An Evidence-Based Approach to Menopause

Menopause marks an important transition in a woman's life.

Every woman’s body is unique and so too is their experience of menopause. Navigating this time can be challenging but there's one thing that is safe and scientifically supported that can help manage symptoms of Menopause: EXERCISE.

Menopause is defined as the calendar date that marks 12 months without a period. Before that date it is defined as perimenopause. This is where women can notice symptoms like weight gain, sleep disruption, loss of strength and muscle tone, mood swings and hot flashes. This can happen as early as late 30s but typically begins in mid 40’s.

During perimenopause, female bodies go from having a regular cycle to anovulatory cycles shifting the balance of estrogen and progesterone. While we usually associate estrogen with the female reproductive system, it is far more than just that. In fact, it works the same way testosterone works in men.

Estrogen affects every system in the body on cellular level, even muscle fibers! It affects the bonding of actin and myosin within muscle cells.The strength of a muscle contraction is dependent on a strong connection between the two. Therefore, the decline in estrogen production can lead to a significant drop off in strength and muscle tone!

The good news is that none of this is inevitable. We can use exercise to not only maintain a healthy body composition but also manage other symptoms like hot flashes and poor sleep. Having said that, according to Dr. Stacy Sims, not all exercise is created equal and what you have been doing up until now might not be what you need moving forward. While most medical professionals recommend 150 minutes of moderate to vigorous activity/week, this is not stressful enough to stimulate muscle growth and too stressful to help regulate serotonin and norepinephrine (anti adrenaline).

There are three specific protocols to implement if you want to see changes:

1. Heavy Strength Training
2. HIIT
3. Plyometrics

Heavy Strength Training

Exercise is an external stress that causes adaptation within the body. Dr. Sims recommends including some “heavy” movements into your training plan.

For example:

Deadlifts for 3-5 sets of 3-5 reps at 70-80% of your max weight.

Compound movements such as squats and deadlifts load your muscular and skeletal system. Heavy lifting invokes a central nervous system response which recruits a certain amount of muscle fibers as quickly as possible. In lieu of the declining estrogen’s effect on muscle contraction, we can use this nerve response to build muscle mass. This type of exercise has also been shown to positively affect your gut microbiome, bone density and serotonin/norepinephrine levels (which can help with hot flashes).

Lifting a light-medium weight for 10-15 reps is not stressful enough to create the adaptations we are looking for. If you are new to exercise then we recommend working with a Kinesiologist or strength coach to learn how to move properly.  Some women start to experience aches and pains during this time. While the scientific recommendations are to lift heavy in order to make the most positive changes, heavy is relative. At the beginning of your journey, your bodyweight might be enough of a challenge. Over time however, you must add incremental load to continue to stimulate muscle growth.

Most women shy away from weights because they fear that they will get too bulky but this is simply not the case. The process of building muscle size requires hours and hours of training each week and a massive surplus of calories.

HIIT

Dr Stacy Sims recommends building high intensity or sprint intervals into your regular workout routines. Once again, however, there are specific protocols for this phase of life.

High intensity interval training or HIIT has become an umbrella term synonymous with circuit classes and bootcamps. Your typical circuit class works around a moderate intensity (70% your heart rate) for 45 mins which can lead to increased cortisol. During peri and postmenopause we live in a sympathetic state (fight or flight, or tired but wired),  so cortisol is already elevated which can lead to weight gain, bloating and residual inflammation.

We want to focus on true HIIT. True HIIT must be polarized; the hard is HARD and the easy is EASY. Intervals have a very high rest to work ratio to allow your heart rate to fully recover. True HIIT aligns with this stage of your life; the intensity required to make changes to your body in peri and post menopause is much higher, >8/10 of max effort.

Exercise examples include kettlebell swings, battle ropes, assault bike or ski erg. Work effort is short but intense (10sec - 2mins) and rest intervals are long (1-4mins) and low intensity (<50% of max). Rest will be determined by the difficulty of the exercise. Because of this level of intensity and subsequent need for recovery, the total workload of HIIT only needs to be 1-4 minutes of your total workout.

When you do true HIIT or sprint intervals, the polarization of work to rest allows for a rebound response or a shift to the parasympathetic nervous system (rest and digest). This switch helps to decrease cortisol and increase testosterone and growth hormone which in turn, helps improve muscle morphology and body composition, as well as enhance sleep. Epigenetic changes within the muscle will help pull glucose into the muscle without insulin, combatting the insulin resistance seen in peri and postmenopause.

Simply put, true HIIT helps the body not only become more resilient to stress but also teaches it how to recover as efficiently as possible.

When it comes to high intensity and sprint intervals start with something you're comfortable with. Intensity should be prioritized over volume to induce physiological response.

Plyometric Training

Plyometrics are explosive movements that involve a muscular stretch followed by a quick muscular contraction. These rapid movements help build power, speed and strength. Plyometric activities include things like jumping, hopping and skipping. While typically used to improve performance, the massive benefit to women in peri and postmenopause is that these drills have been shown to stimulate bone growth. Bones thrive on impact under the correct dosage and application. When done safely, plyometrics can be extremely beneficial. Studies have shown that osteopenic women who did 12 weeks of 10 minutes of jump training, three times per week improved their bone density.

Moving quickly is not just for the young. As we age, our muscle morphology shifts to slow twitch muscle fibers, unless we train the fast ones. While we might not need to sprint a 40 yard dash, we might need to catch ourselves quickly from a fall!

If you are new to exercise or plyometrics, going straight to box jumps is probably not for you. Before jumping, we recommend that you learn how to land safely. Good joint mechanics and baseline strength are vital for these quicker movements. A good starting point can include short bouts of jump rope. It should be done early in your training session while you are fresh. These faster movements are generally non-fatiguing, repeatable efforts.

Nutrition in Menopause

Perimenopausal changes to body composition often lead women to fad diets or super low caloric intakes. Women are starving themselves to lose weight, further depleting their energy, compromising their hormones and muscle stores. Having a healthy balanced diet is crucial at any age and menopause is no exception.

Fasting has been demonstrated to help with weight loss and inflammation; however, most of the data is based on male research. As women, we need more carbohydrates. Studies conducted on perimenopausal women actually showed that fasted exercise led to the opposite results to men! A woman’s hypothalamus is sensitive to lack of nutrition. Furthermore, our endocrine system is more easily affected than men. Even fasted exercise for four days showed a decrease in thyroid function, increasing cortisol and creating a catabolic (breakdown) response of lean muscle.

Menopause is not a time to eat less, rather reconsider what you are eating. If you can eat sufficient protein (in conjunction with heavy resistance training) you can build more lean muscle mass. Muscles are not just for looking good, they support your joints and store energy regulating blood sugar. Muscles also act as an energy furnace, meaning, the more muscle you have the more calories you need to function.

Consider your exercise routine as your opportunity to reclaim control over your body, build confidence and enhance your longevity. If you are nervous about entering a gym, there are plenty of exercises and online home plans available to help guide you!

References:

ZOE Podcast: Stay strong through Menopause

Dr Stacy Sims

As a nutrition scientist and exercise physiologist, Stacy has directed research programs at Stanford, the Auckland University of Technology, and the University of Waikato, in New Zealand.