An estimated 1 billion+ women will be experiencing menopause by the year 2025, 12% of the world’s population. While menopause is an inevitable part of aging, historically it has been a taboo topic tied to a lot of stigma and shame. Read on to learn about the stages of menopause, the common symptoms, the physical and mental health concerns and changes, how to approach weight changes and body dissatisfaction, and what women can do to take charge of their health and well-being.
Knowledge is Power
Despite literally every single woman eventually going through it, women often try to quietly keep their heads down and just muscle through this transitional period of life. Many of the changes that occur during this phase of life are completely out of our control and as a result can be frustrating and raise concern. Developing a better understanding of what is going on inside our bodies and learning how to manage the symptoms can bring a sense of calm.
To me, knowledge is power. A lack of knowledge about this stage of life is disempowering and can leave women vulnerable to all the many snake oil salespeople peddling their products, diets, and supplements and making false claims and promises that ultimately aren’t helpful. As women, building our knowledge and speaking openly with friends and our healthcare professionals about what we are experiencing can empower us to not only get through this phase of life, but to thrive! My hope is that the information and suggestions to follow help to educate, empower, and encourage.
Three Stages of Menopause
Natural menopause occurs in three phases: perimenopause, menopause, and postmenopause. Menopause is a specific point in time 12 months after a woman’s last menstrual period. The years leading up to that point, when women may have changes in their monthly cycles, and experience other physical and mental symptoms, are called perimenopause. Perimenopause most often begins between the ages of 45 and 55 and usually lasts about seven years. After experiencing menopause, women then enter the phase of postmenopause.
Many of us are familiar with hot flashes as a fairly common symptom of perimenopause, but not every woman experiences them. Each and every woman experiences menopause differently. Some don’t experience any symptoms, or their symptoms are milder, while others do and with increased intensity and severity. These symptoms that are experienced can impact many aspects of women’s lives including relationships, work, activities and our mental and physical well-being. Knowing about the varying symptoms and how they show up can provide some peace of mind and help give some validation for what many women are going through in midlife.
The top symptoms of perimenopause and menopause are:
- Period changes and irregularity
- Hot flashes and night sweats
- Increased stress and anxiety
- Sleeping problems
- Brain fog and poor concentration
- Skin and hair changes
- Mood changes
- Low energy
- Joint and muscle aches
- Weight gain
It is important for women to know that the symptoms of menopause are something all women go through, they are not alone, and what is happening isn’t because of something they are doing or not doing. See the “What Can You Do…” section below to find out how to manage symptoms.
Estrogen: The Work Horse of Women’s Health
Many of us know estrogen and progesterone as reproductive hormones. The levels of both of these hormones greatly impact women’s health, especially through the stages of menopause. Estrogen in particular is truly a powerhouse when it comes to women’s health. It is produced mostly in the ovaries during the reproductive years but is also secreted by the adrenal glands and be adipose tissue or body fat. In addition to estrogen’s role in reproductive health, it also contributes to cognitive health, bone health, the function of the cardiovascular system, and the central nervous system. It’s truly amazing the impact that one hormone can have on health.
During perimenopause, the body’s production of estrogen begins to decline, and levels of progesterone also begin to fluctuate. This decline and fluctuation impacts many of the body’s functions and processes and contributes to the menopausal symptoms and health changes that are commonly experienced. Interestingly, the primary estrogen in the body changes from estradiol (E2) to a less potent type of estrogen, estrone (E1), during menopause. After menopause, estrone is the only type of estrogen that the body keeps making naturally.
Estrogen and it’s decreasing levels through the menopausal transition affects:
- Cholesterol levels
- Blood sugar levels
- Bone and muscle mass
- Circulation and blood flow
- Collagen production and moisture in your skin
- Brain function, including your ability to focus
- Metabolism and fat storage
More on what women can do to manage symptoms and counteract the health implications of decreasing levels of estrogen coming up.
In addition to the physical changes that are happening, it’s also common during menopause to experience very real and impactful mental health and mood changes. The impact of menopause on mental health is often unexpected and can be overlooked. Mental health changes that are common include irritability, sadness, lack of motivation, aggressiveness, problems focusing, stress, difficulty concentrating, and anxiety and depression. One study showed that women are two to four times more likely to experience a major depressive episode during menopause than at other times in their lives.
In addition to the known effect of shifting estrogen levels on mental health, there are many other life factors which can impact women’s mental health in midlife. Some common life stressors include dealing with children growing up and leaving the house, concerns about aging parents, relationship changes, increased demands with professional and work life, and getting older in a society that values youth, etc. There is A LOT going on in this phase of life, both internally in women’s bodies and externally in life, so the impact on mental health only makes sense. Being aware and acknowledging mental health concerns, reaching out for help when needed, and making lifestyle changes can all be ways to care for and find treatment to better cope with the mental health changes in menopause.
Weight Gain and Body Image in Midlife
All of life’s challenges plus the added health and body changes that can naturally occur throughout this stage of life can result in an increase in body dissatisfaction and body image issues. The unpopular truth is that it is completely natural and normal to experience body changes, including weight gain and increased fat, as women age and go through this stage of life. Men also experience changes in body composition as they age, but it is often not viewed in the same light.
A specific point of frustration and complaint is the very common “midlife spread” or increased belly fat that happens as women age and go through the different stages of menopause. While women tend to blame themselves for this change, the additional layer of body fat around the middle is actually a direct result of the reduced levels of estrogen leading up to and through menopause.
It is not uncommon for women who haven’t changed a thing in their lifestyle around food or movement to still experience these body changes. The tendency is to heap a lot of blame and shame on ourselves for not eating “right” or working out enough. It’s important to note that body changes can happen regardless of what or how much we eat or how much we exercise. This redistribution of where fat is stored is perfectly normal and natural. Although it may be annoying (nobody likes to put on a pair of pants and find they are too tight) our bodies need this extra layer of body fat, as these extra fat cells produce additional estrogen for healthy functioning. Instead of a spare tire, I have heard this extra around the middle referred to as a life preserver, which I found to be an interesting shift in perspective. That adipose tissue or fat women tend to be so focused on ridding themselves of serves a vital purpose, to protect our bodies.
These changes occurring in middle-aged female bodies are often seen as one more problem to fix. Making aging women a target for both the dieting and anti-aging industries, with many falling prey to chronic dieting, body dissatisfaction. and even eating disorders, like anorexia, bulimia, and binge eating disorder. In fact, it is estimated that 13% of women over 50 have an eating disorder with an even higher percentage with disordered eating. It can be helpful to shift to acknowledging and accepting that women’s bodies naturally change through all stages of life: from puberty, through pregnancy, into midlife and beyond. The idea and expectation that bodies don’t change is a myth and isn’t realistic. Our bodies are meant and designed to change.
What You Can Do to Take Charge of Your Health and Well-Being
It is possible to work with instead of fighting against our bodies. A big part of my work with clients is helping them better care for themselves, and this phase of life deserves special attention in that regard. Here are some specific things to consider during this transitional phase of life.
1. Skip restrictive diets and nourish yourself well.
Many of the recommendations in regard to nutrition around this phase of life are very diet focused and restrictive. The advice usually centers around how to eat as little as possible in order to control our bodies. Thankfully though that isn’t the only approach. Food is nourishment and an essential part of life. It can be hard to sift through the muck of diet culture to figure out what exactly it means to nourish yourself well at any stage of life, but especially in menopause. Working towards simply eating regular, consistent, balanced, nutrient-rich meals can be a game changer.
2. Manage your stress.
Stress is not only no fun but can impact every aspect of our health. In response to stress our bodies increase levels of the stress hormone cortisol which can also contribute to visceral fat storage and possibly contribute to insulin resistance. Finding ways to manage stress is key. Some options to consider: meditation, yoga or gentle stretching, walking in nature, deep belly breaths, reflective journalling, or enjoying a cup of herbal tea. Carving out just 10 minutes a day can help you cope with stress, reduce burnout, and reduce anxiety.
3. Find a form of movement you enjoy and do it regularly.
Every bit of movement is beneficial when it comes to promoting heart health and bone health, decreasing the intensity of perimenopause symptoms, and helping women to connect with and feel better in their bodies. Literally everything counts. The key is finding what you enjoy so it is something you look forward to, instead of something you dread. Including some weight-bearing type exercise is beneficial for bone and metabolic health, not to mention improving how we feel in our bodies and how they function. All forms of movement also help to reduce stress and improve sleep.
4. Prioritize sleep.
The simple luxury of a good night’s sleep can be difficult during midlife. There are many ways to set yourself up for a better night’s sleep and that can make all the difference when it comes to reducing overwhelm from life and the stress of a changing body. Options for improving sleep hygiene include: reducing screen time before bed, avoiding being too full or overly hungry at bedtime, cutting back on alcohol, avoiding caffeine after lunch, and ensuring a cool, dark, quiet sleeping environment. (If you are a light sleeper, I’ve started sleeping with ear plugs and I highly recommend it!) Calming techniques like deep breathing or meditation can also be helpful. Check out the free Insight Timer app for guided sleep meditations.
5. Talk to your healthcare professional and stay informed about your health.
There are treatments and medications available that can help with managing the symptoms of menopause. Menopausal Hormone Therapy (MHT) – formerly known as hormone replacement therapy (HRT) – is an option and can help reduce symptoms. HRT got a bad rap starting with a large study called the Women’s Health Initiative, but there is more information now to guide therapy. Having open lines of communication with a qualified health professional knowledgeable in women’s health and menopause is key. Also, keeping current on labs can help you stay informed about your health and possible areas that need attention, like bone health and cardiovascular health.
Menopause is a natural part of life and isn’t something to be ashamed of or something to suffer through in isolation. Many women will spend a third or more of their lives in this transitional phase. There are many treatment and symptom management options available. It is vital to keep lines of communication open and share concerns with your health professional. Knowing what to expect and gaining a better understanding around the symptoms of menopause can bring peace of mind and relief and help women to live life more fully through each and every stage and age of life.
This is a great article addressing five very common myths associated with menopause…
For more information and further evidence-based, non-diet reading checkout The Menopause Manifesto by Dr. Jen Gunter. Available wherever books are sold.