Eight exercise and diet changes every menopausal woman should make
As debate still rages over HRT, many women are looking for complementary solutions to hormone therapy or alternatives if they can’t take it for medical reasons. Alice Smellie, health expert and co-founder of Menopause Mandate, is one such woman – and has spent the last six months looking at what exercise and diet changes work best for in midlife
For me, yesterday’s walk in a London park with the campaign group Menopause Mandate, alongside chair Mariella Frostrup and supporters Penny Lancaster, Robinson and Cherry Healey, was very poignant. This time last year, I was in the throes of breast cancer treatment and could barely stand, never mind walking in the autumn sunshine.
After campaigning on behalf of women going through the menopause, in March this year, I had to give up my HRT because it wasn’t compatible with my cancer diagnosis. The idea of being without what had essentially become a life-saver for five years filled me with dread. I was 46 years old when I first started displaying symptoms of the perimenopause, which quickly became overwhelming.
I felt constantly stressed and anxious and suffered from terrible insomnia – waking up at 3am, tossing and turning unable to go back to sleep. The smallest thing could trigger a crisis, from taking the kids to school to a work deadline. After being prescribed HRT, within a week I had returned entirely to my old self and I have been happily on it for the past five years.
So to be told that I would now have to cope with more of a “lifestyle” prescription of diet and exercise to stop my symptoms sent me into a panic. As a health writer and the author of two books about menopause, I was aware of how diet and exercise were vital at this time of life, but to understand that this was all I was now going to have to rely on felt very scary.
Determined not to go back to how I had been feeling in my mid-forties, I promised myself I would do everything I could to stave off short- and long-term effects of no oestrogen. Seven months after stopping HRT the effects of lifestyle tweaks on my menopause symptoms have been astounding.
Don’t get me wrong, I am not about to turn into an HRT naysayer. Experts agree that the proven benefits of HRT outweigh the risks for the majority of women and, in a few years, when the risk of my particular cancer recurring is lower, I hope to take it again because I want to benefit from the protection HRT gives you from osteoporosis, which runs in my family.
However, I also agree with experts who say menopause needs to be approached holistically, and that HRT should be seen less as a silver bullet, and more as just one weapon in the armoury against midlife hormone loss. And it comes as no surprise that over 80 per cent of menopausal women are actively seeking complementary solutions to HRT. “If you look after your stress, diet, exercise and sleep, then you're covering most bases,” says Dr Clare Spencer at My Menopause Centre.
Having deliberately focused my lifestyle habits towards menopause relief since March, my body composition has improved, my mind is less stressed, and I feel as though I’m staving off the brain fog. The good news is only 2 per cent of those who answered our Menopause Mandate survey said they do not exercise at all. However, I have discovered that some forms of exercise and diet tweaks work better than others.
This is what I have learnt so far.
Walk it out
The Menopause Mandate survey, whose results were revealed yesterday, showed that 86 per cent of respondents are walking more to help with menopause symptoms. This comes as no surprise to me as walking has become one of the biggest pleasures of my life. I went from five minutes on my indoor treadmill in January, to 10 miles before lunch in the Scottish highlands by late spring.
The benefits of walking read like a mid-life health wish list; stepping out boosts mood, helps maintain a healthy weight, strengthens muscles and bones and alleviates the risk of heart disease and type two diabetes.
Some say that the rhythm of walking is in itself therapeutic as stimulating both the left and right sides of the brain help with emotional processing. In fact, walking and talking, or “outdoor therapy”, as it is called is often called is used to treat anxiety disorders.
“There are three main ways in which menopausal women will benefit from walking,” says Joanna Hall, founder of Walkactive. “It’s a way of reclaiming physical confidence, improving physical shape – losing weight and losing inches around the waist, and it also improves movement quality, without putting strain on joints.”
Her excellent walking technique, the Walkactive Method, involves standing tall, using the entire foot to stride, holding in the tummy (not tensing it) while moving the arms and relaxing the neck.
We used to think that we needed to aim for 10,000 steps a day, but last year a study reduced this to a more achievable 4,000. Even 2,000 steps a day will benefit the heart and blood vessels – oestrogen is cardio-protective, so looking after our cardiovascular system after menopause is vital.
Brush off the flush
Around 80 per cent of us have hot flushes or night sweats and mine came back in full force just a few weeks after stopping HRT.
Hot flushes are down to irregular temperature regulation in the hypothalamus, deep in our brain. But, again, moderate-intensity exercise can help. A 2023 review reported that doing regular exercise after menopause lowers sweat rate and blood flow thresholds, which means that the body becomes better able to cool itself down during a hot flush.
“I’d suggest doing thirty minutes of brisk walking, cycling or swimming, and three to four times a week might be beneficial,” says Kate Rowe-Ham, a personal trainer and author of Fitter, Calmer, Stronger.
Muscle (and bone) bound
The best thing I have done by far is take up strength training, for both muscle and bones. Oestrogen protects bone metabolism; promoting the activity of osteoblast cells which make new bones. We lose bone density in our thirties, but in the first five years postmenopause it can plummet by as much as twenty per cent, which can eventually lead to osteoporosis. Muscle mass is depleting at the same time.
“Weight lifting is the only thing, other than HRT, that can boost bone density post-menopause,” says Rowe-Ham. A study showed that women with postmenopausal osteoporosis who strength-trained twice a week had better bone density than those who didn’t.
And what is good for muscle is good for bones. When you’re exercising you are strengthening muscles, which reduces the risk of falls, and bones react to exercise by building more cells.
“Lifting weights stimulates muscle growth through a process called hypertrophy,” says Rowe-Ham. “Muscle fibres are challenged and they then repair and strengthen.” Strength training also promotes neuroplasticity which, in turn, also helps slow cognitive decline and reduce dementia risk.
You can buy inexpensive weights for home use and try to do a half-hour workout three or four times a week, recommends Rowe-Ham. “Anything is better than nothing,” she adds. There are masses of excellent online classes and apps, I personally love Rowe-Ham’s Owning Your Menopause app.
Cold kick for your metabolism
Weight gain and changing body shape was the top complaint of 76 per cent of women in the Menopause Mandate survey. It’s frustrating, but fat makes oestrogen, so increased fat around your middle is actually your body being clever, storing more fat to try and boost dwindling hormones.
Going cold swimming might help with this. A 2024 UCL study of over a thousand women revealed that this helped with symptoms and boosted metabolism. “Women especially reported a decrease in anxiety, mood swings, low mood and hot flushes,” says lead author Professor Joyce Harper. “We are currently digging deeper into this. I believe it is a cumulative effect of exercising in nature with friends and the calming effects of cold water.”
There is a belief too that cold water increases what’s called brown fat, which burns energy to create heat and help maintain body temperature.
“The important thing is to do it at your own pace,” says Professor Harper. “Breathe deeply, which ensures you get oxygen around your body and keeps your heart rate in check.”
Follow the 30g protein plan
The most reported symptom of menopause in the MM Survey was brain fog – a massive 82 per cent reported this. Other commonly reported symptoms included anxiety, low mood and anxiety.
Having just emerged from chemotherapy, where powerful drugs can affect cognitive function, boosting my protein intake has made an extraordinary difference to my ability to focus throughout the day. The result? A clearer head than I’ve had in years.
“Protein needs to increase in midlife,” says leading nutritionist and creator of the 30g plan, Emma Bardwell. “It fills you up, staves off cravings, helps build muscle and is vital in weight management and blood glucose regulation.”
There is excellent evidence for the benefits of mind-body exercises such as yoga and Pilates, and I do both at least once a week. A 2024 meta-analysis concluded that they help sleep quality and mood amongst menopausal women.
“Yoga regulates your nervous system and decreases the stress hormones cortisol and adrenalin,” says creator of Menopause Yoga, Petra Coveney. Yoga is also associated with increasing the neurotransmitter GABA, which is calming and helps to promote sleep.
The three-minute rule
You don’t have to commit to hours of sweaty workout to get the benefits.
“Any amount of exercise in peri and menopause is good, and trials have show that little and often can be more effective than long workouts that we simply can't fit into our busy lives,” says Lavina Mehta, MBE, who coined the phrase “exercise snacking” and is the author of The Feel Good Fix which is packed with micro-workouts.
“You can do an exercise snack at any time; squats whilst the kettle is boiling, press-ups on the countertop or a minute of star jumps.” She says that three minutes every half hour helps with blood sugar control; menopause is a time when we are more susceptible to developing type 2 diabetes.
“Even a simple self-care stretch at the end of the day can help to alleviate stress and anxiety.”
Do your calcium maths
This is also a time to take a look at your diet; reduce sugar and ultra-processed food and boost your calcium intake.
“UK guidelines recommend 1200mg of calcium a day for women over 50,” says Bardwell. “Aim for three portions of calcium-rich foods a day, such as dairy, fortified plant milks, broccoli and leafy green veg.”
Bardwell says that almost all of us are deficient in fibre. “This is needed for digestion but also to feed gut microbes, which in turn create compounds that benefit hormones, mood, cognition, immunity and even skin health.”
According to experts at ZOE, a health and science company, the gut microbiome changes during menopause. They suggest that estrogen and progesterone boost gut bacteria diversity by feeding them. So low levels of these hormones could result in less diverse bacteria.
“Forget boring, bland bran,” says Bardwell. “Focus instead on plants, fruit and veg but also nuts, seeds, chickpeas, beans and lentils.” She also recommends getting iron levels checked, especially if you’re experiencing heavy or more frequent periods.
The latest advice for good gut health is to eat 30 different types of fruit and veg a week. “This sounds like a lot, but it includes nuts, seeds, legumes and herbs and spices,” says Bardwell. She says to aim for vibrant-coloured spices that pack plenty of flavour.
Studies suggest turmeric is good for inflammation, paprika can help boost bone health and cinnamon helps with blood sugar regulation.
Supplement yourself
I am cautious about supplements post-cancer, and take very few these days. However, around 50 per cent of us are said to be deficient in vitamin D, and this is essential for immunity and for bone health, especially as we age.
The government now recommends people in the UK take 10mcg a day during autumn and winter. I also take omega-three and glucosamine (both from Holland and Barrett), which were recommended for the stiff joints I’ve developed since stopping HRT, and they’ve helped a great deal.
Magnesium also supports better sleep – it’s said to relax muscles and increase the sleep hormone melatonin. HRT helped so much with my insomnia, and it was the one thing I was most scared about coming back. I still have sleepless nights - who doesn’t? But, magnesium has been a game-changer.
You can find out more about Menopause Mandate here
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