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Talking about the menopause: symptoms, support and the role of exercise
Talking about the menopause: symptoms, support and the role of exercise

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2 The benefits of exercise in perimenopause and menopause

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A drawing of a foot on the floor. Underneath the foot, there is a list of terms: Stress, diabetes, hypertension, heart disease, high blood pressure, chronic disease, high cholesterol, insomnia, obesity.

Heart health

Cardiovascular disease is the biggest killer of women in their later years. It can affect heart health, resulting in an increased risk of heart attack. Regular exercise benefits the function and structure of the heart, which is a muscle, and also keeps the blood vessels that make up the circulatory system healthy. And what is good for the heart is also good for the brain, so improved cardiovascular health also reduces the risk of vascular dementia.

Bone health

You will probably have heard of the risk of osteoporosis (thinning of the bones) that affects women in particular as they reach menopause and beyond.

Osteoporosis is serious business! Bone thinning can happen from about the age of 35 (NHS, 2022), leading to a condition known as osteopenia (loss of the protein and mineral content of bone) in perimenopause. And as oestrogen levels fall sharply in menopause, osteoporosis sets in, causing the bones to become brittle and easily broken. Fractures can then occur much more easily than they would in young women, from simple trips and falls. The most common sites for such fractures are head of the femur (hip), spine and wrist. This is why women in their later years are so often to be seen in hospital A & E departments with broken wrists or hips. In a woman with severe osteoporosis, there have even been instances of spinal fracture occurring with the simple actions of bending over or coughing (Mayo Clinic, 2022).

So what are the risk factors for osteoporosis, other than menopause itself? The chances of developing osteoporosis are to a considerable extent impacted by genes. If an individual’s mother has osteoporosis, then there is a 70% chance that they too will develop it in their later years. Other risk factors include early menopause (before the age of 45, either naturally occurring or as a result of a hysterectomy), amenorrhea (loss of periods) for more than 6 months, as a result of dieting, eating disorders or over-exercising, Body Mass Index below 19, smoking, heavy use of alcohol, and long-term use of steroid medications (often used to treat arthritis and asthma), and inactivity over an extended period (NHS, 2022).

The good news is that regular weight-bearing exercise has been clearly shown to improve both bone health, as impact on the bones and the effect of muscles pulling on them can significantly slow down the loss of bone mass linked to reduced levels of oestrogen.

Genitourinary health and the pelvic floor

Declining levels of oestrogen can cause thinning of the skin lining the bladder and urethra (the tube leading from your bladder that allows you to pass urine). This can lead to the various types and levels of incontinence that are common in menopause and beyond. Urge incontinence refers to a sudden and (sometimes unstoppably!) urgent need to urinate and can occur when the bladder starts to become full. Stress incontinence occurs when pressure is put on the bladder, e.g. when we sneeze, laugh or cough, or when we move quickly or lift something heavy.

As well as these effects on the function of the bladder, declining oestrogen impacts on the strength of the pelvic floor. The pelvic floor consists of a sling of muscle that extends from the pubic bone to the base of the spine, working to keep the organs of the lower abdomen in place – the bladder, uterus and bowel. For those who have given birth, have suffered from chronic constipation or are overweight, the pelvic floor may already be weakened when they hit the menopause years. With the fall in oestrogen levels, the pelvic floor is further weakened.

So how can exercise help? Specific pelvic floor exercises are simple to do and, if performed regularly, can help enormously with stress and urge incontinence. The pelvic floor and pelvic floor exercises are explored in Activity 2.

Activity 2 Pelvic floor muscles

Timing: Allow 15 minutes

Watch the film where Baz Moffat from The Well HQ [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] explains how to locate and then train the pelvic floor muscles. Then answer the following questions.

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Transcript: Video 2 Pelvic floor muscles

BAZ MOFFAT
Locating your pelvic floor muscles can be a bit tricky because you can’t see them. So when we ask people to do pelvic floor exercises, they often just squeeze everything. They’ll squeeze their face, they’ll squeeze their tummy, they’ll squeeze their glutes in the hope that their pelvic floor is involved somewhere. But the key is to isolate it, to just work the pelvic floor on its own.
And the best way to do that is when you’re on the loo having a wee, attempt to stop yourself from the flow of urine coming out. Now that is only to isolate it and work out where it is. Don’t do that every single time. And the other exercise is to imagine your passing wind and you don’t want to and to stop yourself from doing that. And those are your pelvic floor muscles, and that’s all you need to do is work out where they are.
So we’re going to do an isolated pelvic floor exercise. Do this in lying or sitting or standing. And the most important thing is to be really relaxed. So I want everyone to relax their tummy, have your feet flat on the floor, relaxed face, and then just imagine your start yourself stopping passing wind and just connect with that part with your anus and close it off, and then relax it.
And then I want you to do the same with your vagina. So you’d close it off and then relax and let go. And you notice that I’m able to talk and I’m doing these exercises, but you shouldn’t notice on the outside that this is happening. And that can often be a lot harder than you think.
So once you’ve worked out that connection, you then want to lift up your vagina towards your belly button, and then relax let go, and then lift up the vagina towards the belly button, and then relax let go. And the relax let go can be as hard as the lift, and it will just take quite a lot of time to get used to doing those.
We get asked all the time, how many exercises women should be doing? And every woman should be doing the basic pelvic floor exercises every single day because they have a pelvic floor. So 10 slow lifts and 10 fast lifts every day.
But that’s not enough for an athlete. That’s not enough for a sportswoman. They need to be making sure that they’re integrating their pelvic floor work into their strength and conditioning, and into their core work. And every trainer and every coach needs to really prioritise getting the pelvic floor onto the gym floor.
End transcript: Video 2 Pelvic floor muscles
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Video 2 Pelvic floor muscles
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Questions

  1. How can you accurately locate your pelvic floor?
  2. How often should you do pelvic floor exercises?

Comment

You can locate your pelvic floor by squeezing the muscles that stop the flow of urine and those that stop you from breaking wind. It is important that you only stop the flow of urine while practicing as doing this regularly can lead to problems, such as a urinary tract infection. You should aim to do these exercises daily and perform 10 lifts slowly and then 10 lifts quickly.

General exercise and physical activity can also improve pelvic floor function, as any movement and in particular intra-abdominal pressure will stress the muscles of the core and pelvic floor, causing them to become stronger.

Mental health

Another benefit that is also widely acknowledged is the positive effect of exercise on mental health and everyday cognitive function (Lox et al., 2019). Among the most distressing symptoms suffered by women in menopause are low mood and even clinical depression, as well as difficulties with concentration and memory. Studies have shown that regular exercise can be as effective as medication in alleviating mood disorders and depression (Lox et al., 2019) and many women have reported that they feel mentally sharper and clearer if they can get some oxygen buzzing around their brain by including exercise and fresh air in their day.