World Menopause day

This time last year few of us gave much thought to that stage in every woman’s life called menopause. Unless of course, you are one of the many women currently experiencing its joys! We can thank some hard-working medical professionals, advocate groups, women and certain media personnel (Joe Duffy and Davina McCall take a bow) for bringing this, often taboo subject, to the wider public’s attention.

Menopause is defined as one year and one day following a woman’s last period. The average age of onset of menopause is 51 but this varies with individuals, and in the years leading up to menopause the transition time of peri-menopause occurs. Some women can go into menopause before the age of 45 and this is referred to as early menopause, whilst some others can go into menopause even earlier, and if this occurs before the age of 40 it is referred to as Premature Ovarian Insufficiency (POI).

So, what actually occurs in menopause, what is it all about? In essence the female hormones, mainly oestrogen, but also including progesterone and testosterone, fall off a cliff as the ovaries stops producing the quantities that would have been present since the onset of periods as a teenager.

The symptoms of menopause are vast and affect women differently. A very lucky 20% of women will report no symptoms but most do suffer symptoms, with about 20-30% reporting severe debilitating symptoms. The most commonly reported and classic symptoms are hot flushes, night sweats and insomnia. Many women blame their lack of sleep for the following symptoms of brain fog, inability to concentrate, poor memory, anxiety, headaches and a flat low mood. Whereas in fact, these actually occur as a direct effect of the drop in hormones also. Other effects that are not as quickly attributed to menopause but are due to the drop in hormone levels are joint pain, muscle aches, and genito-urinary symptoms, including urinary leaking, a sensation of heaviness or prolapse and vaginal dryness. Those are the in-the-moment menopause symptoms.

There are also longer-term effects of having low hormone levels and these include weight gain, increased heart disease and osteosarcopenia.

Many of us are aware that osteoporosis is a loss of bone density or weakening of the bones, but few people are familiar with the term sarcopenia. Sarcopenia refers to the loss of muscle strength and mass. Bone health is determined by the health of both our bones and muscles and the focus of this year’s World Menopause Day is bone health – including this new emerging concept of osteosarcopenia. Osteoporosis is a global health problem, contributing to 8.9 million fractures per year worldwide. Those identified with osteosarcopenia have higher rates of dependency following a fracture and a far higher risk of re-fracture and mortality due to fracture.

Unfortunately, most people are only diagnosed with osteoporosis after they suffer a “fragility fracture” – a fracture of low force, from no higher than a standing height, and that should ordinarily not result in a fracture. At this point the osteoporosis, and morbidity associated with it, is established. Management can certainly improve bone health with medication and lifestyle changes, but must be maintained for life.

It is now appreciated that the key to optimizing bone health is reinforcing the importance of avoiding fractures, through identifying those most at risk; and implementing strategies to prevent fracture. Some of the known risk factors for the development of osteoporosis and sarcopenia include menopause, in particular early menopause and a sedentary lifestyle. At the time of menopause women lose approximately 2% of bone each year, with the fastest rate of bone loss in the year before and 2 years after the last period.

To improve bone health The Royal Osteoporosis Society in the UK guidelines 2018 recommend:

• Impact exercise – at least 50 moderate impacts daily, this includes skipping, jogging, dancing etc.

• Reduce time spent sitting and address any postural issues.

• Strength training – at least 2-3 sessions of 20-30 minutes per week.

• Flexibility training – yoga or pilates to improve balance, coordination and flexibility and reduce this risk of falling.

It can be overwhelming to start a type of exercise that you have no previous experience of, such as strengthening exercises. In PMC Physiotherapy we provide a thorough individualised assessment and introduce you to a safe bespoke exercise programme that will address cardiovascular fitness, strengthening, posture and balance and flexibility. We also provide in-person and online pilates classes.

Here in PMC Physiotherapy, we also recognise that there are many barriers for women during Menopause, which make it difficult to embark on the recommended exercise and lifestyle changes. Many of these barriers include the Genitourinary symptoms of Menopause. Over 50% of Menopausal women suffer urinary leakage and at least 50% of women over the age of 50, that have had a baby, have prolapse. Our Specialist Pelvic Health Physiotherapist Caitriona helps to address and manage these conditions to allow women achieve their exercise goals.