An In Depth Guide to Perimenopause and Menopause
One of the most common issues women notice with perimenopause is the addition of some extra centimetres around the waist. It can be very frustrating to gain weight despite eating and exercising in much the same way as you had before.
Have you wondered the most effective ways to exercise and eat from Perimenopause and into Menopause to support your body?
What is happening to your body?
Menopause is formally defined as the point at which a woman has not had a period for 12 months. The age of onset is typically between 45-55 years, with the age of onset being influenced by both innate (heritable) biological traits and environmental factors, such as smoking and stress.
Perimenopause is the period leading up to menopause and typically lasts for two to eight years (average of seven years) prior to the official onset of menopause. This is the time where the menstrual cycle essentially starts to ‘wind down’, with ovulation becoming less frequent and a drop in oestrogen levels.
Oestrogen is a wonderful hormone, it is
– Protective: against cardiovascular disease; diabetes; depression;
– Anabolic: helps to hold onto muscle mass and bone mineral density
This decrease in the amount of Oestrogen that women have in their bodies heralds a number of physical changes, which have significant implications for a woman’s health and functional fitness:
Metabolic changes – increase in metabolic stress & systemic inflammation – how we process food and how we respond to exercise – weight gain
Decrease in muscle mass and bone mineral density – joint aches and pains
Neurological changes – cognitive function and memory often not as good (brain fog); mood disturbances such as anxiety, depression and irritability
Vassal motor changes – hot flushes (little research on why we have them)
The Great News: most of these changes are positively influenced through the right exercise and considered dietary changes
Where did I put my waistline?
One of the most common issues women notice with perimenopause is the addition of some extra centimetres around the waist. It can be very frustrating to gain weight despite eating and exercising in much the same way as you had before.
The typical response is to significantly cut calorie intake and increase aerobic (cardio) exercise. Unfortunately, this strategy is often not as successful as it may have been in the past because it does not adequately address the underlying metabolic changes driving the weight gain.
Your metabolism is changing in some significant ways and understanding this process is key to managing it. You do not need to be super lean to be healthy and most women will gain a bit of weight overall, but excessive weight gain during this time is linked to poorer health, as well as to worse menopausal symptoms.(6)
Women looking to lose some weight generally gravitate to long, slow, steady-state cardio because they believe this is the best way to burn fat. Technically, it is true that cardio does burn fat but there are a number of issues with this way of thinking – chief amongst which is failing to take into consideration how different types of exercise influence hormones and the nervous system.
Why people gain weight can be complex but, in general, most women will experience:
– an overall decrease in the number of calories required (a ‘slowing down’ of the metabolism associated with age and with the loss of muscle mass(2).
– a decrease in sensitivity to the hormone insulin.(7,8) (blood glucose levels become less well controlled, so consuming foods such as refined carbohydrates cause a spike in blood glucose resulting in greater fat storage).
Dietary changes to address these two things can be hugely helpful – in particular, a moderate decrease in overall calorie intake, specifically lowering the relative number of calories coming from refined carbohydrates. Eat wholegrains and vegetables containing good quality carbohydrates. Protein is also incredibly important as it helps to build muscle mass and is essential for the central nervous system and cognition. Protein intake should be about 1 – 2 grams per KG of body weight if you are active.
Very rapid weight loss should not be your goal unless it is a medical necessity. Women respond to a dramatic calorie reduction differently to men. Men hold onto muscle mass on a low calorie diet but women lose more off their muscle mass and that lowers our metabolic rate. When you come off the very low calorie diet – the weight goes back up because now have lower metabolic rate as have less muscle mass.
Secondly, women responds to stress by ‘battening down the hatches’. On an intermittent fasting or a low calorie diet women are lethargic, tired and grumpy. When women experience the ‘low’ from a very low calorie diet – we get a stress response and a spike in cortisol. Our body responds by holding onto resources (fat) and lowering metabolic rate ensuring survival through this starvation period. So we don’t do our metabolism or energy levels any good.
We need to avoid the loss of muscle mass and the lowering of metabolic rate.
Exercise Changes Muscle tissue is very metabolically active and losing muscle will both decrease our functional strength and slow our metabolism, making it harder to manage our weight in the longer term. Losing bone mass is definitely something older women want to avoid.
With the above in mind, we want to place our focus on exercise that preserves and stimulates muscle mass while burning calories, thereby maintaining a good metabolism. A good-quality strength training programme, along with higher-intensity interval training, should be your go-to, with the caveat that programming should be designed to suit your current level of fitness and health status.
Muscle tissue is about functional strength and has a profound influence on metabolism and, therefore, on weight maintenance. Women tend to go into perimenopause with a lower overall muscle mass than age-matched males. There are definitely biological drivers for this; however, much of the decline in strength and muscle tissue that typically occurs as women go through perimenopause probably has as much to do with lack of appropriate exercise stimulus as it does with biology alone.
All living tissue is metabolically active, but muscle tissue is particularly so. Generally, if you have relatively more muscle mass, your basal – or resting – metabolic rate (how much energy you burn just to stay alive) is likely to be higher (1,2) . The best way to boost your metabolism is to maintain or build your muscle mass. This means that strength training should be a key component of any functional capacity and weight-management programme.
Misconceptions about women and muscle mass.
The first misconception is that strength training will make women bulky. However, while it is possible for some biologically gifted women to put on significant muscle mass, it takes hard, hard work and it is very unlikely that a woman who is middle aged or above and on a moderate calorie diet will significantly bulk up. Furthermore, the kind of weight training you do for strength is not the same as you would do for body building.
The second misconception is that older people, and older women in particular, can’t add muscle mass. That a steady decline in strength and function is just inevitable. This is similar to the fallacy that older women cannot add bone mineral density. Both are demonstrably incorrect. (3,4,5) Even where it is very difficult to put on extra muscle, it is possible to retain muscle or, at the very least, slow the decline of muscle loss into old age. Additionally, much of a person’s strength has to do with training the nervous system. With an appropriately structured strength programme, you can get significantly stronger without adding much or any muscle mass.
Heavy strength training is very counter- cultural for women of this age but arguably we need it the most.
If you’re heading into middle age or above and want to manage your weight, maintain your muscle mass, build bone and keeping your nervous system happy, strength training should be at the top of the hierarchy.
Bones
Older women are generally at higher risk of developing low bone mineral density (BMD) than other sections of the population.
For a start, women will generally go into perimenopause with lower BMD than their age-matched male counterparts. Women have smaller bones than men on average but women are also far less likely to participate in bone-building exercise/activities throughout their lifespan than men are. Osteopoenia (clinically low BMD) and osteoporosis are far more common in women than in men and the majority of older adults who present with a hip fracture are female. Once hormone levels begin to decline, it becomes more difficult to both build new bones and to hold onto your existing bone. There is a common misconception that it is not possible to add extra bone at this time in your life: this is not true. A high-quality strength training programme is absolutely essential for women of all ages but particularly for older women. Strength training and weight-bearing exercise should be at the top of the hierarchy of exercise for building bone.
The Nervous System
Given the profound impact the nervous system has on just about every aspect of health, it receives a criminally low level of attention when people are thinking about exercise. In the context of perimenopause, the nervous system is of interest in some key areas, including strength and functional fitness, cognition and mood.
Functional strength, balance, co- ordination and all that good stuff has as much to do with the nervous system as it does with muscle. In addition, exercise is absolutely essential for good mental health and cognitive functioning into old age. This isn’t just about ‘feel good’ hormones; it is also about the health of the nervous system itself.
Strength training has a profoundly positive effect on the nervous system and its effect on mood(10) and cognition(11) is often under- appreciated. All exercise will have a positive effect on mood; however, weight training is effective not only in the management of depression and anxiety but also in the maintenance of cognitive functioning. In addition to basic strength work, consider adding novel movement and physical challenges that are unfamiliar to the body. This can be as simple as learning a new exercise or doing something in a different way.
Raising the bar
If there is a single take-away from this article, it is that women, and older women in particular, need to be doing heavy weight training.
References
The information in this article is from a Webinar, article and Podcast by Marcelle Malan. She is an exercise physiologist working in a private practice in Melbourne, Australia, and she works primarily with older adults to build and maintain physical and mental resilience.
Zurlo F, Larson K, Bogardus C, Ravussin E (1990), Skeletal muscle metabolism is a major determinant of resting energy expenditure, J Clin Invest., 86(5): 1,423-7.
Henry CJ (2000), Mechanisms of changes in basal metabolism during ageing, Eur J Clin Nut., 54(3): S77-S97.
Howe TE et al (2011), Exercise for preventing and treating osteoporosis in postmenopausal women, Cochrane Database Syst Rev., 6(7).
Maltais ML, Desroches J, Dionne IJ (2009), Changes in muscle mass and strength after menopause, J Musculoskelet Neuronal Interact., 9(4): 186-97.
Marzetti E et al (2017), Physical activity and exercise as countermeasures to physical frailty and sarcopenia, Aging Clin Exp Res., 29(1): 35-42.
Koo S et al (2017), Obesity associates with vasomotor symptoms in postmenopause but with physical symptoms in perimenopause: a cross-sectional study, BMC Women’s Health, 17(1): 126.
Lee CG, Carr MC, Murdoch SJ et al (2009), Adipokines, inflammation, and visceral adiposity across the menopausal transition: a prospective study, J Clin Endocrinol Metab., 94: 1104-10.
Franklin RM, Ploutz-Snyder L, Kanaley JA (2009), Longitudinal changes in abdominal fat distribution with menopause, Metabolism, 58: 311-5.
Christensen P et al (2018), Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi-centre intervention study after a low-energy diet in 2500 overweight, individuals with pre-diabetes, Diabetes Obes Metab., 20(12): 2,840-51.
Gordon BR et al (2018), Association of efficacy of resistance exercise training with depressive symptoms: meta-analysis and meta-regression analysis of randomized clinical trials, JAMA Psychiatry, 75(6): 566-76.
Wilke J et al(2019), Acute effects of resistance exercise on cognitive function in healthy adults: a systematic review with multilevel meta-analysis, Sports Med., 49: 905-16.