approach may take longer if you haven’t done any purposeful harder exercise for years. 

I’m 58 in a few months. I went through menopause a decade ago. One day my period just stopped, a few hot flashes for a couple months and that was the extent of my menopause drama. After learning what I now know about menopause, this time of life and experiencing 10 years of menopause so far, I find the years before curious. I had my last baby at 40, so I wonder how close my body was to that finality postpartum. It feels like the lines of postpartum and peri or straight to menopause are really blurred. When I was postpartum, I had all the concerns that women in menopause now have. My hormones are “different”, I can’t lose weight the way I used to be able to, I can’t eat as much, of the fatty foods I like, some types of exercises and intensities suddenly started to make things hurt…Then I started to do all the basics that I’ve talked about in this blog. I traded in daily 10k runs for proper strength training and varying my cardiovascular exercise.  My energy levels improved, I lost weight, I became more muscled, I slept like a baby until menopause caused night waking that isn’t too bad if I don’t think or look at my phone when I wake. I also notice that following the days that I lift weights and work in the moderate to intense ranges that I have no night waking. Our bodies thrive on moving, and moving well!

I think that anyone who says age is just a number is out to lunch. I didn’t feel middle age the month I lost my period. The years around the start of menopause and following, I was the fittest and most muscled I’d ever been. But through these past 5 middle age years I can’t deny that I have changed, and that our bodies do change. I can’t do the extreme kettle bell complexes and dozens of sets of running stairs day after day without rest anymore. I need more recovery time. I need to put days of mobility and zone 2 cardio in between my barbell lifting workouts. I don’t choose protein and vegetables first just because I like the way they make me look in clothes as opposed to multiple pieces of cheesecake anymore. Instead, I find myself choosing them now because I wonder what my aging organs look like. 

Menopause, middle age, is that time of realization that we are not invincible. We start to see people around us getting sick and dying.  Its that time of maturity that really hits, that we see what we can and can’t control. The control that we do have is through the choices that we make. It’s those that determine the quality of how these middle life years are going to go. 

Women live longer, and women are living longer than decades ago. Choosing to do the basics won’t allow us to live forever, it won’t erase or eradicate the markers of aging, but it will keep our bodies in the best working order that the inevitability of aging will allow. How you choose to age is ultimately summed up in the daily actions that you take for the duration of this time we call menopause.  Make it golden, its never too late.

Carolyn Box