Why should health and fitness professionals gain menopause education? Christien Bird MSc, MCSP, co-founder of Menopause Movement and specialist Women’s Health Physiotherapist, explains why the right support can help women to change and improve their fitness during menopause.
For all women, all roads lead to menopause. Unlike men who go through a slow change, women experience fluctuating patterns in hormone levels in the perimenopause with hormones going up and down, creating havoc, flatlining only after menopause. One of the main hormones in the menopause story is oestrogen which acts like an anabolic steroid, affecting all the systems in the body - mental health, heart health, the musculoskeletal system, you name it! Oestrogen talks to all the different organs in the body including skin, hair and the bladder, so given its range, the challenges when supplies run low will be different for each woman. Whilst some may sail through it, the majority, about 70%, experience significant symptoms – including hot flushes, mood disorder, depression, anxiety, weight gain and menopause-related osteoporosis.
Exercise is the main medicine in menopause. We want to prescribe rehab and prescribe movement. I quite like the term ‘prescription’ because it reflects the importance of exercise and movement, no drug or other intervention will be as effective. It benefits mental, cardiovascular and bone health.
There are some specifics around how to really get the best out of that benefit, for instance, for bone health, you need to load the bones through exercise. Loading can be through running, but simply running might not be enough, it's got to be multidirectional. There’s a whole scope of movements that women need to do to maintain bone health, and to make sure they keep muscle bulk. But that's only part of the benefit of exercise – it improves mental health, cardiovascular health, reduces cancer risk - the list goes on and on! So basically, exercise is the big non-negotiable into the menopause.
It seems to be that across the board, women of all ages, ethnicities and social economic groups want to feel and look good, but the barriers to exercise are many and the million-dollar question is how to help women to overcome them? It breaks my heart that for women one of the main barriers is shame - shame about exercising, shame about body shape, (the reason we know that some women exercise at five o’clock in the morning), or not being fit enough to go to the gym or just get started. But it's complex - woman are also too busy, or too tired.
We strongly believe at Menopause Movement that this can only be done when fitness professionals, healthcare professionals and the community start working together. One of the beautiful things that came out of the recent Women In Sport research was that women respond very well to a buddy system. The research showed that understanding what a community could offer, where to go and having a buddy/mentor/trainer that checked up on them, to see how they were getting on, seemed to be something that worked well.
A lot of it I think is about giving women permission for self-care and making them understand that self-care isn't selfish - if they want to be able to deal with looking after the family, sustaining relationships, and navigating the demands of the working world, they need to look after themselves, and this absolutely becomes more important in the menopause with its raft of hormonal changes. Rest and recovery might have slowed down so sleep, self-care, exercise and good nutrition become more and more relevant.
We need to reframe and think of ways for supporting women and it’ll be different for all women - some over train but so many under train. I think community, working together, supporting each other, and having fun together, are key to removing those barriers.
The WHO recommendation is five hours of physical activity per week. Two and a half hours of physical activity - walking to the shops, hoovering, gardening, any movement at all, plus 2.5 hours of moderate to vigorous activity. Most women in the UK don’t meet those targets and we know that many women going into the menopause drop out of exercising even more. So, encouraging, supporting and motivating them is key.
No size fits all! It depends on exactly where women are at, and where they need to get to. Those women who are very unfit and sedentary and start to do a little bit of exercise will see a huge difference.
Whatever their starting point, we want to aim for all women doing resistance and impact exercise - strength really matters, muscle build really matters! Strength declines for all of us in our third decade and accelerates exponentially in menopause. It’s so important to share the message that we can reverse that decline to some extent, with exercise.
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Research on strength and conditioning routines, training and diet is mainly done on men. There’s a real move now to share the mantras that women aren’t ‘small men’, or ‘men with boob and tubes’ but that they have completely different physiologies. Our training and nutrition needs are different. It’s not rocket science but the hormones that fluctuate in perimenopause and flat line into menopause need to be taken into account.
It’s not the end post-menopause when women’s hormones flat line with few hormones – anabolic steroids which rebuild and help with recovery aren’t as present as they were when they fluxed and surged in perimenopause. Something for us all to consider!
My message to women going through menopause, or to the treaters or trainers, if you or the women you work with aren’t feeling it in an exercise session, ease off, take time to rest and recover.
Remembering the difference between men and women and the impact of the hormonal changes, recovery becomes very important. We need to make sure that exercise doesn’t add to stress and that it decompresses the body from stress. Women shouldn’t train again if they haven’t recovered, otherwise they’ll get a negative training effect. If they run up the stairs and still feel a muscle ache or are completely out-of-breath, they’re probably not ready for their next session yet. This is where expert professionals come in – they’ll be able to guide a woman through this using their understanding of how to train women on a hormonal profile.
Fitness professionals know much better than somebody like me, a healthcare professional, how to train women, how to set programmes and how to build bespoke programmes. But what we want to share is the impact of changing hormones on perimenopausal and menopausal women and how a fitness or health professional who understands their specific needs, can help.
The professional treater or trainer can take women by the hand and navigate them through the changes. As well as recovery and decompression from stress, for the women who want to make changes there’ll be a level of discomfort - an informed professional can guide women through that discomfort and help them understand what the ultimate gains are.
By collaborating and creating communities – this might be communities in gyms or in community projects or within the NHS it doesn’t matter where we sit - as therapists and fitness professionals, we can help women to reframe thought patterns and get started on a positive exercise journey that’s so essential for women’s health in mid-life and the rest of their life.
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