The Menopause and Peri-Menopause Dec 19 2019

The menopause usually happens between the ages of 48 and 55 and can be diagnosed when a woman has not had a period for a year. The symptoms of menopause are often varied and far reaching due to the hormonal changes within the body and include anything from feelings of depression and anxiety to changes in muscle strength and tone, weight gain, hot flushes and vaginal atrophy. The list of potential symptoms are documented at the end of this blog post for your reference.                                         

Peri-menopause is defined as the a period of time of up to 10 years before the menopause when a woman can experience menopausal-type symptoms. This is often under recognised in women and makes the management of their symptoms quite difficult. People often presume that whilst they’re still having periods they won’t be experiencing menopausal symptoms but this is not the case. 

During the menopause your oestrogen levels drop from up to 350 picograms per millilitre of blood to lower than 10 picograms per millilitre. Oestrogen is used in the body to strengthen bones, to maintain cholesterol levels, lubricate the vagina, help maintain body temperature, improve the collagen content and suppleness of skin and stimulate processes in the uterus and fallopian tubes for reproduction. It also helps to regulate hair growth and maintain brain function. Considering the pivotal role that oestrogen plays in a woman’s body it’s no wonder that a considerable drop in this has a whole host of symptoms associated with it. 

During peri-menopause oestrogen levels can fluctuate greatly, sometimes being much lower than expected and sometimes even higher. This means that using a blood test to try and diagnose peri-menopause is difficult due to the ever changing levels of oestrogen in the blood. Peri- menopause is often diagnosed based on patient’s symptoms. 

It’s important to try and manage the symptoms of menopause and peri-menopause by ensuring that you eat a healthy balanced diet rich in calcium (for bone health) and stay physically active to try and regulate cholesterol levels (which increase during menopause) and prevent weight gain (another common feature of menopause). Muscle atrophy occurs during menopause so strength training should be a key component of any programme. Exercise is considered to be one of the most beneficial and noncontroversial way of managing menopausal symptoms. 

Continence issues during the menopause and peri-menopause are common due to pelvic floor atrophy. Oestrogen helps to keep the pelvic floor strong and the vagina lubricated. If you are experiencing continence issues speak to a pelvic health physiotherapist to get a tailored programme to strengthen your pelvic floor and surrounding muscles. Strengthening the core, gluteal muscles and hamstrings is essential when tackling pelvic floor dysfunction but this needs to be done in a way that prevents excessive strain on the pelvic floor. 

If you are struggling with menopausal symptoms it’s important to speak to your GP or relevant health care professional. Some women choose to increase their oestrogen levels with Hormone Replacement Therapy (HRT), which can greatly improve symptoms. HRT has been under the spotlight recently due to a study that found that taking HRT can increase a woman’s risk of breast cancer. Whilst this is true it’s important to look at the evidence as a whole so one can make an informed decision about the treatments available to them. The table below which can be found at shows the relative risk of someone contracting breast cancer depending on various lifestyle factors. As you can see, the risk of developing breast cancer is much greater if you are obese or drink more than 2 units of alcohol per day, than if you take HRT. HRT reduces the incidence of heart disease and stroke, helps to prevent menopausal weight gain and protects bone health. It can also help to regulate the emotional and psychological symptoms of menopause. HRT is available as a vaginal gel, skin patch or tablet and is combined with a progesterone hormone to protect the uterus. For further details and advice on the menopause and HRT go to 

If you want advice on how to maintain or return to your preferred exercise program then get in touch with us at Executive Physiotherapy for an assessment to see how physiotherapy can address your specific needs.

Leanne O'Brien - Pelvic Health Physiotherapist at Executive Physiotherapy

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