THE MENOPAUSE

I’ve put off writing this for a while. It’s not that it’s a subject I’m not familiar with - it effects every single person I work with - but it’s a complicated area and it’s not one people talk about openly.  

I’m talking about the menopause.  

I’ll not profess to being an expert - I’d actually claim the contrary. I have spent years reading about endocrinology, and years working with peri-menopausal and menopausal women, but it’s a working knowledge and the more I learn the more I realise there is to learn.  

From hot flashes, night sweats, difficulty sleeping, reduced libido, brain fog, headaches, heart palpitations, anxiety, joint stiffness, aches and pains to the increased risk of osteoporosis, it can have a serious impact on the day-to-day life of the women I coach.  

And if you’re a guy reading this you better understand this effects you too. If you’re on the wrong end of a ball-crushing mood swing you need to be kind. Like I said, the menopause effects everyone in some way, shape or form.  

Perhaps the biggest challenge for everyone involved is it’s somewhat invisible. Your biochemistry is changing and it’s hard to know what’s what.  

Unlike more obvious physical ailments - like a broken leg or bereavement - it comes out of nowhere and symptoms change daily.  

I know in discussions with clients more recently the worst thing (and I’ve been guilty of it) is to be dismissive. I can only imagine how hard it is for some people. But it’s made doubly-bad by the coy nature in which it’s discussed.  

I can totally understand why women don’t want to talk to me about vaginal dryness - it’s way beyond the scope of my practice - but there are issues around pelvic floor health (your muscles will atrophy) and this can really effect a clients physical health, confidence and motivation.  

I’ve learnt to err on the side of caution knowing people don’t disclose and make safer exercise selections, and despite calls for me to be more assertive I try to be more gentle with nutritional and lifestyle recommendations. Like I said, the symptoms ebb and flow and my client might not know what they’re experiencing.  

I’d strongly recommend finding a good doctor and talking to them about it. Judging by the response from some clients this can be easier said than done. It’s quite common for appointments to seem hurried and some people suggest there’s misunderstandings from their GP.  

They end up being prescribed prozac instead of HRT or they’d prefer to try and manage themselves with diet and lifestyle rather than medicate, but there’s not the depth of knowledge and understanding with their GP nor the time to explore options thoroughly in the allotted appointment time.  

There was a suggestion from a client that if you have the means this might be something you could do privately. Again, I’m aware of the scope of my practice and whilst I can prime a client to ask better questions of their doctor I’d never discourage them from following the doctors advice.  

But (and this is pretty fundamental) your health is your responsibility. How you approach this is up to you. If you’d rather not medicate, eat better and exercise, but are willing to align your chakras and to fix your aura with reiki then that’s entirely your decision.  

I’ll admit (and I know this makes me sound like an ignorant prick) more recently when asked by a friend and client about the menopausal symptoms I flippantly said most people have spent the 20 years prior to the cessation of their periods bludgeoning themselves with terrible diets, erratic exercise routines (if any), poor sleep and stressing about trivial things.  

Then the tsunami of peri-menopausal symptoms hit (and let’s face it most of the challenging symptoms occur when you’re peri-menopausal) and you comfort yourself with wine and inactivity…  

I need to be kinder when I approach this. Like I said, I know the symptoms of menopause can be overwhelming and you’re trying to find comfort in anything, but given the most common complaint I hear is around weight gain the inactivity, poor diet and lifestyle mean you don’t stand a chance.  

It can be like telling a depressed person to cheer up or someone who is anxious to chill out. It’s a fundamental misunderstanding about the condition and it’s unhelpful. But being proactive in your approach to the menopause and having a resilient attitude can make any intervention more effective.  

Like I said, one of the more common concerns about the menopause is around weight gain.  

You might be surprised to know the research is unclear on if this is due to the menopause or a natural consequence of ageing.  

What makes research tricky is the varying ages at which women encounter menopause and their varying experience.  

Either way the reduction in sex hormones leads to reduced fat free mass, lower resting metabolic rate, reduced physical activity energy expenditure, increased visceral fat, changes in storage location of subcutaneous fat and increased insulin resistance.  

This essentially means you’ll experience a reduction in energy expenditure and fat oxidation and so you’ll have to consume less calories and it’ll take you longer to get results from the exercise you do.  

But there’s more to eating healthy and exercise than weight management. There’s issues around bone density, pelvic floor health, cardiovascular health and diabetes too.  

The challenge with exercise and making better food choices is you can often feel exhausted and confused from the disrupted sleep, you might feel embarrassed and self-conscious by the hot flashes and this will effect you motivation and adherence.  

Here are just a few of the many considerations around training and eating which might help:  

✅ If someone is struggling with energy then they’ll feel good on some days and exhausted on others. Having a scalable effort options is key. Sometimes it’s better to spend an hour doing stretching and mobility rather than a spin class.  

✅ If you find hot flashes a challenge you might feel more comfortable if you weren’t in a gym class, but trained outside or at home. There are more options to get fit than the conventional gym membership. The environment you choose to exercise can make or break your fitness habit.  

✅ Feelings of anxiety and overwhelmed are heightened during the menopause. There’s no point adding stress to a stressed out body with excessive exercise. It is important for you to exercise, but you don’t have to overexert. Moving through essential movement patterns (like squat, hip-hinge, lunge, pushing and pulling) with a simple mobility matrix and a little bit of core exercise will help.  

✅ The menopause often coincides with other life events like parenting teenagers, kids leaving home, caring for ageing parents or career changes. This can make it difficult to manage you mood, energy and emotions. Taking time out to rest and breath can help. Going for a walk or doing some meditation might serve you. You can download the headspace app for free.  

✅ More than 40% of women report depressive symptoms associated with menopause. Whilst I’m often on hand to listen to a client, I’m not a qualified counsellor therefore I refer out. I’ve seen clients get great results when speaking to counsellors. But the biggest challenge is in getting them to make the initial phone call.  

✅ Eating better helps, but be careful not to add more stress to your life with a strict diet. You might struggle to adhere and this can make you feel like a failure. Committing yourself to a few healthy habits will do you wonders. Again, there’s more to healthy eating than weight loss.  

✅ Think about your digestive system - it’s like your second brain. Women are twice as likely to experience constipation. Given that’s where your happy hormones are created that’s not good. Couple this with the additional pressure put upon your pelvic floor muscles (both sit in the pelvic basin) then this makes it an important issue. Include a little more fibre in your diet. This helps reduce the risk of cardiovascular disease and helps blood glucose regulation too.  

✅ You need to think about your hydration status. This is an area most women are painfully shy. They’re understandably afraid of going back and forth to the loo. But being dehydrated has consequences. From increased heart rate, greater perception of effort during exercise, increased core body temperature to decreased cognitive function and headaches. Forget the recommendation of 2 litres a day - that might be too ambitious. Try adding one or two glasses of water a day and see how you feel.  

✅ There’s no research for this, but you might notice some foods magnify symptoms of menopause. If you can identify them then you might be able to manage them. This is a bit of a trade off. You might find more comfort from whatever you’re eating and drinking than the discomfort you experience from the symptoms. There’s no judgment here, but I’m thinking about stuff like alcohol, caffeine and chocolate. Again, if you notice they coincide with certain symptoms you might reduce or avoid it.  

✅ HRT. You might’ve noticed I skirted one of the more talked about issues. That’s for good reason. Firstly, I’m not qualified or insured to make a recommendation. You’ll need to do your own research and ask lots of questions of a medical professional for this. I do feel some of the negative associations with being medicated are a little unjust (I feel the same about the antidepressants). It’s not a case of one or the other. The combination of a more natural approach and medication can be very effective. Again, speak to a doctor about this.  

Like I said in the outset, I’d never profess to being an expert in this. The more I read about it the more I realise I don’t know.  

I’ve spent years working with peri-menopausal and menopausal women and know it’s incredibly complex.  

I tend to favour an overly simplistic approach which involves consistent moderate exercise, healthy eating and a fuck-ton of empathy.  

The challenge in writing an article about this is demonstrated by the research in the area. The variance in ages it occurs and the symptoms experienced make it tricky. Some people breeze through others really struggle.  

This is compounded by the lack of good information on the Internet. I understand some women are clutching at straws and will try anything to find comfort.  

From acupuncture to herbal treatments, there’s anecdotal evidence but its unsubstantiated. This doesn’t mean it’s not worth trying. Again, you need to find what works for you.  

But I feel the best start point is to take better care of yourself generally. This involves a eating more fruits and veggies, adequate amounts of protein, a few more fibrous foods, drinking a little more water, being proactive with your rest, striving to get a few more steps a day and doing regular prescribed exercise.