Perimenopause And Exercise

Overview

What is perimenopause?

Perimenopause is the word used to describe the transition phase when a person assigned female at birth (AFAB) begins to enter menopause. This happens when the female body decreases its production of oestrogen (female hormone produced by ovaries) and other hormones leading to multiple physiological and mental changes.

The importance of exercise during perimenopause

Engaging in some sort of exercise is one of the best ways to prevent non-communicable diseases (non-infectious diseases, for example, diabetes, cancer and coronary heart disease) and other ailments that arise as we age. Exercise can also be beneficial in managing the symptoms that manifest during perimenopause.

Perimenopause 

Characteristics of perimenopause

Perimenopause is the transition phase when any with AFAB begins to have changes in hormone production which leads to menopause. Symptoms indicating hormonal changes will start to manifest during this period of time and these symptoms can occur while the person still menstruates. Menopause is defined as the time when there has been an absence of a menstrual period for at least 12 months. Menopause tends to happen in AFAB people between the ages of 45 and 55.

Symptoms of perimenopause

Hormones regulate multiple processes in the human body. As perimenopause is the result of changes in hormone production, this is translated into different symptoms including (but not limited to):

• Hot flushes
• Depressed mood and anxiety
• Sleep disturbances and night sweats
• Loss of libido
• Cognitive symptoms (memory loss/brain fog)
• Vaginal dryness
• Urinary symptoms (leaking urine/incontinence)
• Somatic symptoms (stiff joints, soreness)
• Weight gain¹

The benefits of exercise during perimenopause

Physical and psychological benefits

The latest World Health Organisation guidelines recommend 150 to 300 minutes of moderate-intensity physical activity per week or 75 to 150 minutes of vigorous-intensity physical activity per week as part of a healthy lifestyle and to reduce the risk of non-communicable diseases.² 

Exercise during perimenopause can be used as a lifestyle strategy to manage its symptoms. The physical and psychological benefits of exercise during perimenopause include the following:   

• Overall improvement in perimenopausal and later menopausal symptoms³
• Improvement in symptoms of depression³
• Overall improvement in quality of life³
• Maintainance of healthy weight, and decreased body fat⁴
• Preservation of bone density⁴
• Cardiovascular benefits (reduced blood pressure, cholesterol, and blood glucose)⁵
• Improvement in cognitive functioning, functional capacity (fitness), sleep quality ⁶
• Maintaining muscle function, strength and volume⁷

Social benefits

Besides these physical and psychological benefits, exercise also has social benefits. Exercising in groups with other people who are experiencing or have experienced perimenopausal symptoms can make people feel like they can relate to each other, gain a sense of mutual support and be understood. This creates a feeling of extended support, community, and interpersonal connection that can also enhance social functioning.⁶

Types of exercise

Exercise is usually divided into two main types – aerobic and anaerobic.

Aerobic exercise  

Aerobic exercise (also known as “cardio”) increases your heart and breathing rate, involves your cells using oxygen to produce energy from glucose, and provides the most cardiovascular benefits.

Many activities count as aerobic exercise. Some examples include:

• Walking/power walking
• Jogging or running (indoors or outdoors)
• Cycling (outdoors or on a stationary bike)
• Dancing (Zumba, aerobics, etc.)
• Certain sports involving running (football, rugby, hockey, etc.)
• Skipping (Jumping rope)       

Anaerobic exercise (strength and flexibility)

Anaerobic exercise is a type of exercise that involves more intense short bursts of physical activity with the energy coming from glucose without oxygen being required in the glucose breakdown process. 

Exercises strengthening muscles and bones through weight training generally come into this category. Recent research has shown that this type of exercise has a particular benefit as the body ages and should be performed at least 2 to 3 times a week to obtain its benefits. 

Most of its benefits are functional (mobility and strength of muscles and bones) and in particular the prevention of sarcopenia, or muscle wasting, that happens as the body ages.⁸ Therefore, performing anaerobic exercise during perimenopause provides these additional benefits for countering ageing’s negative impact on muscle and frailty.

Examples of anaerobic exercise include:

• Weight lifting (free weights, dumbbells, heavy bags)
• Body weight exercises (push-ups, sit-ups, planks, etc.)
• Resistance bands.  

There are other types of exercise that can provide further benefits. For instance, gentle yoga or pilates are low-intensity and provide psychological benefits (e.g., stress management). Furthermore, Tai Chi and Qi Gong are also beneficial forms of physical activity. Research suggests that Tai Chi can improve bodily pain, general health, and bone density in the spines of patients with perimenopausal symptoms. ⁹  

Other considerations

Individual needs

Before starting any exercise program (especially if you have not engaged in any type of physical activity before or for a long time) it is important to consult with a healthcare professional (e.g., GP, nurse, physiotherapist) to make sure that there are no contraindications to performing particular types of exercise. 

People with conditions such as cardiovascular disease or diabetes may have to follow particular instructions to ensure they are safe while exercising (e.g., regarding the type of exercise, frequency, intensity, duration and target heart rate). Likewise, for people with joint or mechanical problems (neck, back, shoulders, hips, knees, etc.) the exercises performed have to be adapted to the individual’s mobility capacity and ability to avoid aggravating any existing health problems.

It is also important for you to ‘listen to your body’ when you start to exercise, especially when it is for the first time. For instance, if you start exercising and you feel that some type of exercise is too intense, does not agree with your body, or is creating or aggravating pain in certain joints or muscles, it is important to ‘listen to your body’ and check with a physiotherapist whether this is creating an injury that could become chronic or exacerbating an existing condition.¹¹ 

Physiotherapists can guide you to do exercises that will help strengthen certain muscle groups beforehand to prevent injury later when doing other exercises. For example, they may focus on strengthening your shoulder girdle stabilising muscles before you attempt to lift weights.

Exercise should be tailored to your individual physical needs, but also to personal preferences. Engaging in activities that are enjoyable means they are more likely to become a habit and part of your daily routine.

Recovery

Rest and recovery are also important parts of exercise that are often neglected. They are as important as exercise itself, especially if high-intensity exercise is practised because the body, particularly as it ages, needs time to recover from the effort that has been expended. 

In order to recover it is important to have proper nutrition, hydration, and sleep. Taking a day off from exercise to recover after a day of hard effort will allow your muscles to repair. It is also possible to engage in “active recovery”, which can involve light activity such as gentle walking or light yoga. 

Recovery is helpful in preventing aches and pains that often naturally occur after vigorous exercise. Since pain will be reduced, this can help you to adhere to your exercise routine.¹⁰ 

Frequently asked questions       

How do I start exercising during perimenopause?

To start exercising during perimenopause, it is important to first check with a healthcare professional and once they have given the go-ahead, start gently exercising, gradually increasing the frequency and intensity so the body can adjust to the exercise routine. 

This means starting with a realistic goal and then increasing time, frequency, and intensity gradually. Another important point to consider when starting to exercise during perimenopause is finding an activity that is truly enjoyable which will help motivate you to adhere to your exercise routine in the long-term.

How can I overcome barriers to exercising?

People can find it difficult to adhere to an exercise routine for multiple reasons. One of the most common reasons is time constraints, so it is important to prioritise making time for exercise rather than finding the time to do it. 

It has been suggested that exercising first thing in the morning is a good way to make exercise part of your daily routine. Another common barrier can be a lack of motivation. However, research suggests that motivation follows habit, not the opposite. Therefore, making exercise part of our daily routine can help create the motivation to exercise.

Summary

Exercise is a lifestyle intervention that can help in the management of many of the symptoms that may manifest during perimenopause. There are different types of exercise and it is important to engage in a combination of these to optimise the benefits that exercise can provide. 

Research also suggests that implementing a holistic approach through multi-disciplinary support of gynaecologists or other medical professionals in conjunction with health psychologists can provide support that results in great benefits for AFAB people experiencing perimenopause by promoting uptake of, and adherence to, exercise programs.⁶ This in turn will lead to all the physical, psychological and social benefits of managing perimenopausal symptoms and long-term health benefits.