Menopause: What Is Actually Happening to Your Body?
Women can spend ⅓ of their lives in menopause and the postmenopausal years, and yet so many of us aren't properly educated on what is actually happening in our bodies. So let's talk about it.
What is menopause?
Menopause is one point in time. It is when you have gone 12 consecutive months without a menstrual period and there is no other reason for your period to have stopped. The average age of menopause is around 50–51.
What we often call “menopause” is actually a much bigger transition that can occur over 10 years. The years leading up to menopause are called perimenopause, and during this time estrogen and progesterone fluctuate quite a bit. Once menopause occurs, estrogen and progesterone remain at significant lower levels than what you previously had.
Menopause impacts your entire body.
Your brain
“Menopause brain” is a real thing. Our brain responds to the shift of hormones by slowing down processing speed.
You may notice:
Difficulty remembering things
Trouble finding words, names, or numbers
Losing your train of thought
Feeling more distracted
Forgetting why you walked into a room
Having a harder time switching between tasks
Your joints and muscles
Joint aches and pains are common around menopause. There are a lot of factors that can contribute to this, but one important piece is the loss of muscle mass that naturally occurs with aging and declining estrogen. Muscle is one of the tissues that helps support our joints.
This is one reason why strength training to preserve and build muscle becomes even more important as we age. This is also a good time to increase protein intake to help support building muscle.
Your metabolism
Changes in estrogen, muscle mass, activity levels, sleep, and appetite can all contribute to changes in body composition and metabolism during this time. You body requires more energy to continue participating in your day to day.
Your heart
Estrogen has a protective effect on the cardiovascular system. As estrogen declines, cardiovascular disease risk increases. This is a good time to get cholesterol levels tested to see if there are any concerns. Fiber, fruits, veggies, whole grains, fatty fish are all good for cardiovascular health!
Your bones
Estrogen plays a major role in maintaining bone density. When estrogen levels decrease, bone breakdown can increase by 2% each year. Our bones respond to load.
Strength training, impact exercise, and other forms of appropriately dosed loading can help your bones adapt and become stronger. You don't need to avoid lifting weights because you're getting older. In fact, strength training may be important now more than ever.
This is a good time to increase calcium intake to help with bone health.
Your pelvic floor and genitourinary system
Changes in estrogen can affect the tissues of the vulva, vagina, bladder, and pelvic floor muscles.
You may experience:
Urinary tract infections
Urinary leakage
Pelvic floor dysfunction
Prolapse symptoms
Vaginal dryness or inadequate lubrication
Burning or irritation
Pain with sex
Pain with urination
Changes in vaginal discharge
Sexual dysfunction
You do not have to accept these symptoms because you're getting older. Pelvic Floor PT can help address so many of these symptoms!
Hot flashes and night sweats
This is probably the symptom most people associate with menopause.
Your brain's temperature regulation system becomes more sensitive to small changes in body temperature as estrogen levels decrease. Your body can essentially interpret a small change in temperature as “WE ARE TOO HOT!” The blood vessels are triggered to dilate in order to release heat and result in a hot flash.
These vasomotor symptoms can happen multiple times throughout the day, up to 20x, and can also occur at night. When you're waking up multiple times a night drenched in sweat, it's no surprise that sleep, mood, cognition, and your ability to function during the day can also be affected.
Sleep and mental health.
Women going through menopause can experience more difficulty falling asleep and staying asleep. Sleep apnea risk also increases during this time.
THIS IS A LOT! Yes, I know. But..
You don't have to just live with these symptoms.
There are things we can do.
Pelvic floor physical therapy
Pelvic floor PT can be incredibly helpful for women during perimenopause and after menopause. A Pelvic floor PT can work on things to address:
Urinary/Fecal incontinence
Prolapse symptoms
Pelvic pain
Painful sex
Chronic constipation
Pelvic floor coordination
Strength and load tolerance
Strength training
Muscle is protective. Our bones respond to load.
Strength training can help us maintain muscle mass, support our joints, improve bone health, and maintain the strength and capacity we need for everyday life and the activities we love.
Movement
Exercise can help with some of the symptoms associated with menopause, including vasomotor symptoms potentially decreasing the frequency of hot flashes per day.
Nutrition and fueling
Your body is going through a pretty significant physiological transition. Undereating while simultaneously asking your body to exercise, recover, maintain muscle, and support bone health can exacerbate menopausal symptoms.
Getting enough energy, protein, and nutrients is an important part of supporting your body through this transition.
Hormone therapy
For some women, hormone therapy can be an incredibly helpful option, particularly for vasomotor symptoms and some genitourinary symptoms.
It is something important to discuss with your physician or other qualified healthcare provider based on your individual health history.. Use this link to find a provider near you who specializes in menopause. Click Here.
Sleep
If you're struggling with sleep during perimenopause or menopause, there are some simple things that may help:
Keep a consistent sleep and wake schedule.
If you're waking up to pee, try limiting fluids for about 3 hours before bed.
Limit bladder irritants such as alcohol, especially in the evening.
Keep your bedroom cool—around 65°F.
Try to keep your bedroom primarily for sleep and sex.
Limit screens before bed.
If your brain is racing, do a “brain dump” on a piece of paper before getting into bed.
Exercise during the day.
Limit long daytime naps.
So, where does this leave you?
Menopause is a normal part of aging, but that doesn't mean you have to feel terrible and assume there's nothing you can do about it. Your body is changing. That means you may need to change how you train, how you recover, how you fuel, and how you approach your symptoms.
You Can Still
get stronger
take care of your bones
have great sex
be worry free of urinary/fecal incontinence
improve your sleep
talk to your doctor about hormone therapy
continue doing the things you love
At Flow State, I work with women to build strength, improve pelvic floor function, and stay active through all stages of life. You don't have to stop doing the things you love just because your body is changing. You just might need a different approach.
Resources:
“The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028
Liu T, Chen S, Mielke GI, McCarthy AL, Bailey TG. Effects of exercise on vasomotor symptoms in menopausal women: a systematic review and meta-analysis. Climacteric. 2022;25(6):552-561. doi:10.1080/13697137.2022.2097865
Dąbrowska-Galas M, Dąbrowska J, Ptaszkowski K, Plinta R. High Physical Activity Level May Reduce Menopausal Symptoms. Medicina (Kaunas). 2019;55(8):466. Published 2019 Aug 11. doi:10.3390/medicina55080466
Metcalf CA, Duffy KA, Page CE, Novick AM. Cognitive Problems in Perimenopause: A Review of Recent Evidence. Curr Psychiatry Rep. 2023;25(10):501-511. doi:10.1007/s11920-023-01447-3