Menopause — the period of time following the last menstrual period — typically occurs between the ages of 48 and 55. In the United States, the average age is 52, but can be earlier; women who are undernourished, smokers, or live at high altitudes are especially at risk for an earlier age of menopause. Menopause is “confirmed” as having occurred if a woman does not have a menstrual period for 12 months.
Due to the shift in hormones during menopause, the body experiences a variety of physiological and psychological symptoms. But these hormonal changes can also impact exercise and training.
Physiology
As the body ages, so do the ovaries; this leads to less of a response by the ovaries when stimulated by follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The lack of response by the ovaries leads to shorter or less regular cycles, fewer ovulations, and less progesterone production. The ovaries are not able to produce the same amounts of estrogen, and this decrease of estrogen allows FSH and LH levels to go unchecked.
These hormonal changes culminate in the way the endometrium — the inner lining of the uterus, which is shed during a menstrual period — develops. The endometrium is not able to develop fully, which causes menstrual cycle irregularity. Eventually, the menstrual cycle stops altogether.
Menopause is a naturally-occurring process. However, it’s important to note that menopause can also occur as a result of a hysterectomy (removal of the uterus) or an oophorectomy (removal of the ovaries).
Changes in the body post-menopause
The deficiency in estrogen causes a variety of physical symptoms. These include hot flashes, night sweats, migraines, heart palpitations, and incontinence or increased frequency of urination. Psychologically, women experiencing menopause can also feel increased anger or irritability, depression, anxiety, and difficulty sleeping or concentrating.
Bone loss (also called osteopenia) is common in post-menopausal women. Estrogen’s decline increases the breakdown of muscle, so women are more at-risk for osteoporosis. In fact, women can lose up to 20% of their bone density during the first five years post-menopause.
One big change also lies in body composition; with the decline of estrogen, it’s easier for the body to gain fat and lose muscle. This happens for a couple of reasons. For one, the body’s ability to synthesize muscle protein (i.e. “build muscle”) drops. Secondly, with menopause, the body cannot efficiently use stored fat as a fuel source during exercise. And thirdly, insulin sensitivity decreases, which leads to the body being put in an almost constant state of storing food as fat.
The decline in estrogen also affects fat distribution; after menopause, fat distribution changes from concentrating around the hips and thighs (pear-shaped) to concentrating around the abdominal cavity (apple-shaped). This switch also leads to increased fat around the internal organs, as well, and can increase the risk for cardiovascular disease.
As mentioned above, exercise can help mitigate some of the symptoms of menopause, but it can also improve quality of life by reducing the risks for osteoporosis and heart disease.
What are the benefits of exercise for postmenopausal women?
The existing research suggests that some menopause symptoms (hot flashes, night sweats, and sleep disturbances) can be lessened through physical activity, and the studies showed that both aerobic training and resistance training both showed this positive effect.
Exercise will also help increase insulin sensitivity and improve blood lipid profiles. It also improves mood, helping to mitigate some of the mental side effects (depression, anxiety, irritability, et cetera) from menopause.
Aerobic exercise is also extremely protective for cardiovascular health. High-intensity interval training (HIIT) can provide the stimulus for the body to build muscle and burn visceral fat. However, the greatest impact on menopause can be seen in the way it affects bone mineral density: resistance training, which requires load-bearing movement, directly increases bone density and helps prevent the bone loss associated with aging and menopause.
Training with free weights was found to be the most beneficial for increasing bone density — especially in the hip joint, which is prone to age-related fractures. Free weights were also shown to improve joint range of motion and mobility. Additionally, training at least twice a week produced the highest effect on preserving bone density.
How does menopause affect training?
While post-menopause training can be very similar to training pre-menopause, it’s important to allow the body sufficient time to recover. Workouts can still be intense, but rest, sleep, and mobility work all promote post-exercise recovery and lower cortisol levels. However, sleep disturbances, caused by the hormonal shifts, can significantly impact recovery and can result in lower energy or motivation.
Muscle strength and power also decline after menopause. Estrogen contributes to the muscles’ overall strength and power output, so a decrease in the absence of estrogen is to be expected. Exercise tolerance and aerobic capacity take a hit, too; post-menopause, and during the transition into menopause, the body cannot efficiently utilize fat for fuel during exercise. This lack of “metabolic flexibility” — a.k.a. the body’s ability to shift between using carbohydrates or fat as fuel — makes aerobic training more difficult.
What should an exercise program focus on?
If you read the above paragraphs and felt discouraged, don’t be. Despite the changes and new challenges with menopause, maintaining or starting a routine of physical activity is completely possible.
In broad terms, an exercise program for post-menopausal women should include aerobic exercise (for endurance and conditioning), strength training (for preserving bone density and muscle mass), and balance/stability work (for preserving bone density and reducing fall risk). However, we at Hyatt Training would argue that everyone, not just post-menopausal women, can benefit from these components, and well-rounded exercise program should include all of them.
Weight-bearing exercises should be prioritized in order to preserve bone density and muscle mass. Nearly all exercises are weight-bearing, with the exceptions of cycling and swimming; however, these are both excellent options for increasing cardiovascular fitness.
The body’s flexibility also decreases with age, so an effective, diligent warm-up should also be part of the exercise routine; ten minutes, with low-intensity cardio and mobility/activation work, will suffice. For strength training and stability work, bodyweight exercises and free weights are great places to start — and post-menopause, using heavier weights will help preserve the level of muscle mass the body had pre-menopause.
Aerobic exercise can include running, walking, using a treadmill or stair stepper, cycling, swimming, or even dance. And HIIT training, as mentioned above, also helps to encourage muscle building and the utilization of visceral fat.
If you’re new to the gym, working with a professional trainer can help ensure safety and correct exercise form. A trainer can also help design a comprehensive program for you and your body’s unique needs, that includes all of the components mentioned above.
Conclusions
Exercise is beneficial at any stage of life, but can have some additional benefits for women during and after menopause. Preserving bone density, muscle mass, balance and stability, and flexibility will all promote longevity and lead to a higher quality of life.
To get started with a trainer, reach out to us at go@hyatttraining.com.
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