Every woman has experienced the lethargy, stomach cramps and feelings of irritation which regularly make an appearance during the menstrual cycle. But as if that wasn’t enough, once our fertile years are over, the tell-tale symptoms of menopause begin.

For many women this period of life brings more unpleasant feelings, such as mood swings, sleep disturbance and the dreaded hot flushes. Not surprisingly, none of these are conducive to an energetic desire to work out, but according to new research from Denmark, the menopausal years are the perfect time for women to not only continue with ongoing exercise regimes but to renew with a vigour or even start for the first time.

The study, published in the Journal of Physiology, suggests the reduction in oestrogen during menopause may improve the take-up of oxygen in the muscles.

Early action

Aisling Grimley, who lives in Dublin with her four daughters, can relate to this as she started experiencing menopausal symptoms in her late 40s and having been pre-warned of the possibility of putting on weight, actually started exercising more and while it was difficult, the hardship has been worth it.

“One of the big fears many of us have at menopause is the dread of putting on weight and getting fat around the middle,” says the 52-year-old. “A friend warned me that even though she hadn’t changed her routine, she was gaining weight. So I became motivated to get exercising and saw it as an investment in my future.

“One of my great pleasures in life is food, both cooking and eating – so it’s vital for me to take some form of exercise every day. Getting moving also improves my mood and sense of well-being so it’s a double positive.

“I try to cycle or walk rather than drive and I make sure to move every day as I would rather do this than be medicalised.

“I have to say I have never felt as strong or healthy as I do now. This is because I know the importance of approaching menopause in good shape: mentally and physically.

“I also discovered the need for weight-bearing exercise daily to protect my bones from osteoporosis. I believe gentle exercise helps to alleviate symptoms like hot flushes, insomnia, anxiety and fatigue.”

Difference

The Dublin woman, who set up mysecondspring.ie to offer support to other women going through menopause, says although she wasn't a fitness fanatic pre-menopause, her new regime has made a huge difference to her life.

“I was never a sporty person at school or as a young person, due to lack of confidence and poor body image,” she admits. “Now that I’m more comfortable in my own [midlife] skin, I reckon I’m fitter than ever – I walk [and talk with friends], go to the gym, cycle and swim regularly. I’ve even taken up dancing for fitness and fun.

“I find it very empowering to know how worthwhile it is to stay in shape in terms of health and vitality as I age. I can see the point in striving for healthy lifestyle now more than when I was younger.

“Aside from ensuring a smooth menopause transition, good diet and exercise make me feel happy and reduces the risk of heart disease, cancer, stroke and a raft of other diseases.”

Medical view

Dr Khushal Chummun, consultant obstetrician and gynaecologist at the Rotunda and Connolly Hospital, says while exercise is indeed beneficial to menopausal women, it may not improve every symptom.

“There is always a good time to start exercising,” he says. “Physical activity benefits people of all ages and reduces morbidity, allows healthy ageing and increase life expectancy.

“For older adults [including menopausal women], exercise increases physical fitness, reduces risk of cardiovascular disease, stroke, diabetes, weight gain, osteoporosis, anxiety, depression and cognitive decline, all of which are independent consequences of menopause.

“There is evidence that active women have fewer menopausal symptoms. So doing regular exercise such as walking, jogging and aerobics is important to prevent osteoporosis. But there is limited evidence as to whether this helps with hot flushes specifically. However aerobic exercise can improve common menopause-related symptoms such as mood and insomnia.”

The expert in female health says once an exercise programme has been undertaken, it needs to be maintained otherwise all the benefits will be lost, so choosing something which is enjoyable is the first step.

“It is important to start gradually,” says Dr Chummun. “And to know that while exercising is beneficial, this is quickly lost if the woman stops, so it’s important to have a regime that is enjoyable enough to allow long-term compliance.

“In general people should exercise at least 30minutes a day on at least five days of the week and if they cannot exercise for 30 minutes straight then to do 10 minutes exercise three to four times per day.

“Aerobic exercises such as walking, running and swimming are bound to be beneficial for general physical and psychological wellbeing as well as prevention of cardiovascular disease.

“Weight-bearing exercise such as brisk walking, running, dancing, hiking or gardening provide an additional benefit towards prevention of osteoporosis. Infrequent very high-impact exercise on the other hand can make things worse.”

Stigma

Aishling Grimley says one of the biggest issues with menopause is the stigma that still surrounds it and which makes women reluctant to talk about their symptoms.

“Because menopause has never been discussed openly, I think many of us have just heard dark mutterings that sounded very negative and these have been stored in our consciousness,” says the mother of four.

“In the past, I certainly had absorbed an unwritten secretiveness around the word and time of menopause. I wanted to break this cycle for my own daughters when I realised I was heading in the menopause direction, aged 47.

“So when I was considering the idea of an information website four years ago, I surveyed women informally – asking what they knew. The responses were almost all negative.

“Menopause was synonymous with the end of attractiveness, a state of being dried up, cast aside, old and over the hill.

“Many said that their mothers had endured awful menopauses. So it was hardly surprising that most women recoiled as if I might be carrying a contagious disease.

“At mysecondspring.ie we’ve strived to reframe menopause as a positive life phase, full of new opportunity and potential. For every troubling symptom of menopause, there is a solution.”

Coping with symptoms

Dr Chummun says there are many ways in which the symptoms of menopause can be eased for women – these include medication but also simple lifestyle changes.

“Treatment depends on the patient’s complaint and also the prevention of long term effects of lack of oestrogen in menopause such as osteoporosis and cardiovascular disease,” he says. “So a combination of medication and lifestyle modification may be important.

“Medication includes hormone replacement therapy, non hormonal medication, vaginal lubricants and moisturisers, calcium, vitamin D supplements and bisphosphonates to prevent osteoporosis.

“Natural remedy such as isoflavones [phytoestrogens] and black gohosh may relieve hot flushes, however their safety is uncertain as they may stimulate breast tissue similar to oestrogen and interact with other medications.

But lifestyle modifications are also very important – these include:

• Smoking cessation.
• Weight loss.
• Limiting alcohol and caffeine not only because they can trigger hot flushes but also because they are additional risk factors to cardiovascular disease and bone problems.
• Steps such as wearing lighter clothes and sleeping in a cooler room may reduce number of hot flushes.
• Going to sleep and getting up at the same time and avoiding naps can improve sleep problems.

Advice

Menopause is here to stay and Aishling Grimley, who has experienced its symptoms and found her own solutions, offers advice to other women and says people are slowly becoming more open about the topic and this is definitely a step in the right direction.

“I get inquiries from all around the world every day – we have over 2,000 hits daily,” she says. “I think there’s a growing awareness amongst women of about 45 that menopause is around the corner as symptoms are felt while they still have periods and this can lead to confusion and misdiagnosis.

“So the feedback we get from visitors to the site is first and foremost, relief. Many women are confused about the changes taking place in their bodies. Personally I have found good nutrition and some supplements to be helpful in managing low energy levels.

“I have a good exercise regime which helps with everything – stress, serotonin levels, waistline plus bone and muscle strength. I would encourage other women to read up about menopause.

“If your symptoms are limiting your quality of life, make sure to get the help and support which resonates best with you. This could be from your GP, a counsellor, a homeopath, reflexologist, acupuncturist, naturopath or herbalist.”

Menopause explained

What is it: natural menopause is defined as permanent cessation of menstrual period for 12 months and beyond.

When does it happen: It typically occurs between the ages of 45 and 55 with average age being 51-52 years. This is affected by a number of factors including genetics and smoking. Menopause before the age of 40 is considered abnormal and is termed premature ovarian failure.

What's before the menopause? The final menstrual period is usually preceded by the perimenopause which on average starts four years before (around 47 years). During the perimenopause there are hormonal fluctuations that can cause irregular cycle, hot flashes, mood swings, sleep disturbance.

10 Symptoms

Changes in menstrual cycle: Nearly all women experience menstrual irregularities. There is usually an increase in the cycle length followed by skipped menstrual period before the final menstrual period. Some women may experience shortening of their cycle and heavier menstrual blood loss.

Hot flushes: This is the most common symptom and can affect up to 80 per cent of women. It is described as a sudden onset of heat around the chest and face that becomes generalised. It can be associated with perspiration, palpitation followed by chills and anxiety. It is particularly common at night.

Sleep disturbance: This affects nearly 40 per cent of women in the perimenopause. It can be a problem on its own or can be due to other symptoms of menopause such as hot flushes, anxiety, depression which in turn affects sleep.

Depression: feeling low, problems with concentration, no interest in normal activities.

Vaginal dryness: This is due to lack of oestrogen that causes thinning of the vaginal tissue giving a sensation of dryness and can cause itch and painful sexual intercourse.

Sexual dysfunction: Lack of oestrogen and reduced blood flow to the vagina and vulva results in decreased vaginal lubrication which can cause painful intercourse. Hot flushes, lack of sleep and depression can contribute to a loss of libido.

Cognitive changes: Some women describe difficulty concentrating and memory loss. This could be due to lack of oestrogen and sleep or depression

Breast pain: This is common in the early stages of the perimenopause.

Menstrual migraines: These are headaches that occur around the time of menstrual period. Some women can experience increase in its frequency in the perimenopause.

Aches: Some womend can experience pain in the skeletal joints.