MENOPAUSE & PERIMENOPAUSE: SYMPTOMS, EXERCISE & PHYSIOTHERAPY

Although 50% of the population experience menopause, until quite recently, there was limited understanding of the physical, hormonal, and emotional changes it brings, and how best to support women though this stage of life. Today, thanks to research, we have much more knowledge about menopause, perimenopause, and how to manage symptoms effectively through lifestyle changes, physiotherapy, and targeted exercise.

Menopause officially marks the end of the reproductive years and kicks in when the ovaries stop releasing eggs, leading to the end of menstruation. It is officially diagnosed 12 months after a woman’s last period.

Perimenopause is the transitional stage before menopause, marked by fluctuating oestrogen levels. This stage can cause irregular cycles and a range of menopause symptoms such as hot flushes, mood swings, and joint pain. While people often use “menopause” as a catch-all term, many symptoms actually occur during perimenopause.

Oestrogen is an important hormone that is needed by many areas of the body, it is vital for brain function, digestion, muscle health, and reproductive organs. When oestrogen levels drop after menopause, women face an increased risk of:

• Heart disease and stroke
• Dementia
• Osteoporosis and bone loss
• Musculoskeletal pain and weakness
• Weight gain and body fat redistribution

During perimenopause and menopause, symptoms may include:

• Hot flushes and night sweats
• Vaginal dryness or discomfort during intercourse
• Abdominal weight gain
• Mood changes, irritability, or anxiety
• Joint stiffness, muscle aches, and reduced muscle mass
• Increased risk of chronic pain conditions such as fibromyalgia

For decades, women were told there was little to be done about menopause. Now, we know that lifestyle changes and targeted physiotherapy programs can make a huge difference.
Evidence-based strategies include:

• Stopping smoking
• Reducing alcohol and caffeine intake
• Exercising regularly (tailored aerobic + strength training) (Nguyen et al., 2020)

Our physiotherapists can design a menopause exercise program tailored to your needs, helping with:

• Mood and mental health
• Weight management
• Bone density
• Cardiovascular health
• Reducing the risk of Type 2 Diabetes and stroke (Khalifi et al., 2023)

Research shows that whole-body strength training, at a moderate intensity for at least 8 weeks (3+ sessions per week), is most effective for improving quality of life during menopause, including an improvement in hot flushes! (Nilsson et al., 2022).

There are many risk factors that can contribute to a decrease in density (race, family history, thyroid conditions, bowel conditions, sedentary lifestyle, excess alcohol intake, smoking) and then bone density naturally declines after menopause due to lower oestrogen. This can increase the risk of osteoporosis, leading to fractures and long recovery times.

To protect bone health:

• Eat calcium-rich foods (dairy, leafy greens, tofu, canned salmon with bones)
• Maintain vitamin D levels through sunlight and/or supplements
• Engage in weight-bearing and resistance exercises

💡 At Hartwell Physio, we run Bone Strengthening Classes to improve bone density and reduce fracture risk – find out more here.

Menopause-related hormonal changes can impact pelvic floor function, leading to:

• Stress urinary incontinence
• Urinary urgency or frequency
• Pelvic organ prolapse
• Vaginal dryness or discomfort

A pelvic health physiotherapist can help manage these symptoms and restore pelvic strength and function with:

• Pelvic floor exercises
• Bladder and bowel management strategies
• Lifestyle and diet advice

💡 Our pelvic health physio, Brooke, has 20 years’ experience in menopause pelvic floor care – book an appointment here.

Menopause is a natural life stage, but with the right support, you can minimise symptoms, maintain your health, and protect your long-term wellbeing.

Book a consultation with our experienced physiotherapist Brooke Willams to create your personalised menopause health plan today.

References

• Nguyen, T. M., Banks, J., Hiller, C. E., & Baxter, G. D. (2020). Exercise and quality of life in women with menopausal symptoms: A systematic review and meta-analysis of randomised controlled trials. International Journal of Environmental Research and Public Health, 17(19), 7049. https://doi.org/10.3390/ijerph17197049

• Khalafi, M., Symonds, M. E., Karimi, P., et al. (2023). Influence of exercise type and duration on cardiorespiratory fitness and muscular strength in post-menopausal women: A systematic review and meta-analysis. Frontiers in Cardiovascular Medicine, 10. https://doi.org/10.3389/fcvm.2023.1122264

• Nilsson, S., Jonsdottir, I. H., & Hammar, M. (2022). Resistance training reduces LH hormone levels in postmenopausal women in a substudy of an RCT: A clue to how resistance training reduces vasomotor symptoms. PLOS ONE, 17(5), e0267613. https://doi.org/10.1371/journal.pone.0267613

1. What is the difference between menopause and perimenopause?
   Perimenopause is the transition period before menopause, when oestrogen levels fluctuate and symptoms like hot flushes and mood swings often appear. Menopause is confirmed when you haven’t had a period for 12 months.
2. Can physiotherapy help with menopause symptoms?
   Yes. Physiotherapy can help manage menopause joint pain, improve bone health, support pelvic floor function, and design exercise programs that reduce hot flushes, weight gain, and fatigue.
3. What is the best exercise for menopause?
   Research shows a combination of aerobic exercise and strength training is most effective for reducing menopause symptoms and improving overall health.
4. How can I improve bone density after menopause?
   The best ways to protect your bones include weight-bearing exercise, high-resistance training, eating calcium-rich foods, maintaining vitamin D levels, and avoiding smoking and excess alcohol.
5. Can menopause cause pelvic floor problems?
   Yes. Lower oestrogen after menopause can weaken the pelvic floor, leading to urinary incontinence, urgency, or prolapse. A pelvic health physiotherapist can help restore strength and function with targeted pelvic floor exercises and lifestyle advice.