Menopause is formally defined as the point at which a woman has not had a period for 12 months. The age of onset is typically between 45-55 years, with this age of onset being influenced by both innate (heritable) biological traits and environmental factors such as smoking and stress.
The period leading up to menopause – called perimenopause – typically lasts for 2-8 years (average of 7 years) prior to the official onset of menopause. This is the time where the menstrual cycle essentially starts to “wind down” with ovulation becoming less frequent. The vast majority of women will experience at least some of these common symptoms:
- Irregular and/or erratic menstrual cycles, increased PMS symptoms.
- “Hot flushes” (technically called Vasomotor Symptoms).
- Mood disturbances, typically an increase in irritability, depression and anxiety.
- Cognitive symptoms including difficulty with memory and “brain fog”.
- Insomnia
- Weight gain, particularly around the abdomen.
- Joint aches.
These changes are driven primarily through declining levels of the hormones produced by the ovaries, the two most well-known of which are Oestrogen and Progesterone. Apart from being the primary female sex hormones, Oestrogen and Progesterone also have a hand in just about every system of the body. As hormone levels begin to shift, women will typically start to notice some physical, and possibly psychological, changes.
What Does This Have To Do With Exercise?
Perimenopause heralds a number of physical changes which have significant implications for a woman’s health and functional fitness. The good news is that most of these changes are positively influenced through exercise. Here I want to focus specifically on the role of strength training for older women. Strength training has traditionally been very counter-cultural for this cohort, the very cohort that arguably needs it the most. Strength training should be at the top of the hierarchy of exercise for women heading into middle-age and above for managing weight, maintaining muscle mass, building bone density and keeping the nervous system happy.
Sun’s Out, Guns Out.
Muscle tissue is about functional strength, yes, but is isn’t just about strength. Muscle tissue has a profound influence on metabolism, and therefore on weight maintenance. Women tend to go into middle-age with a lower overall muscle mass than age-matched males. There are definitely biological drivers for this, however, much of the decline in strength and muscle tissue that typically occurs as women go through perimenopause has as much to do with lack of appropriate exercise stimulus as it does with biology alone. Up to very recently, women as a whole have just not engaged in strength training and are still not participating in strength-building exercise nearly as much as men.
All living tissue is metabolically active, but muscle tissue is particularly so. Generally, if you have relatively more muscle mass, your basal, or resting metabolic rate (how much energy you burn just to stay alive) is likely to be higher (it’s more complex than that, but the correlation between lean tissue mass and resting metabolic rate is significant). So simply speaking, the best way to boost your metabolism is to maintain or build your muscle mass. This means that strength training should be a key component of any functional capacity and weight management programme.
There are two common misconceptions about women and muscle mass, each of which roundly contradicts the other. The first misconception is that strength training will make women bulky. Let me start by saying, categorically: there is nothing wrong with being bulky. However, whilst it is possible for some biologically-gifted women to put on significant muscle mass, it takes hard, hard work and it is very unlikely that a woman who is middle-aged or above and on a moderate calorie diet, will significantly bulk up. Furthermore, the kind of weight training you do for strength, is not the same as you would do for body building.
The second misconception is that older people, and older women in particular, can’t add muscle mass and a steady decline in strength and function is just inevitable. This is similar to the fallacy that older women cannot add bone mineral density. Both are demonstrably incorrect. Even where it is very difficult to put on extra muscle, it is possible to retain muscle, or at the very least slow the decline of muscle loss into old age. Additionally, much of a person’s strength has to do with training the nervous system. With an appropriately structured strength programme, you can gain significantly strength without increasing muscle mass at all.
It becomes much harder to increase bone or muscle mass once you are post-menopausal, compared to pre-menopause. Starting before the onset of menopause gives women the best chance at building the strength they will need for a resilient older age. That being said, it’s never too late to start.
Now where did I put my waistline?
One of the most common issues women notice with perimenopause is the addition of some extra centimetres around the waist. It can be very frustrating to gain weight despite eating and exercising in much the same way as you had before. The typical response is to significantly cut calorie intake and increase aerobic (“cardio”) exercise. Unfortunately, this strategy is often not as successful as it may have been in the past because it does not adequately address the underlying metabolic changes driving the weight gain.
In short, your metabolism is changing in some significant ways, and understanding this process is key to managing it. You do not need to be super lean to be healthy, and most women will gain a bit of weight overall, but excessive weight gain during this time is linked to poorer health and more severe menopausal symptoms.
Women looking to lose some weight generally gravitate to long, slow, steady-state “cardio” because they believe this is the best way to burn fat. Technically, it is true that cardio does ‘burn fat’, but there are a number of issues with this way of thinking – chief amongst which is failing to take into consideration how different types of exercise influence hormones and the nervous system. What the science suggests often flies in the face of what is commonly believed. Why people gain weight can be complex, but in general, most women will experience an overall decrease in the amount of calories required (a “slowing down” of the metabolism associated with age, as well as with the loss of muscle mass) and a decrease in sensitivity to the hormone Insulin (commonly associated with Diabetes and Polycystic Ovarian Syndrome). Dietary changes to address these two things can be hugely helpful. In particular, a moderate decrease in overall calorie intake, specifically lowering the relative number of calories coming from carbohydrates. However, the general tendency is to restrict both carbohydrates and overall calorie intake too much, leading to what is often referred to as the “yo-yo dieting” effect, which can wreak havoc with metabolic health.
Very rapid weight loss should not be your goal unless it is a medical necessity. You will lose fat, but you will also lose a significant amount of muscle and bone mass. Muscle tissue is very metabolically active and losing muscle will both decrease your functional strength and slow your metabolism, making it harder to manage your weight in the longer term. Losing bone mass is definitely something older women want to avoid. Slow and steady wins the race every time.
With the above in mind, we want to place our focus on exercise that preserves and stimulates muscle mass whilst burning calories, thereby maintaining a good metabolism. A high quality strength training programme, along with moderate to higher-intensity interval training should be your go-to, with the caveat that programming should be designed to suit your current level of fitness, your health status and your recovery capacity.
Them Bones.
Older women are generally at higher risk of developing low bone mineral density (BMD) than other sections of the population. Women have smaller bones than men on average, but women are also far less likely to participate in bone-building exercise/activities throughout their lifespan than men are. Osteopenia (clinically low BMD) and Osteoporosis are far more common in women than in men, and just over 70% of older adults who present with a hip fracture are female. Once hormone levels begin to decline, it becomes increasingly difficult to both build new bone and to hold on to your existing bone. There is a common misconception that it is not possible to improve bone density at this time in your life: this is not true. It just gets a bit harder. A high-quality strength training programme is absolutely essential for women of all ages, but particularly for older women. Strength training and weight-bearing exercise should be at the top of the hierarchy of exercise for building bone.
Getting On Your Nerves.
Finally, there is the nervous system. Given the profound impact the nervous system has on just about every aspect of health, it receives a criminally low level of attention when people are thinking about exercise. In the context of perimenopause, the nervous system is of interest in some key areas, including strength and functional fitness, cognition, and mood.
Functional strength, balance, co-ordination and all that good stuff has as much to do with the nervous system as it does with muscle. In addition, exercise is absolutely essential for good mental health and cognitive functioning into old age. This isn’t just about “feel good” hormones, it is also about the health of the nervous system itself. Brain health in Menopause has been woefully neglected, both in terms of addressing mental health, and in terms of addressing the much higher risk for developing Dementia in this population. Far more research needs to be done in this area, however the research that does exist, points at exercise as having a significant role to play in the maintenance of brain health into older age.
Strength training has a profoundly positive effect on the nervous system, and its effects on mood and cognition is often under-appreciated. All exercise will have a positive effect on mood, however weight training is effective not only in the management of Depression and Anxiety, but also in the maintenance of cognitive functioning. In addition to basic strength work, consider adding these other elements: complex 3-dimensional movement, particularly exercises that require movement across the mid-line of the body; novel movement and physical challenges that are unfamiliar to the body. This can be as simple as learning a new exercise, or doing something in a different way.
Accessing Good Information and Support.
If there is a single take-away from all this, it is that women, and older women in particular, need to be doing strength training. This is so important from a health perspective, and yet there are still significant barriers that stand in the way of women accessing strength training, including access to good quality instruction in a safe and supportive environment. Strength training, unlike say, walking for exercise, is a skill-based form of exercise – i.e you need to be taught how to do it. In addition, women going into perimenopause and menopause should ideally have a solid understanding of the physiology of this time of life, and how to best structure exercise, nutrition and recovery techniques to make sure they get the best out of the effort they put in.
This article was written by Marcelle Malan. To book an appointment with Marcelle please find our online booking page here.
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