By 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion, with 47 new entrants each year (The demography of menopause: Kenneth Hill). Menopause is the time in your life when you naturally stop having a menstrual period. Menopause marks the end of the reproductive years. The average age that women go through menopause is 51 years (American College of Obstetricians and Gynaecologists). Diagnosis is when women missed menses for 12 months continuously. The average age of menopause of Indian women is 46.2 years much less than their western counterparts (51).
Due to the cessation of estrogen and progesterone hormone, women became more prone to stress, anxiety, irritability, sleep disorders, hot flash, mood swings, joint stiffness with aches and pain, fatigue, and forgetfulness. For some women, the symptoms of menopause might be mild but for some, it is severe and can stay for 4-10 years. Postmenopause usually marks a decrease in the uncomfortable symptoms of menopause. But evidence of losing muscle mass, cardiovascular diseases, increased chances of having Type 2 Diabetes, weakening of supporting tissue around the pelvic floor and osteoporosis is seen. Lifestyle modification and exercise is the best long-term solution. Here are the benefits of exercising in the premenopausal to postmenopause phase:
Improves quality of life.
Helps in maintaining weight thereby reducing the risk of obesity and reducing the risk of metabolic syndrome.
Improves mood and emotional well-being.
Improves sleep and concentration.
Strengthens muscles and reduces muscle wastage.
Improves balance and endurance thereby reducing the chance of fall and fracture.
Maintains bone density which helps delay the onset of osteoporosis.
Simple exercises which women can proactively start from premenopausal to postmenopause phase can be walking, using a stationary cycle, elliptical cycle, swimming and deep breathing exercises for relaxation. High-intensity exercise and contact sports with a high incidence of falls should be avoided. Research indicates that postmenopausal women who engage in a comprehensive programme, benefit by maintaining a healthy body, bone density and good mental health. Comprehensive exercise can be planned by your physiotherapist who knows your fitness level and condition well. An exercise plan for postmenopausal women should include aerobic, strength training and balance exercise.
Aerobic exercise: Aerobic exercise can be in the form of brisk walking, light aerobic dancing, jogging, water aerobics, swimming etc. Aerobic exercises improve the cardiovascular system, enhance maximal oxygen uptake, help in weight loss. The North American Menopause Society states that “for healthy postmenopause women, 12 weeks of aerobic training is effective in eliciting favourable cardiovascular adaptation regardless of the presence of short-term hormone therapy.” Start gradually with a 10-15 min walk to 10 min brisk walking and slowly progress to jogging or 40-50 min of walking. You can progress or add aerobic exercises, water aerobics or low impact Zumba.
Resistance/strengthening exercises: In postmenopause, women lose their bone mass by up to 6% in a span of three years. There is also a loss of muscle mass called sarcopenia which is a progressive and generalised loss of skeletal muscles due to age, physical inactivity or disability. Strength training can be started by using our own body weight or by using exercise resistance bands, dumbbells, and kettlebell weights. When you start weights, start with less resistance or lesser weights and gradually increase the resistance or weight.
Stretching and balancing exercise: Specialised exercise like pilates, Tai Chi, Barre or yoga helps improve flexibility, coordination, balance and improve the tone of the muscle and help in coordination. This form of exercise requires focus, deep breathing, precise movement, repetitive controlled movement in a pattern and balance. Such exercises are best to start under the guidance of a trained person. 10 mins of stretching exercise before bedtime decreases menopausal and depressive symptoms in middle-aged women. Stretching also reduces aches and pains around the joints and muscles.
Improving pelvic floor health: During the menopause and postmenopause phase, there is a significant weakness of pelvic floor connecting tissues. For women who already have pelvic floor issues like urinary incontinence, urge incontinence, stress incontinence, painful urination, faecal incontinence, constipation, pelvic pain and nocturia, these symptoms can become more exacerbated. A physiotherapist can significantly improve your pelvic floor health by assessment tools in their hand and specialised exercises, bladder control training, pelvic floor release and pelvic floor strengthening exercises accordingly.
As a whole, exercise is the most easily available, cost-effective and effective choice for improving symptoms related to menopause with vitamin supplements and healthy food habits. It is never too late to start exercising.
Let this phase be the time of learning new things and exploring different types of exercises and gaining maximum benefits.
However, before starting an exercise regime, do consult your doctor or physiotherapist.
(The author is a senior physiotherapist.)