What thoughts and feelings does menopause bring up for you?  

Menopause is a very normal and natural stage of life, but depending on your background and cultural experiences, there can be some negative connotations: physical, emotional and psychological changes that can affect quality of life. The current average life expectancy for all women is over 75 years in New Zealand, so while menopause signals the end of the reproductive stage of a woman’s life, this is a great time to reassess your personal needs and reframe this next stage of life.   Taking the time to do some intentional planning based on good quality information. seeking healthcare advice and prioritising your health, it is possible to live a productive and fulfilling life for many years beyond the menopause.      

For some, symptoms of the menopausal transition can be very distressing and have a major impact on your quality of life, sense of wellbeing, productivity and relationships, but there are effective treatment options that can be very helpful for these symptoms.  Medication (both hormone therapy and non-hormonal options) very much have their place in helping women through this transition (we will cover this in more detail in our blogs), but there is increasing evidence that lifestyle choices matter and make a difference to symptoms, health (including breast cancer and vascular disease); we will highlight some of the important work that researchers such as Lisa Mosconi and Pauline Maki and others are doing in this space.

Exercise
We all know that exercise (together with good nutrition, and sleep) is good for you, but for it can be hard to prioritise, particularly as our lives are often busier than ever during mid-life.  It can be good to be reminded of some of the benefits.  

Studies shows that women who exercise regularly have less flushes and sweats.  Estrogen is not as effective (or safe) in women who smoke.   Find an exercise regime to support your wellbeing over the menopausal transition and beyond; do something that you enjoy, with people you like.

Weight and BMI

Consider where your weight sits compared with your height.  Weight can be tricky to manage over the menopausal transition, with a tendency to distribute more body fat around the mid-section and often less around your hips and bottom, due to a change in metabolism.   Exercise will help to counter the change in metabolism. A pro-active approach to managing weight through good nutrition, regular exercise and good quality sleep early in the menopausal transition will stand you in good stead for the future; however even starting late is better than never, with the aim of maintaining current weight long term is an achievable and less daunting goal. It is not impossible to lose weight during or after menopause, and it can be helpful to enlist the help of a dietician, psychologist (if emotional eating or stress eating are a problem) and your doctor; in some situations, medications can be helpful when there is a significant amount of weight to lose. At the other end of the spectrum, avoiding excessive weight loss and maintaining a BMI >19 helps to protect against osteoporosis, so it’s a bit of a balancing act to maintain weight in the healthy range. In addition to weight and BMI, body composition (increased fat compared to muscle ratio) is important, so if you feel that you have some excess fat tissue, but your BMI is within the healthy range, it can be helpful to work with a dietician and personal trainer to increase your muscle and reduce fat, rather than aiming for weight-loss per se. Thsi all depends on budget and there are some great  

Sleep

On the topic of weight loss, sleep deprivation can make it very difficult to lose weight through pathways such as increasing the stress hormone cortisol, affecting appetite regulation and making emotional eating and poor eating choices more likely!  Sleep deprivation can also make menopausal symptoms worse, reduce productivity and over the long term increase the risk of cancers and other health issues.  Dr Matthew Walker and othe experts are doing some excellent research in this area.  On the flip side, if you have identified that you are sleep deprived, you can make a major difference to your sense of wellbeing, health and productivity by working to improve this.  Sleep hygiene practices such as having a wind-down bedtime routine, avoiding screens and vigorous exercise 2 hours before bed, and avoiding caffeine after mid-day can be helpful as can getting some sunlight first thing in the morning.  Sleep quality can naturally reduce with age so you might find that these lifestyle aspects are more important to incorporate than when you were younger, but with consistency you can make significant improvements. 

Anxiety management
During menopause, anxiety can rise and mood can drop.  Awareness of this is the first step.  And during the perimenopausal transition, PMS symptoms can worsen or occur for the first time.  This is especially important if you have a history of depression or anxiety.  Be proactive about noticing change and ask for medical help early.   Ask someone close to you,whom you trust, to help monitor your mental health and give you feedback.  The literature around mindfulness techniques is very positive and if you have never looked at this start to explore and see if some of these strategies work for you.  Exercise can also help boost your mood by releasing endorphins.   Alcohol tends to be  a mood depressant – another good reason to limit alcohol over this transition.  

Medical screening
This is a great time to make sure that all of these checks are up to date with your GP.  When did you last have a mammogram and cervical smear?  Have you had a check of cholesterol and your blood glucose in the last 12 months?  Has your family doctor checked your blood pressure recently?   If you are older than 50 years should you consider a colonoscopy? Talk to your GP about your heart disease risk for the future and what you can do to optimisethis risk.  A regular check up with a regular GP pays significant dividends for health and quality of life in the future.  

Dementia risk
Lisa Mosconi’s fascinating work is telling us that brain changes that increase women’s risk of dementia startabout the time of the menopausal transition.   So again, the choices you make now can change your risk and therefore your quality of life for the future.  Getting enough oxygen n to your brain matters – be a non smoker or vaper and get outside to exercise when you can.   Alcohol has negative impacts on the brain. Consider the number of alcohol-free days per week you have in your routine.   Prioritise sleep.  Diet matters – currently the Mediterranean diet is coming up trumps for future brain health.  Keeping your brain active and social is also key.  

Stress management

Stress can worsen menopausal symptoms and can impact long term health as well.  Mindfulness techniques, meditation, yoga and seeing a psychologist can all be helpful for stress management. Carve out some time to recharge and do things that you love.  Think about things you might like to do in this next stage of life, whether that is to pick up hobbies you used to enjoy, try something you always wanted to, or start planning your dream holiday.   If you have time to dive into these thing, great!  Even if life is really busy, see if you can take at least a little time on a regular basis to do something for yourself.  You may be surprised at how much this can energise and inspire you.  

The reality of modern life is that for many of us, the time of the menopause transition coincides with a very busy time of life, often balancing career with home life, caring for children and older relatives and other demands.  It can be easy to fall into a cycle of pressing on and trying to get as much done as possible despite feeling exhausted and depleted!  But remember, this is when it is more important than ever to prioritise your self care.  When you are at your best, most energised and most productive, that is when other people will also benefit from having you at your best! How would it feel to see self care not as an optional luxury, guilty indulgence or something to do if you get the time after tending to everyone else -but to see it as a strategic investment in being your best, healthiest self, not only for yourself but for those you care about?

For more information and step-by-step guidance on implementing lifestyle changes and when to seek medical attention for menopausal symptoms, join the waitlist for ERH Menopause Course coming out soon with our new App!