Menopause: A Time for Improving Health Behavior
Women who are now forty- or fifty-something look to exercise to help them improve their health during the “change of life.”
Until recently, menopause was rarely a subject of discussion in the fitness center. For one thing, it just wasn’t something we talked about. For another, women over the age of 40 or 50 were not often seen in fitness facilities.
But times have changed. Women of all ages have embraced the concept that lifelong exercise confers important health benefits. Women who are now forty- or fifty-something look to exercise to help them improve their health during the “change of life.”
What is menopause?
Menopause is a term for the permanent cessation of the monthly menstrual cycle, and comes from the Greek roots for “moon” and “to cease.” Menopause typically occurs between the ages of 45 and 55; 51 is the average age in North America. The term menopause is often confused with the term climacteric, which refers to a broader time period during which the gradual change from the reproductive to the non-reproductive phase of life occurs.
The climacteric begins with the late premenopausal period during which a woman’s ovaries become less responsive to the hormones that cause them to produce the monthly rise of estrogen and progesterone. This usually occurs somewhere between the ages of 40 and 50. The climacteric also includes the perimenopausal period when the ovaries stop producing eggs and hormones, and extends through the postmenopausal stage during which conditions related to changes in hormonal levels may develop (approximately ages 55 to 65).
As can be seen from this description, menopause is not something that just happens one morning, but is a gradual process. Women in their late 40s and early 50s know they are approaching menopause when menstrual periods become irregular and finally stop. Although estrogen is still produced by the adrenal glands and adipose tissue, levels drop significantly during menopause, producing a variety of symptoms.
Menopause symptoms: A body/mind event
Anyone who has experienced symptoms of premenstrual syndrome (or psychological side-effects from taking steroids) can testify that the physical and psychological symptoms of changing hormone levels are not “all in your mind.” The same is true for menopause. The most common physical symptom, experienced by at least 80 percent of women, is hot flashes. During a hot flash, the blood vessels to the skin dilate. The increased blood flow causes flushing, heat and sometimes copious sweating. We don’t know why the little muscles that line the arteries and regulate blood flow relax at the wrong time, but we have a name for it: vasomotor instability.
We joke about hot flashes, but for many women they are not funny. Ten percent of women find them to be very intrusive and embarrassing. It’s OK if your face turns red and your clothes get drenched during exercise class — no one will even notice! But imagine having a hot flash while giving a high-powered business presentation. Or at 4 a.m. when you are trying to sleep. Intrusive hot flashes are the most common reason that women seek medical treatment for menopausal symptoms.
Other symptoms include vaginal dryness and problems with urination (needing to go more urgently and frequently). Some women experience headaches, insomnia, hair loss and/or weight gain. Psychological symptoms include mood swings and depression.
Health consequences of decreasing estrogen levels
After menopause, a woman’s risk of developing certain chronic diseases rises. In women, estrogen is associated with lower levels of LDL cholesterol, the “bad” kind of cholesterol that leads to the development of arterial plaque. Women tend to lag about 10 years behind men in the development of cardiovascular (CV) disease. Once past menopause, their risk for CV disease begins to rise.
A woman’s risk of osteoporosis also increases after menopause, especially if she has other risk factors, such as a small frame and Northern European or Asian descent. Estrogen inhibits the activity of osteoclasts, the kind of bone cells that break down bone tissue in the remodeling process. Less estrogen means more active bone breakdown and consequent loss of bone mineral.
Both CV disease and osteoporosis take decades to develop, and while their progression accelerates after menopause, they do not suddenly appear. To the fitness professional, the existence of these health consequences simply reaffirms the importance of medical clearance as part of the intake procedure for your clients. Menopause is one of the steps that mark the aging process, and we are more likely to see chronic health problems in our older clients, both men and women.
To treat or not to treat: The medicalization of menopause
One of the biggest issues your menopausal clients will face is whether to undergo hormone or estrogen replacement therapy. If they come to you for advice, refer them back to their physicians. The decision regarding replacement therapy (RT) must take into consideration a number of important variables, and is difficult to make because information on the health benefits and risks of these therapies is incomplete.
Besides, replacement therapy is a hot topic, and no matter which point of view you take, you will be wrong in someone’s eyes. Some people view RT as an interruption of a natural process. They believe menopause should not be viewed as a “deficiency disease” requiring treatment, especially a treatment whose long-term consequences and side effects are still unknown. On the other side of the issue are those who see RT as the answer for their hot-flash-induced insomnia or high risk of osteoporosis.
Menopause and exercise
It was once believed that not only could you not teach old people new tricks, but you couldn’t even improve their fitness levels. Fortunately, many studies have shown that fitness can be improved at any point in the life span, and that the principles of conditioning apply to every age group.
A woman’s menopausal status independent of her health and fitness level will have little impact on the exercise program you design for her. In other words, you will still design a program tailored to her health concerns and fitness level, just as you would for anyone else. Studies have shown that postmenopausal women reap the same fitness benefits as premenopausal women. Both groups improve cardiovascular fitness and body composition to similar degrees in response to a conditioning program.(1)
Menopause is a reminder for many women that time is passing. During the climacteric, they may become more concerned than ever about slowing the aging process and preventing chronic diseases such as cardiovascular disease and osteoporosis. Take advantage of this interest, and gear your recommendations to your client’s interests. Many of the changes previously associated with menopause, such as a decline in aerobic capacity, are due largely to the aging process combined with a decrease in physical activity. Exercise is one of the best ways to slow the age-related decline in physical function and prevent many of the chronic diseases that take the shine off the golden years.
REFERENCES
Hargarten, K.M. Menopause: How exercise mitigates symptoms. The Physician and Sportsmedicine 22: 49-58, 1994.
Rosenburg, L. Hormone replacement therapy: The need for reconsideration. American Journal of Public Health 83: 1670-1673, 1993.
Worcester, N., and M.H. Whatley. The selling of HRT: Playing on the fear factor. Feminist Review 41: 1-26, 1992.
By Barbara A. Brehm, Ed.D. Professor of exercise and sport studies at Smith College, Northampton, Mass.