Embracing change - managing menopause with lifestyle medicine and health coaching

Dr Jennifer Cooney, Health Physiologist and Women’s Health Coach

Menopause is a significant life transition that all women experience as they age. It's a natural biological process marking the end of the reproductive years and the beginning of a new phase in a woman's life. Whilst menopause is a universal experience, its symptoms and impact can vary greatly from one individual to another. Fortunately, there are many very effective options for women, to not only help them manage their symptoms, but also to optimise their health now and in the future.

Health coaching has emerged as an effective tool to help women navigate this life stage, manage symptoms, and improve overall health outcomes. In this post, we will explore what menopause is and how health coaching can help women thrive in this phase of their life.

Understanding Menopause

The word menopause is made up of two words – ‘meno’ meaning menstrual cycle and ‘pause’ meaning to stop. Technically menopause is just one day in time, and that is, the day after you have not had a period in the previous 12 months. The time leading up to menopause, is called perimenopause and this is when hormone levels (oestrogen and progesterone) start to decline and can fluctuate wildly (particularly estrogen), as ovarian function declines. The initiation and duration of perimenopause will differ for everyone, but it can happen months, years or even more than a decade before menopause itself. The time after menopause has occurred, is termed post menopause during which sex hormones (oestrogen and progesterone) will remain low.

The average age menopause occurs in the UK and Ireland is 51 years, with an average age range of 45-55 years, so it is very common for women to start noticing and experiencing symptoms related to menopause in their early forties and it is not impossible that women may also notice symptoms in their mid-late thirties. An early menopause is classed as menopause that occurs in women before the age of 45 years, and Premature Ovarian Insufficiency (POI) is the term used when menopause occurs before the age of 40 years. POI occurs in approximately 1/100 women under the age of 40 years and approximately 1/1000 women under the age of 30 years. Women may also experience menopause symptoms if they have had an oophorectomy (surgery to remove their ovaries), this is known as a surgical menopause or if they are taking medication that suppresses hormone production, this is known as a chemical menopause.

Symptoms associated with perimenopause and/or menopause

Each woman’s experience of menopause will be very individual. However, it is reported that approximately 75% of women experience symptoms, with 25% of women experiencing severe symptoms. The following are some of the most widely reported symptoms of peri/menopause:

·       Hot flushes

·       Night sweats

·       Heavy/light periods

·       Worsening PMS

·       Tiredness/fatigue

·       Poor sleep

·       Weight gain

·       Low/loss of libido

·       Heart palpitations

·       Tinnitus

·       Headaches/worsening migraine

·       Head pressure

·       Dizziness

·       Muscle and joint pain/stiffness

·       Poor memory, poor concentration

·       Brain fog

·       Itchy skin

·       Hair/skin changes

·       Loss of sense of self, self-confidence

·       Mood swings

·       Crying spells

·       Irritability

·       Anxiety, panic attacks

·       Low mood, depression

·       Vaginal Dryness

·       Frequent urination

·       Frequent urinary tract infections

Menopause support options

Treatment options for menopause symptoms vary depending on the type and severity of symptoms and a woman's individual health profile and preferences. Treatment options for menopause symptoms can include lifestyle medicine and lifestyle changes (good nutrition, regular physical activity, quality sleep and stress management), hormone replacement therapy, non-hormonal medications and complementary therapies, e.g. acupuncture, herbal medicine, yoga etc. It is very important for women to work closely with their healthcare providers to determine the most suitable treatment options based on their specific needs and preferences.

The role of health coaching

Health coaching is a collaborative, client-centered approach that supports clients to make meaningful, individualised, and achievable lifestyle changes, that will not only help clients improve menopause symptoms now but will also help clients to enhance their current and future health and well-being. Throughout the coaching process clients will learn exactly how to optimise their nutrition, how to increase their physical activity from their current level of fitness, how to optimise sleep and how to build meaningful stress management/relaxation practices into their day. The coaching process supports clients to implement these lifestyle changes step-by-step, to achieve lasting behaviour change that goes beyond the coaching process. This is hugely important as we know menopause is associated with increased health risks, in particular increased risk of heart disease, osteoporosis, and cognitive decline. Health coaching also focuses on long-term health outcomes, helping women transition into post-menopausal life with an emphasis on health optimisation.

Yes, menopause is a natural and inevitable part of a woman's life journey and while it can bring challenges, it can also offer an opportunity for personal growth, self-discovery, and renewed health. Health coaching is an invaluable resource during this transition, offering personalised support and guidance to manage symptoms and improve overall well-being. By embracing the changes that come with menopause and leveraging the expertise of a health coach, women can absolutely navigate this phase of life and thrive, with improved health outcomes and future health and longevity.

Here are some of Dr Jen’s health coaching case studies

Client A, age 45, perimenopause

Symptoms: bloating, weight gain, headaches, hip pain, no energy, irritability, poor sleep

Medication: body identical hormone replacement therapy (started prior to health coaching)

Health coaching programme: 12-weeks and 6 follow-up sessions over 6 months

Main Lifestyle changes:

Nutrition – optimise gut health by increasing fibre intake, plant diversity, colourful plants, introduce fermented food, reduce alcohol and ultra processed foods, increase home cooking, increase water intake

Movement – client already had a good level of physical activity. We increased daily step count, worked on consistently strength training 2-3 times per week, introduced running 1-2 times per week

Sleep – regular sleep routine, evening wind down routine, breathwork

Stress management – regular breathwork/meditation and weekly yoga

Outcomes: No more bloating, weight loss, no more hip pain, reduced headaches, improved mood and energy levels, improved sleep

Client B, age 55, post menopause

Symptoms: Weight gain, bloating, joint pain/stiffness, low mood, loss of sense of self, no energy, poor sleep, cravings, felt stuck in a rut and not doing any exercise.

Health coaching programme: 12-weeks

Main Lifestyle changes:

Nutrition – optimise gut health by increasing fibre intake, plant diversity, colourful plants, introduce fermented food, reduce alcohol, reduce snacking, reduce sugar intake, overnight fast 12-14 hours

Movement –increase daily step count and time in nature, started strength training and increased this to 3 days per week. Started weekly yoga.

Stress management – started regular breathwork throughout the working day and every night before bedtime, yoga.

Outcomes: No more bloating, improved mood and energy levels, improved sleep, less perceived stress, improved adherence to Mediterranean style diet, increased physical activity, more positive outlook and mindset, feels in control of daily habits and future health

About the author

Dr Jennifer Cooney is a Health Physiologist and Women’s Health Coach at the Synthesis Clinic and has a special interest in supporting women from peri-post menopause, make lasting lifestyle changes for optimal health and well-being.

ScarWork - a blog by Octavia Hamilton, physiotherapist and rehabilitation specialist

Scar Work is a new emerging therapy that is not only breaking down adhesions but changing the way that we do rehab (rehablitation). It evolved from the Rolfing technique, a light facial tissue, body work treatment designed by Dr Ida Rolf in the 70’s. It has since progressed, through the work of Sharon Wheeler into the new accredited Scar Work and is beginning to build a body of research to support its benefits.

Scar Work is a light treatment done without oils or moisturiser. It is responsive to what the therapist finds and aims to hydrate and help the healing, appearance, and functionality of old and new scars.

Open wounds can take up to 3 years for the scars to fully mature therefore, there is a huge window of opportunity to support healing and ensure or maintain good mobility in the area. After a short period, usually from 6 weeks (providing no infection and an all clear from the surgeon), treatment can begin starting with light touch, encouraging the return of normal sensation to the area. Gentle sweeping actions towards the scar brings the body’s natural chemicals to hydrate and heal the area. Then, as new collagen is laid down these areas are also worked on to ease movement, pain and prevent fibrosed tissues developing.

Treatment is always individualised and often supported with a movement or exercise program. It should be pain free and there will be an element of emotional healing that comes with starting to accept one’s new body image and function.

A common question is “Isn’t it too late to start work on my scar”?  The answer seems to be no. A study by de Valois et al. (2021) showed that improvements could be seen in appearance, consciousness, and improvements in symptoms such as itching, discomfort and numbness in all scars from 4-17 years old was also seen. The approach however is slightly different as, due to adhesions being more established and therefore compensations setting in throughout the body, the focus would be on the period in-between treatment sessions encouraging strength work to help you cope with the changes occurring. Therefore, instead of weekly sessions you might do a more staggered approach watching and reacting to how the body responds.

Aftercare following surgery is not currently focused on scar management beyond preventing infection. An accredited Scar Work practitioner can advise you on optimal nutrition, hydration, patches, and gels to promote smooth scars and optimal healing and support you through the trauma that you and your body has just been through. It is a holistic therapy and, before long, will be considered an essential part of your recovery.

About the author

Octavia Hamilton is a musculoskeletal and orthopaedic physiotherapist with over ten years’ experience and a true passion for rehabilitation. Octavia offers physiotherapy, exercise-based rehabilitation, mobilisation and manipulation, acupuncture, ScarWork and Pilates at Synthesis Clinic.

Physical activity to support you through the perimenopause, the menopause and beyond

Blog by Anna Coles, Level 4 personal trainer and GP referral exercise specialist

I have consistently collaborated with midlife women to address the often-debilitating conditions that present themselves during the ageing process. I suspect, in terms of my own experience, that I have been perimenopausal for at least 10 years. Experiencing this first-hand places me in a position to have an understanding of how it actually feels to live with these symptoms and equally the salient results of managing them through movement and activity.

Through regular tweaks to my own exercise patterns and nutrition, I have been able to manage my symptoms and consider myself truly fortunate. However, ageing is a constantly changing process and we need to be continually open to adapting and changing the way we move, to accommodate these changes and live well for longer.

What type of exercise should you be doing and what are the benefits of exercise in general?

First off, it is worth noting that physical activity and exercise are not the same thing, but both are beneficial to your health and will help enormously through midlife and also as we continue to age.

·       Physical activity is any activity that works your muscles and requires energy and can include work, household, or leisure activities.

·       Exercise is a planned, structured, and repetitive body movement done to improve or maintain physical fitness.

The word "exercise" may make you think of running laps around the gym but exercise includes a wide range of activities that boost your activity level to help you feel better.

Certainly running, lifting weights, playing tennis and other fitness activities that get your heart pumping can help but so can physical activity such as gardening, washing your car, walking around the block, or engaging in other less intense activities. Simply any physical activity that gets you off the sofa can help improve your mind and body.

Aerobic or cardio exercise is good for your heart and lungs. Walking, for example, is one of the best choices, because you can do it anywhere, anytime. Other examples of aerobic exercises include swimming, cycling, tennis, and dance.

How much should you do to feel the benefits? Exercise moderately for at least 30 minutes most, if not all, days of the week (the government guidelines state that we should all be aiming for 150 moderate intensity exercise per week).

I think of cardio or aerobic exercises as the foundation of good overall fitness and health, and you can build from here depending on your individual goals and needs.

You don't have to do all your exercises or other physical activities at once. Broaden how you think of exercise and find ways to add small amounts of physical activity throughout your day. For example, take the stairs instead of the lift. Park a little further away from work to fit in a short walk. Or, if you live close to your job, consider cycling to work.

How physical activity can help during midlife

Let us look at some of the different symptoms we may experience:

Anxiety, depression and mood swings

The links between depression, anxiety and exercise aren't entirely clear, but we do know regular exercise releases feel good endorphins and other natural brain chemicals that enhance our sense of well-being. It also stimulates the growth of new brain cells improving concentration and slowing down age related decline.

On a more basic level, it can take your mind off worries so you can get away from the cycle of negative thoughts that feed depression and anxiety.

Regular exercise has many psychological and emotional benefits too. It can help you:

·       Gain confidence. Meeting exercise goals or challenges, even small ones, can boost your self-confidence. Getting in shape can also make you feel better about your appearance.

·       Get more social interaction. Exercise and physical activity may give you the chance to meet or socialise with others. Just exchanging a friendly smile or greeting as you walk around your neighbourhood can help your mood.

·       Cope in a healthy way. Doing something positive to manage depression or anxiety is a healthy coping strategy. Trying to feel better by drinking alcohol, dwelling on how you feel, or hoping depression or anxiety will go away on its own can lead to worsening symptoms.

Weight gain

What is it about menopause that makes it so hard to keep off the weight?

One of the reasons we gain weight during midlife and our body shape changes, is loss of muscle mass and consequently an increase in visceral fat, which in turn lowers our resting metabolism. Muscle stores and uses energy more efficiently than fat so it’s vital that we maintain as much muscle as possible. It is therefore SO IMPORTANT for midlife women to introduce strength training into their exercise regime (more on this in a moment).

The rate at which we can use energy during exercise also declines. To use the same energy as in the past, and achieve weight loss, you will most likely need to increase the amount of time AND intensity you're exercising, no matter what your past activity levels were. This is one of the reasons why those 10 miles runs that always kept the waist trim suddenly don’t work!

How exercise and specifically strength training helps with weight management, bone density and lean muscle mass in menopause

Weight management will primarily come from your nutrition, but it is essential to support it through exercise. Strength training helps build lean muscle mass and in turn improves metabolic rate. Strength training also helps you maintain bone mass. Because you lose muscle mass as you age, add strength training to your workouts, if you haven't before. Aim for two or three times a week.

Examples of strength training include using your own body weight and the force of gravity, e.g.

·       squats

·       Plank variations and push ups

·       Weight machines

·       Dumbbells

·       Exercise bands

·       Gardening.

Forget the myths that weight training will make you “bulk out” - the heavier you lift the leaner you will become! Because muscle is metabolically more active than fat, strengthening your muscles will make you into a more efficient calorie-burning machine, even when you're at rest!

General benefits of exercise during and after menopause

Exercise has many other benefits aside from weight loss, including:

• Lower risk of osteoporosis by increasing bone density

• Lower risks of metabolic syndrome, heart attack, and other cardiovascular diseases

• Improved insulin sensitivity

• Keeps joints and muscles strong

• Helps bowels work more efficiently

• Relieves depression and anxiety

• Improves overall health

Good exercise choices during and after menopause and their specific benefits

It needs to be about balance, and it needs to be what you enjoy but there are certainly guidelines which will help!

Resistance training

For improved muscle mass, bone density, to improve body composition, less fat, more lean muscle – at least twice a week.

·       Can be with body weight, bands, or weights.

·       Demo push ups, seated row, shoulder press.

Functional movement

here are seven basic movements the human body can perform, and all other exercises are merely variations of these seven:

·       Pull

·       Push

·       Squat

·       Lunge

·       Hinge

·       Rotation

·       Gait

When performing all these movements, you will be able to stimulate all of the major muscle groups in your body and benefit from improving your day-to-day quality of movement.

Examples: squat, plank, bent over row and chest press

Regular aerobic exercise

For improved cardiovascular and respiratory fitness, daily 30 minutes

This is a steady, rhythmic, moving pattern at an intensity that should be comfortably maintained. The foundation or building block of good fitness and the impact of running and walking is important for bone health.

HIIT Exercises

High Intensity Interval Training. HIIT is an exercise method designed to burn more calories in a shorter amount of time. For many women, HIIT workouts can be significantly more effective than endurance workouts for overall weight and fat loss and change in overall body composition during menopause. Again, this explains why so many of us who have stuck to cardio for years suddenly stop seeing the results we have previously got.

Aim for once or twice a week - intensity should be at least 80% of MHR (maximum heart rate) and doesn’t need to be high impact. Your general endurance, fitness and stamina will improve.

Recent studies are pointing to the fact that it’s intensity, rather than duration, which leads to the weight loss during the menopause. This is where another type of exercise comes in to play.

Yoga, Pilates, stretching (Daily)

For improved mobility and flexibility. This is so important to help counter the stiff and sore joints often experienced during menopause and to stop the body functioning in a limited range of motion.

 About the author

Anna Coles is a Level 4 Personal Trainer and GP referral exercise specialist with a keen interest in metabolic health and supporting women through perimenopause and menopause.