You are never too young, or too old, to learn about this dreaded and confusing phase in a women’s life

The menopause is feared by some, misunderstood by others, and is about as easy to understand as Chinese handwriting to the rest of us. But half of us have got it coming whether we like it or not, and the other half of us would be well advised to at least pretend to understand the process. We recently spoke to Lisa who gave us a thorough and detailed insight into what the menopause is, why it happens, how it affects people differently and what could be done in advance to minimise the effects.

My name is Lisa Austin, I am a personal trainer and soft tissue therapist. I am also studying cognitive behavioural therapy which is proven to be a hugely beneficial therapy for women in menopause suffering with hot flushes, anxiety and low mood.

I am a 49-year-old mum of 3 boys, 22, 15 & 14. Menopause and puberty in the same household is not be laughed at!

I had a total hysterectomy & oophorectomy in December 2019, so I am now in surgical menopause as I have no ovaries. I embarked on a journey to learn everything possible about menopause when I was told of my upcoming surgery in May 2019.

Even though I was 47-years old I did not think I was in peri- menopause! I didn’t have hot flushes, anxiety, or brain fog (the most well-known symptoms) so I didn’t connect the strange onset of constipation over the previous 18 months to being peri- menopausal. The worrying thing is, neither did the colorectal consultants, GP or gynaecologist who performed a number of invasive tests to only note everything was initially normal. It’s only when I started to dig deeper that I realised my digestive/bowel issues were caused by the falling oestrogen levels. This constipation over time led to a severe uterine prolapse and there I was, booked in for major surgery and facing a future with surgical menopause.

One thing I noticed while researching surgical menopause was how little information was available regarding exercise for peri & post-menopausal women. Yes, there are mentions of the benefits and you can find general information, but I was looking for the deeper science, the specifics and evidence in medical journals of research papers documenting proven results and most importantly the programming. As a personal trainer I wanted to find the best proven type of training to give me the finest possible quality of life going forwards.

Menopause is a completely natural and normal event that every woman will experience. Our reproductive years end and our periods stop. Meno – Pause, translates to the pausing or stopping of menstruation. We are deemed to be peri- menopausal in the time of transition prior to this and post menopause after 1 year of our last period. In the UK the average age for a women to reach menopause is 51.

If the menopause occurs before the age of 45, it is medically classed as early menopause and this actually affects around 10% of women. We also have women that are put into early menopause, surgically. My mum died of breast cancer at the age of 41 and was put into surgical menopause at the young age of 37. I was only 17 at the time, but I recall the hot flushes, night sweats and her mentioning heart palpitations.

Let’s look first at what happens to a woman’s body when we start to enter peri- menopause. Women have two ovaries, grape sized glands located at either side of your womb (uterus). The ovaries produce the eggs for fertilization and they produce hormones – oestrogen, progesterone and testosterone. These hormones regulate mood, affect processes such as growth and development, sexual function and reproduction. Each hormone is important and as our ovaries come to the end of their natural life, the amount of each hormone reduces.

Oestrogen – Protects our arteries and heart, lubricates the vagina, regulates mood, body temperature and memory (cognition). It also helps stimulate bone growth, maintains strength and lubricates the joints. We also produce small amounts of oestrogen in our adrenal glands and fat tissue but the main source is from our ovaries. So with depleting oestrogen comes a reduction in muscle mass (sarcopenia) and this loss can be reduced by resistance training

Most adults will lose approximately 6 pounds of muscle per decade, which is a huge amount of wonderful muscle mass to drop! Muscle keeps our joints supported, moves our limbs, improves our metabolic rate and gives us shape/structure. Having strong muscles will reduce our risk of injury, improve stability and improve our performance in daily life. There are other factors that reduce muscle mass as well as physical inactivity and oestrogen loss, such as inadequate dietary protein, injury, illness and some neuromuscular conditions.

Sarcopenia in women starts to occur most rapidly after the age of 50. Here are some facts:

• One study showed 0.6% decline in muscle pass per year after menopause
• The composition of muscle changes, not just the total mass (e.g. higher content of non-contractile tissues, such as intramuscular fat, compared with younger women).
• One study showed that post-menopausal women had twice the amount of non-contractile muscle tissue than pre-menopausal women – so our muscle to fat ratios change
• Most of the motor units lost are the fast motor units, leading to loss in muscle strength and power (affecting pushing yourself out of a chair, climbing steps, or re-gaining posture if you become unbalanced)
• Lack of physical activity and poor nutrition are also very likely to be involved

Several studies have shown that resistance training is effective in reducing age-related loss of muscle mass in post-menopausal women (e.g. 3 times a week for a year)

• Resistance training combined with HRT was even more effective
• Supplementation with phytoestrogens (e.g. isoflavones from soy) has been studied, but none of the studies showed a significant benefit for muscle mass with this approach (e.g. 25g of soy protein per day, combined with resistance training 3 times a week for 16 weeks, was no more beneficial than resistance training alone)
• The greater the severity of sarcopenia (muscle mass loss), the greater the risk of functional impairments (e.g. walking, climbing stairs) and physical disability (inability to perform daily tasks, such as self-care, shopping)
• The loss of muscle mass has been shown to precede the loss of mobility – low muscle mass in women was associated with a 34% increased risk of mobility limitations 5 years later

Menopause is also associated with a reduction in bone mineral density, and use of HRT and resistance training can both reduce the extent of these losses

Bone is a living tissue that regenerates throughout our lives. Up to the age of about 30 we will build more bone than we lose but after that, our bone tissue naturally starts to decrease, hence we see skeletal degeneration. Lack of oestrogen impacts on loss of bone density hence why it reduces so much after menopause

• In women tested in peri-menopause and again 9 years later, bone mineral content (BMC) was reduced in the distal radius, but the use of HRT protected against these losses
• In an analysis of evidence from 24 clinical trials, resistance training was shown to significantly increase bone mineral density (BMD) at the femoral neck and lumbar spine, but the effects were most pronounced in studies that combined resistance training with high-impact or weight-bearing protocols
• Vibration and mechanical loading are thought to be needed to increase bone strength, and trigger changes to the architecture of the bone

It’s not looking great for menopausal women is it? Muscle loss and reduced bone density! I was not ready to become weaker and risk broken bones. But with evidence showing that weight bearing/strength/resistance training is hugely beneficial I started looking for more evidence and research for a specific tested program to refer to that related directly to women and menopausal symptoms – such as hot flushes! Can we continue to build muscle mass as we age and go into our menopause?

Reduced hot flushes

In 58 post-menopausal women, a 15-week high-load resistance training programme has been shown to reduce the frequency of hot flushes in women (average age 55 years)

• Average 43% reduction in frequency of flushes in the exercise group (from 7.5 flushes/sweats per 24 hours to 4.4) and no change in the control group (from 6.5 to 6.0 flushes/sweats per 24 hours)
• Frequency was halved in 45% of participants
• Reductions in flush frequency were seen from 3 weeks
• Details of the programme are shown below – the study author described the training programme as challenging, “To actually push themselves harder than they were used to was new to them. They had to be encouraged to increase the load more so they would get the effects of the training,” she said. “After they progressed, they enjoyed it and almost everyone continued to exercise after the intervention.
• Other studies have also shown similar results – it seems that high-load is needed (e.g. yoga or walking are not enough, on their own, to affect the frequency of hot flushes)
• Effects may be related to the release of endorphins, which have some actions in the thermoregulatory centre

Here are the details of the specific program

• 15-week training program performed three times/week
• 7–10 minute warm-up, followed by dynamic and static stretching
• Six exercises in seated resistance machines
  • Chest press, leg press, seated row, leg curl, latissimus dorsi pull-down, leg extension
  • 8–12 repetitions in two sets with two minutes’ rest between sets
  • Initially, to minimise injury, women trained at 15–20 RM, with 15–20 reps per set for the first 3 weeks
  • One session per week was done in the presence of a physiotherapist, who gradually increased loads (for 8–12 rep maximum)
• Two body-weight exercises
  • Crunches and back raises
  • Performed until exhaustion in two sets (approximately 20 repetitions/set)

Participants in the control group were instructed not to change their physical activity habits during 15 weeks and to avoid any other treatment for hot flushes.

Physical activity doesn’t strengthen all bones, just those that are stressed, so you need a variety of exercises or activities to keep all your bones healthy. Such “weight-bearing” exercises include walking, dancing, jogging, weightlifting, stair-climbing, tennis & badminton, aerobics. Swimming is a useful form of exercise for the heart and cardiovascular system but because water supports the bones, rather than putting stress on them, it’s not considered a good “weight-bearing” exercise for bone strength so is not my go to for menopausal women.

I have always been an advocate for strength and resistance training for women. Many ladies worry that they will become bulky and look masculine when they start a strength/hypertrophy program but I assure them that muscle is very difficult to build. It is much easier to lose fat than build muscle and women lack human growth hormones, we cannot bulk up the same way men can without stimulants.

When I take on a new female client and I ask them what is your goal? The most common reply is ‘to lose fat and get toned!’. This ‘tone’ is muscle so please do not be fearful of lifting heavy weights, it is of huge benefit to us.

Nutrition

Jo Latham, a Nutritional Therapist from Well & Nurtured, works with me to provide all nutrition plans and recipe books to ensure women are given the most up to date and correct advice on nutrition. We offer bespoke, personalised plans and also a full testing platform if women want investigate gut health and intolerances.

What we eat can make a real difference to the way we look and feel and this is particularly true in the lead up to and during the menopause. A few small changes in your diet can have a big impact, providing your body with the essential vitamins

Remove/Reduce the following…

1. Refined sugars –they have no nutritional value!
2. Processed foods –this means foods that come in a box or a bag and contain more than one item on the list of ingredients
3. Saturated Fats – red meats, sausages, bacon and some dairy foods are not great for our hearts
4. Alcohol -drink in moderation and on special occasions only.
5. Salt–particularly white table salt.
6. Caffeine– stick to two cups of tea/coffee a day before midday.

Eat plenty of fruit & vegetables…

• Aimfor7-10palm sized portions per day
• They are packed full of phytochemicals, antioxidants and fibre.
• Eat a variety of colours each day to maintain good gut health (think of the colours of a rainbow)

Go for complex carbs…

Ditch white carbohydrates and opt for brown rice, whole wheat pasta, beans, chick peas, oats and wholegrain breads. You will feel fuller for longer and your energy levels will stay constant.

Love good fats…

We need the right kind of fats to balance hormones, keep skin supple and prevent heart disease, cancer and even depression.

• Best sources are oily fish such as salmon, mackerel, anchovy, sardines and herring. These are an excellent source of fat called omega 3.
• They help to reduce inflammation, support the production of hormones and cellular function.
• Other good sources are olive oil, avocado, nuts, natural nut butters, flaxseeds and pumpkin seeds

Know your phytoestrogens…

• Phytoestrogens are compounds that naturally occur in plants. They are said to mimic the actions of oestrogen in the body and as such may help protect you from osteoporosis, hot flushes and various other menopausal symptoms.
• Great sources of phytoestrogens are flaxseeds, pumpkin seeds, rice, oat, rye, wheat, apples, cherries, lentils, chickpeas, kidney beans, garlic and celery.
• Keep hydrated to help support elimination of waste and excess hormones.

 Drink a minimum of 2 litres of water daily per day.

Look for good sources of Fibre…

Aim for a minimum of 30g per day to support regular bowel movements, calcium and magnesium absorption and blood-sugar balance.

Grains such as oats, barley, quinoa, buckwheat, wholegrain wheat and rye

Fruit especially raspberries, oranges, strawberries, kiwi, apples, blueberries, figs, grapefruit, plums.

Beans and Pulses such as chickpeas, lentils, black beans, pinto beans, kidney beans.

Vegetables such as carrots, parsnips, beetroot, squash, green peas, spinach, Brussels sprouts, cabbage, Swiss chard, cauliflower, kale, sweet potato, white potatoes, mushrooms (shiitake), onions, leeks.

Calcium…

Calcium is a vital mineral for bone health. It is also very important for other physical functions, such as muscle control and blood circulation. Calcium is not made in the body — it must be absorbed from the foods we eat. Jo recommends that we only consume organic dairy products due to the added antibiotics and growth hormones in non-organic products.

Enjoy the sunshine…

Vitamin D is vital for hormone and general health.

The best source is the sun! Around 5 –30 minutes daily exposure on face, neck and arms minimum is beneficial, especially if you work indoors.

Helpful Tip: depending on your skin type you may need more or less sun exposure; the darker your skin, the longer you need to get adequate levels of Vitamin D from the sun.

Supplementation of 10 micrograms is recommended by Public Health England during October to March.

Ensure you get adequate amounts of restful sleep…

It will reduce stress levels and support adrenal function. Exhaustion can lead to blood-sugar imbalances. At night time our bodies eliminate toxins and produce hormones, so restful sleep is so important.

Tip: Create a daily routine to help support your natural circadian rhythms. Wake up and go to bed at the same time, even on weekends.

Stay calm…

It’s not easy to reduce stress levels in this day and age. But it’s vital to support the balance of hormone production as adrenal fatigue, from being stressed over long periods, can dramatically alter this balance. Try adaptogens such as Rhodiola, Ashwaghanda and Korean Ginseng.

A GREAT RECIPE TO GET YOU STARTED

The Easiest Breakfast Smoothie –

Deliciously Ella

Serves 1

1 banana

1 big handful of spinach (35g)

2 handfuls of frozen berries (these keep it cool and are much cheaper than fresh berries, but fresh berries and a little ice work perfectly instead)

1 cup of almond milk (250ml)

3 tablespoons of oats

1 tablespoon of hemp powder

1 tablespoon of chia seeds Optional:

2 medjool dates

Simply peel the banana and pit the dates, then pour everything into your blender and blend until smooth.

Please feel free to contact me if you would like any advice on exercise protocols. I will be offering sessions from mid-June in line with government guidelines following social distancing and cleaning.

Lisa Austin

lisa@rockhealthandfitness.co.uk

Lisa runs a gym based in Great Offley which is near Hitchin, Hertfordshire called Rock Health and Fitness. They offer personal training, group classes, Yoga, a free running club and various other workshops and events throughout the year.