My Best Advice for Perimenopausal Women

Perimenopausal women are often confused about why the things they’ve always done to look after themselves don’t work anymore. It’s true: physiologically we are not the same after menopause. Midlife is a prime time for re-evaluation in many areas of our lives. Here’s my collection of “pearls” from years of treating perimenopausal women.

REFRAME Menopause

I often use the acronym “REFRAME” to describe key areas to consider at perimenopause. It stands for:

• Recognise the signs and symptoms
• Exercise
• Food
• Relationships
• Attitude
• Mental Health
• Expert advice

R: Recognise the Signs and Symptoms

Menopause is normal, but different for every woman. No matter what symptoms you have or how you experience them, it’s YOUR experience. Menopause is a normal physiological life-stage defined as when there’s been no ovulations (and hence no periods) for 12 months. 80% of us will get some menopausal symptoms along the way, some barely any but others will get the whole shebang. Of those who get symptoms around 1 in 5 report them as being moderate to severe.

The most common symptoms include hot flushes or night sweats, mood changes, sleep disturbance, muscle and joint pains, vaginal dryness and sexual or urinary issues.

E: Exercise

Two important things happen at menopause that should guide you in your exercise and dietary choices from here on: heart disease risk starts to rise, and bone density starts to drop. Both of these are linked to a decline in estrogen amongst other things.

More women die of heart disease than almost any other cause. To help offset the rise in heart disease risk it’s very important to focus your exercise on getting your heart rate and breathing going faster. For most of us this means increasing the intensity of exercise, rather than the duration.

One or two short bursts of exercise daily, even of just 5 minutes each, will go a lot further to improve your cardiovascular fitness than an hour of comfortable walking. You can do short intense intervals of exercise at home with no special equipment (otherwise known as HIIT, or High Intensity Interval Training). Check out this video for some ideas, or this one.

You can lose up to 20% of your bone density in the five years after menopause. Combat this bone loss by making sure to get some impact into your exercise routines. You don’t need to be madly jumping up and down until you wet yourself, just get some jolt forces going through your skeleton. Some activities will build and retain bone better than others, as this article demonstrates. Another easy bone-booster is to step up onto the bottom step of your stairs and jump lightly back down about ten times daily.

Try to also include some strength training in your routine. As we age it’s much harder to maintain muscle mass, which is active metabolic tissue that burns calories 24/7. Staying strong keeps your bones strong and protects against falls and fractures. And in case you still need any more convincing about the benefits of exercise, it’s also protective against dementia. Check out this factsheet from Dementia Australia for more information.

F: Food

Declining estrogen at perimenopause has a range of effects which can increase weight and heart disease risk. Firstly, we are burning less calories because:

• Women (on average) reduce their activity levels by around 50% at menopause
• Muscle mass declines (ie. reduced active, calorie-burning tissue), and
• Metabolism slows

Then, even though we are burning less calories most women don’t reduce their portion sizes accordingly, so weight begins to accumulate. Adding insult to injury, extra post-menopausal weight tends to accumulate centrally around our organs, which further increases heart disease risk.

The basic principles of healthy eating after menopause are therefore:

• Eat LESS food overall
• Focus on good calcium intake and nutrition, and
• Manage your weight

If you are not yet menopausal and are overweight, now’s the time to really get serious about weight loss. Entering menopause at a healthy weight puts you in a great position to maintain it over the coming decades, which will be hugely powerful in reducing heart disease risk as you age. It is still possible to lose weight after menopause but it will generally be more difficult.

For more information about exercise and food around menopause check out our Blog posts: Diet and Exercise After Perimenopause (with embedded Webinar video), Weight Loss After Perimenopause and How to Beat Weight Gain at Menopause.

R: Relationships

If we only focus on our physical wellbeing during this transitional stage of life we’re missing a huge part of the picture. Midlife is an amazingly dynamic time, with changes occurring in many areas of our lives:

• Parenting role: kids more independent, leaving home (and often bouncing back!)
• Caring role: parents becoming elderly, more dependent, and dying.
• Work role: more responsibilities, facing retirement
• Partners: divorce, repartnering, perhaps facing being alone.
• Sexual and physical changes with ageingà impact on self-image

Humans are social creatures; our quality of life is interdependent with the quality of our relationships. Take the time to reflect on whether you are appropriately prioritising relationships with your partner, friends, family, community and yourself.

A: Attitude

Celebrate the positives! Menopause is not something to be dreaded or ashamed of. Let’s talk about it with one another. Celebrate the wisdom, confidence and insight you’ve gained. Your experience is enormously powerful, so use it to educate our daughters about menopause. Most of all, stay proactive and future-focussed. Our brain’s plasticity (ability to remodel itself) persists into old age, stimulated by learning and adapting to new things. Change is growth, and “use it or lose it” is definitely true when it comes to your brain.

In a practical sense there are many reasons why menopause can be an empowering time. It’s different for each of us, but the changes it brings can include:

• Freedom from periods and sanitary products
• Financial security
• Reduced childcare responsibilities
• Retirement, giving you time to pursue goals you never could before
• The joys of Grandparenting
• Travel opportunities
• Confidence borne of wisdom and experience
• New or deepening relationships
• Letting go of obsessions with youth and beauty

M: Mental Health

Perimenopause is a time of increased risk for the development of mood symptoms including anxiety and depression. Hormonal fluctuations around perimenopause can definitely be a contributor but they usually aren’t the only cause. Other contributing factors can include:

• A history of mental health disorders, eg. postnatal depression, anxiety
• Family or relationship problems
• Caring for ageing parents or high-needs family members
• Work stress
• Poor physical health, chronic pain or disease
• Lack of exercise
• No time for self-caring and reflection
• Other significant perimenopausal symptoms, like hot flushes
• Drug and alcohol dependence
• Negative perceptions of ageing, eg. body image and sexuality
• “Empty nest” grief
• A perceived lack of purpose or meaning in life

It is difficult to separate out all the possible causes of a woman’s mood symptoms, therefore effective treatment demands a holistic approach. All the contributing factors need to be considered and addressed. The treatment plan may include:

• Counselling or psychological therapies
• Relationship or sexual counselling
• Online education and electronic resources
• Meditation, mindfulness, relaxation therapy
• Exercise
• Treatment of other medical issues
• Improved diet
• Development of hobbies and other meaningful activities
• Medication

Your GP can help guide you to an understanding of your particular issues and connect you with the resources you need to treat them. It may even be possible to treat hot flushes and mood symptoms at the same time with a single medication. Check out our Blog post and Webinar about Mental Health Issues Around Menopause, this fact sheet about mood problems at menopause from the Australasian Menopause Society, and this extensive guide to electronic mental health resources.

E: Expert Advice

You don’t have to put up with dreadful menopausal symptoms! There are many misconceptions surrounding menopause; fear and misinformation prevent women from discussing it or seeking treatment. This deprives them of opportunities for symptom relief, better quality of life and ongoing health benefits. A doctor who is experienced and knowledgeable about menopausal treatments can discuss your options and help to put your individual level of risk versus benefit into perspective.

It can be difficult to find a health professional with expertise in managing menopause though. Even excellent GP’s can’t know everything and may lack knowledge about treating menopausal symptoms, particularly in more complex cases.

Added to this, people living in more remote areas rarely have a choice about which medical professionals they see. Now expert menopause care is available by Telehealth however, so women can get the specialised help they need regardless of where they live.
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What is WellFemme About?

If you can’t find the professional help you need for your perimenopausal symptoms then book a Telehealth consultation with an expert WellFemme menopause doctor.

WellFemme is Australia’s first dedicated Telehealth menopause clinic, servicing locations nationwide including: Melbourne, Sydney, Adelaide, Darwin, Perth, Hobart, Brisbane, Dubbo, Bendigo, Broken Hill, Broome, Alice Springs, Launceston, Cairns, Mildura, Lightning Ridge, Kalgoorlie, Albany, Toowoomba, Charleville, Port Headland, Katherine, Ballarat, Coober Pedy, Bourke, Albury… and your place! 🙂