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The Menopausal Transition

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My lifestyle hasn't changed that much, but my body sure has. 

The menopausal transition represents a significant physiological milestone in a woman's life, marked by the cessation of ovarian function and a decline in estrogen and progesterone levels. It encompasses the perimenopause years, often the time of highest symptom burden starting in a woman's mid to late 40's, and the final menstrual period, which heralds the post menopause phase.

 

This hormonal shift has profound implications for musculoskeletal health, particularly concerning muscle mass, bone mineral density, as well as cardiovascular risk factors (BP, lipid profile, insulin sensitivity), aerobic fitness level and body fat distribution. Despite no major changes to lifestyle during this transition period (diet, exercise), many women describe a noticeable decrease in muscle mass and strength, in addition to an increased waist circumference. Many feel they can't physically recover from stressors as easily, especially intense exercise, and feel achey and sore all over, with niggles in the hips, shoulders and feet. 

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Fitness

​​Muscle Mass Decline: research indicates that women may lose up to 1-2% of muscle mass annually post-menopause without intervention. Resistance training has been shown to be highly effective at preserving, and even increasing, lean muscle mass, particularly when focused on heavy lifting. 

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Bone Mineral Density: BMD can decline by approximately 2-5% per year post-menopause, particularly in the first 8 years post menopause, increasing fracture risk. Weight-bearing and resistance exercises are proven to slow this decline by stimulating bone remodeling and improving structural strength.

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Body Composition Shifts: many women experience changes in body composition, including a loss of muscle mass and central weight gain, due to hormonal changes, particularly reductions in estrogen. Targeted strength training and high-intensity interval training (HIIT) can enhance metabolic health..

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Traditional strategies, such as significant calorie restriction and large amounts of low-moderate intensity cardio are insufficient to address the unique physiological needs of menopausal women. They will work against your physiology. ​We know that movement programmes should incorporate moderate-to-high intensity resistance training, but at the correct dose. A weekly - monthly periodised approach is best to ensure optimal musculoskeletal adaptation and reduce the risk of tendinopathies. The careful addition of sprint interval and high intensity interval training is recommended, alongside moderate intensity cardio. 

 

Your movement programme must work in tandem with your lifestyle and preferences.  Factors such as symptoms, resources, responsibilities (work, children, elderly parents), nutrition (e.g., protein timing and amount etc), stress management, and sufficient sleep, need to be considered.

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By adopting evidence-based exercise routines, you can thrive through the menopausal transition and beyond. These routines not only mitigate physical risks but also improve mental health, sleep quality, and overall energy levels, empowering you to do what's important.

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