VITRUVIAN EXERCISE PHYSIOLOGY
News & Information
Menopause
What is Menopause?
Menopause is a natural biological process that marks the end of a woman's menstrual cycle, and therefore the end of her reproductive years. This typically occurs between the ages of 45 and 55. It is officially diagnosed after 12 consecutive months without a menstrual period. The transition is driven by a decline in ovarian function whereby the number of ovarian follicles declines and the ovaries become less responsive to follicle-stimulating hormone (FSH) and luteinising hormone (LH), reducing the production of estrogen and progesterone. While menopause is a normal phase of life, it can bring a variety of physical and emotional symptoms that impact quality of life.
Menopause is a natural transition that can be supported through lifestyle changes, medical interventions, and targeted exercise programs. Women may experience different symptoms and challenges depending on their genetic background, overall health, and environmental influences.
Contributing Factors
Several factors can influence the timing and experience of menopause:
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Age: Natural menopause typically occurs between 45–55 years, with an average age of onset around 51.
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Family history: Genetic factors can influence both the age of onset and severity of symptoms.
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Medical or surgical causes: Treatments like chemotherapy, pelvic radiation, or bilateral oophorectomy (removal of the ovaries) can cause early or sudden menopause.
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Lifestyle factors: Smoking, low body weight, and poor nutrition may lead to earlier onset or exacerbate symptoms.
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Autoimmune or metabolic conditions: Conditions like thyroid disease or type 2 diabetes may impact hormonal balance and the menopause experience.
General Signs & Symptoms
Menopausal symptoms can vary widely in type and severity. Common symptoms include:
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Vasomotor symptoms: Hot flushes and night sweats
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Sleep disturbances: Difficulty falling or staying asleep, insomnia
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Mood changes: Irritability, anxiety, depression, mood swings
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Cognitive changes: Memory lapses, difficulty concentrating, "brain fog"
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Vaginal and urinary changes: Vaginal dryness, painful intercourse, recurrent urinary tract infections
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Musculoskeletal symptoms: Joint pain, muscle aches, reduced flexibility
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Body composition changes: Weight gain, particularly abdominal fat, and decreased lean muscle mass
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Skin and hair changes: Thinning hair, dry skin
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Decreased libido
These symptoms can last for several years and affect personal, professional, and social functioning.
Stages of Menopause
Stages
Characteristics
Stage 1: Perimenopause
The transition phase that begins several years before menopause. Estrogen levels fluctuate, and menstrual cycles become irregular. Symptoms such as hot flushes and mood changes often begin during this time. Symptoms can begin in late 30s or early 40s and may last for several years.
Stage 2: Menopause
Stage 3: Postmenopause
Officially diagnosed when a woman has gone 12 consecutive months without a menstrual period. Hormone levels stabilize at low levels, and symptoms may continue or intensify.
The stage following menopause. While some symptoms subside, others like bone loss and/or cardiovascular risk factors may increase. This is a key period for implementing long-term health strategies.
Diagnosis
Diagnosis is based on the presence of menopausal symptoms and changes in menstrual patterns. Blood tests may be used in cases of premature menopause, after hysterectomy, or when symptoms are atypical.
National Institute for Health and Care Excellence (NICE) diagnostic guidelines for women ≥45 Years:
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Perimenopause: Vasomotor symptoms and menstrual changes (shorter or longer cycles, altered blood loss).
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Menopause: No menstruation for ≥12 months without hormonal contraception.
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Surgical cases: Based on vasomotor or related symptoms after hysterectomy.
In certain cases, blood tests may be used to confirm the diagnosis or rule out other conditions:
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Follicle-stimulating hormone (FSH): Elevated levels suggest reduced ovarian function.
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Estradiol: Low levels support a menopause diagnosis.
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Other tests: Thyroid function, iron studies, or pregnancy testing may be used to rule out alternative causes of symptoms.
A comprehensive clinical history and symptom review remain the most important diagnostic tools.
Treatment & Managment
Pharmacological Options
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Hormone Replacement Therapy (HRT): Also known as hormone therapy (HT) is the most effective treatment for moderate to severe vasomotor symptoms. This will typically involve estrogen alone or in combination with progestogen (for women with a uterus). Risks and benefits must be carefully considered with your medical team, and treatment is tailored to you based on age, symptoms, medical history, general health, and risk factors (e.g. history of breast cancer).
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Non-hormonal medications: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), gabapentin (an anticonvulsant), and clonidine (a vasodilator) have been shown to reduce hot flushes and may be appropriate alternatives for women who cannot take HRT.
Non-Pharmacological Options
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Cognitive Behavioural Therapy (CBT): Can reduce anxiety and ability to cope with symptoms.
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Lifestyle changes: Regular exercise, balanced diet, stress management, and smoking cessation all contribute to better symptom management.
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Complementary therapies: Some women find relief with acupuncture, herbal supplements, or mindfulness-based practices, although evidence varies.
Role of Exercise
Exercise is a powerful non-pharmacological tool in menopause management. Regular physical activity can:
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Reduce vasomotor symptoms: Particularly through resistance training.
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Improve cardiovascular health: High-intensity aerobic training leads to improved cardiac structure and function in both premenopausal and postmenopausal women.
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Enhance mood and cognition: Exercise boosts endorphin levels, supporting emotional and mental well-being.
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Promote muscle mass and bone density: Critical in preventing sarcopenia (age-related muscle loss) and osteoporosis (reduced bone density).
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Improve balance and prevent falls: Especially important during postmenopause.
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Support metabolic health: Reduces central adiposity and risk of type 2 diabetes and other metabolic conditions.
Resistance training (RT) is particularly vital, and can elicit the following benefits:
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Reduces hot flushes: One study found a near 50% reduction in frequency after 15 weeks of RT.
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Improved muscle strength, lean mass, and bone mineral density—areas especially affected by reduced estrogen.
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Enhanced mood, sleep, and cognition via effects on serotonin and norepinephrine.
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Helps regulate glucose and insulin response. This is important as estrogen/progesterone levels drop.
Estrogen acts in women like testosterone does in men: Its decline affects lean muscle mass, strength, and the ability to contract muscles forcefully. Resistance training can therefore act as a replacement stimulus to maintain these systems.
Mechanisms Behind the Effect of Exercise
Exercise exerts its benefit through multiple physiological pathways:
Hormonal adaptations
Physical activity may improve the sensitivity of estrogen receptors and support hormonal balance.
Muscle preservation
Maintaining muscle mass through strength training reduces sarcopenia (age-related loss of muscle) and metabolic disease risk.
Vascular function
Exercise maintains endothelial function (inside lining of blood vessels) and reduces cardiovascular risk, even as estrogen declines.
Central nervous system stimulation
Heavier loads activate the central nervous system, helping offset the absence of hormonal stimulus.
Stress and cortisol regulation
Chronic low/moderate-intensity cardio (like long classes) may raise cortisol, contributing to fat gain, bloating, inflammation, and sleep disturbances. Resistance training and high intensity interval training may help lower baseline cortisol levels over time.
Bone health
The presence of estrogen slows the loss of bone. With reduced estrogen levels the risk of osteoporosis increases. Appropriate loading of the skeletal system can maintain, and even improve bone mineral density.
Thermoregulatory
function
Resistance training may increase central β-endorphin production, which stabilizes temperature regulation and reduces hot flushes.
Mental health
Physical activity positively affects brain-derived neurotrophic factor (BDNF), supporting mood and cognitive function.
Exercise Prescription in Perimenopause,
Menopause & Postmenopause
Individualized exercise programs are essential during the menopause transition. A clinical exercise physiologist can tailor the program based on general health status, co-occurring conditions, symptom severity, and fitness goals. Below are some of the elements that your program may entail, likely in combination for best results:
Frequency and Duration
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3+ sessions per week
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45–60 minutes per session
Modalities and Guidelines
Resistance Training (RT):
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A combination of targeted weighted exercises +/- bodyweight exercises
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2+ sets of 8–12 repetitions for all the major muscle groups
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Moderate to high intensity (adjusted over time based on progress and adaptation). Lift heavy to invoke central nervous system response
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‘Heavy’ is relative. When beginning resistance training, the focus will be on learning good technique. As you progress, loads will increase safely
Focus on technique and long-term consistency
"You’re training for the rest of your life."
High-Intensity Interval Training (HIIT):
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Short bursts of high-effort exercise followed by rest or low-intensity recovery
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Shown to improve cardiovascular health and cardiorespiratory fitness
Mind-Body Exercises:
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For example; yoga, tai chi, or Pilates
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Effective for stress reduction, and improving mood and sleep quality
Aerobic Training:
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For example; walking, cycling, swimming
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For general health, the World Health Organisation guidelines recommend 150 minutes of moderate intensity or 75 minutes of higher intensity aerobic exercise per week
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Current evidence around peri-menopause suggests higher intensities may elicit better outcomes regarding menopause symptoms
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The general health benefits of moderate intensity aerobic activity are still relevant for these populations, and additionally, can help support mood and mental health, stress management, and encourage social engagement
Addressing Misconceptions
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“Lifting will make me bulky”: This is a myth. Especially during peri- and post-menopause, building large muscle mass requires extreme effort and calorie surplus.
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“Cardio is best”: Overemphasis on moderate-intensity cardio may worsen fatigue and inflammation. Instead, resistance and high-intensity interval training (HIIT) are recommended as the primary form of exercise, and cardio as a supplementary option.
Final Recommendations
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Train for strength and power: Women in midlife must focus on muscle and bone-preserving strategies
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Prioritise recovery: Rest days, sleep, and stress management are key
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Individualise your plan: Tailor according to your goals, symptoms, experience, and preferences
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Tailored Nutrition: ensuring you are fuelling optimally for both your training and overall health will lead to the best outcomes, often exercise & nutrition work best hand-in-hand
For support from one of our clinical exercise physiologists and tailored programs during menopause and beyond, contact Vitruvian Exercise Physiology.
The Vitruvian Team.
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