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The Perimenopause & Menopause

From when a woman reaches puberty up to approximately the age of 35, hormone levels are stable and fluctuate naturally each month in line with the menstrual cycle. When there is a healthy hormone balance, women will have regular periods unless they are on a form of contraceptive or hormone replacement medication. Before reading this, refer back to the post on exercise during the menstrual cycle for a brief summary of the menstrual cycle.

This post will explore what happens during the perimenopause & menopause; & how individuals can minimise the symptoms & consequences of the associated decline in oestrogen. All women will at some point go through the menopause, although often will not consider it until it is upon them. I hope this post helps increase understanding for everyone. What is the perimenopause? Generally, as a woman enters her early to mid 40s the ovaries start to become less responsive, resulting in the start of the perimenopause. This is where oestrogen and progesterone levels fluctuate more and periods become less regular. The perimenopause is the period of time during which the body makes the natural transition to menopause, marking an end of the reproductive years. Women start the perimenopause at different ages - some will notice signs such as menstrual irregularity in their 40s, whereas some will notice changes earlier in mid to late 30s. Oestrogen and progesterone levels gradually reduce during the perimenopause and follicle stimulating hormone (FSH) and luteinising hormone (LH) levels increase. This can result in an imbalance of hormones which can cause irregular periods, hot flushes, mood changes, vaginal dryness and loss of libido. Not everyone will have these symptoms and there is no known clinical evidence to predict who will. What is the menopause? The menopause is the date of the last period, the average age for this is 51. Simply put, it is when the ovaries no longer respond to the messages from the pituitary gland and no longer produce oestrogen. Refer back to previous post for more information on the menstrual cycle. Although the transition to menopause is an entirely natural phase of a woman’s life, there are consequences of a reduction in oestrogen. What is oestrogen? Oestrogen is mainly produced by the ovaries, but is also made in small amounts in the adrenal glands. Alongside progesterone, it is the main female sex hormone. Oestrogen exists in three forms:

  • Oestrone

  • Oestradiol

  • Oestriol

Oestradiol is the most common form of Oestrogen in a woman of childbearing age. Oestriol is the main Oestrogen during pregnancy and Oestrone is the only form of Oestrogen produced post menopause. What does Oestrogen do? As previously discussed, hormones are like chemical messengers travelling around the body in our blood, effecting a huge range of functions. Oestrogen helps control the menstrual cycle & is a key hormone in fertility. It is also important in the function of the brain; bones & soft tissues; blood vessels & the urogenital system (bits below the waist). Oestrogen & Bone Health

Declining levels of oestrogen results in a reduction in the density of bones, increasing the risk of osteoporosis. In the 7 years following the menopause, women can lose up to one fifth of their bone density due to declining levels of oestrogen. Diet and exercise play a key role in bone health, as well as other key lifestyle factors such as:

  • BMI below 18.5

  • Smoking

  • Excessive alcohol

  • Long term steroids

  • Lack of physical activity during ages 20-30 years

In addition to medications & supplements, lifestyle modifications such as stopping smoking, reducing alcohol intake & increasing protein intake have been shown to have a positive impact on bone density. Exercise is an effective & simple tool for declining bone density:

  • Weight bearing, strengthening & resistive exercises can increase bone density in post menopausal women

  • 4-6 months of progressive, resistance training is the minimum amount required to increase bone mineral density

  • If an individual stops exercising, bone mass loss occurs within one month

Pilates is an excellent form of exercise to improve bone health, it is a proven and effective exercise method to improve strength and bone density. Oestrogen & Muscles As we age, there is also a normal & natural ageing process within our musculoskeletal system. There is a loss of spinal motor units (the control system of our muscles) and a reduction in muscle hypertrophy (growth). For men and women, as we get older we have a decline in muscle function and size. Oestrogen is an anabolic hormone - it helps build muscle tissue and prevents protein breakdown. This means that the normal effects of ageing are exacerbated by the decline in oestrogen that occurs with the menopause. Women will therefore lose more strength than their male counterparts with increasing age. Women of all ages should be educated and advised on how to exercise for LIFE to maintain neuromusculoskeletal health in later years. The stronger foundation an individual begins from, the less the impacts are likely to be in the perimenopause and menopause. Oestrogen and the bits below the waist

The role of the pelvic floor is to support the internal organs of the pelvis and plays a huge role in bladder and bowel continence. The smooth muscle walls of the vagina and the skeletal muscles and ligaments of the pelvic floor are rich in oestrogen receptors. Oestrogen improves the function of the muscles and connective tissue of the pelvic floor, as well as the function of the urethra, bladder and vagina. As discussed in the previous post on the menstrual cycle, oestrogen has an effect on connective tissue throughout the body, these effects can be a significant component of pelvic floor dysfunction in the perimenopause and menopause. What can be done to help? Pelvic floor muscle training is a proven method for increasing strength and endurance of the pelvic floor. This can reduce incontinence and vaginal prolapse symptoms. Pelvic floor dysfunction effects almost half of all menopausal women - it is common, but doesn’t need to be accepted. Pelvic floor dysfunction is treatable, please do not hesitate to get in touch if you have any concerns about your pelvic floor or you have any questions about anything were have discussed in this post. The take home message is that women should be educated and empowered to exercise for life to support their future self. Exercise is a crucial & proven method to improve bone density, strength, mood & well-being as well as reducing pelvic floor dysfunction. I truly believe that Pilates should be part of everyone's life, supporting their usual routine of exercise by building a robust foundation of strength to support the body & mind.

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