Is What You Believe About Menopause True?
Yoga Therapist, Lindsey Brown, writing for The Minded Institute, debunks the most common myths associated with Menopause, and gives her experience and advice on the best therapeutic yoga tools to help with menopausal symptoms. As with most things, menopause has had its fair share of old wives’ tales and hushed voices behind closed doors whispering misinformation about this (not so anymore) taboo subject. Partly to blame may be the fact that, up until recently, most women weren’t encouraged to have open and honest discussions about their experiences. Most women were told to ‘just get on with it’, made to feel inadequate because they weren’t coping well, felt shame because their work performance had taken a downward spiral, didn’t understand why their cognition was not on point and productivity was low, or experienced anxiety about the very visceral sensation of hot flashes. This lack of awareness and recognition has a long history, and due to an absence of menopause education many women have felt disconnected from their bodies and minds, struggled with self-worth and lacked the knowledge of how to mitigate their symptoms to enable a better quality of life.
Luckily we are experiencing a clear shift based on an increase in research and perhaps, most importantly, anecdotal evidence. Every woman is different. Every voice and experience needs to be heard and learned from, and equally, this demonstrates that a blanket approach does not work. So yes, many women will still experience challenges as they navigate menopause, but education is knowledge and knowledge fosters self-empowerment helping to make, what can be a challenging experience, more manageable.
What We Now Know About Menopause:
There is a lot of misinformation about menopause. In line with Menopause Awareness Month and World Menopause Day on the 18th of October, we dive into science-backed research to debunk some of the ‘common myths’:
Myth: Menopause starts at 50.
The average age (as a guide only) is 51 but many women experience symptoms from their mid-40s and even earlier . 40-45 is considered early menopause and is experienced by 5% of women, and 1% of women under 40 go through premature menopause due to POI (premature ovarian insufficiency)(1). Women may experience early menopause due to surgical menopause, a hysterectomy, treatment for cancer, family history of early menopause, health conditions such as autoimmune diseases and chronic fatigue syndrome and sometimes there is no cause.
And, what does starting menopause even mean? You are officially in menopause once your periods have stopped consecutively for 12 months and then you are in postmenopause. Perimenopause is the stage before your menstrual cycle ends during which ovaries begin to slow down the production of sex hormones (oestrogen and progesterone) and eventually stop releasing eggs. These hormones do not decline at the same speed, they fluctuate and sometimes you may be oestrogen dominant and other times progesterone dominant. The process is non-linear with some women experiencing symptoms for a few years and others for over a decade with around 10% of women experiencing long-term symptoms.
2. Myth: You should expect weak and brittle bones.
Yes, there is a higher risk of osteoporosis because oestrogen does offer a protective element to our bones, however, this is not definitive or insurmountable and there are other elements to consider. As women, our peak bone mass is reached around age 30 and then it simply begins to break down more than build up. According to Dr Susan Brown, a bone specialist, the average woman loses 10% of bone mass during the menopause transition, specifically during the year before periods stop altogether and for 2 years after. Therefore, it is especially prudent to look after your bones during these 3 years. The good news? Most women can manage this bone loss just fine without deleterious consequences, however, some women experience a greater degree of bone loss of up to 20% (2).
What are the risk factors and how can we prevent bone loss from worsening?
Modifiable risk factors are poor diet, stress, smoking, medication and lack of exercise, and non-modifiable ones are family history, however, there are still steps you can take to support bone health. Ask your GP for a Dexa (bone density) scan if there is a family history of broken bones, especially a hip fracture.
We can reduce the risk of osteoporosis through better nutrition, exercise (yoga, weight training, resistance training, dancing, walking), reducing stress in our lives, quitting smoking and avoiding excessive alcohol consumption (3). If you are on medication it may be worth checking with your GP if any side effects affect bone health.
3. Myth: Onset of forgetfulness in menopause is a sign of early dementia
Do not fear! You are not going mad. As my Grandma used to say who died at 102, ‘If you don’t use it, you lose it’. More on this later but for now, let’s understand why we may feel forgetful, foggy and struggle with recall as part of the transition.
Oestrogen offers many protective elements for our brain and body which, aside from bone health, include memory and cognition. We have oestrogen receptors in neurons and other cells that play a role in learning, memory, cognitive functions (planning, executing, reasoning), emotion and homeostatic regulation (blood pressure, heart rate and hormones amongst others). During menopause, these receptors become deprived of oestrogen and therefore are unable to conduct their various roles efficiently. Further research is still required to fully understand the effect of oestrogen on the brain but it is clear that it influences cognitive function.
The good news? Studies show that our learning ability and memory improve at postmenopause stage (4)! This is the antithesis of what was thought! On the other hand, it is important to note that stress hormones (specifically cortisol) impact memory and affect brain function; this is a really key area to focus on when considering how to mitigate menopausal symptoms.
4. Myth: Weight gain is inevitable
No, however, it is important to acknowledge that changes will happen as your body adapts to the changes in hormones. Oestrogen helps to regulate our metabolism and insulin levels so when it declines our metabolism slows down (as it does anyway with age) and we risk higher levels of blood glucose which means we may see a redistribution of fat around our middle (visceral fat). This is nature’s way of trying to store more oestrogen because some of it is produced in adipose (fat) tissue.
Although these changes are taking place we can make lifestyle changes to support any weight gain we may experience. This is a good time to consider:
Nutrition (there is a lot of guidance out there)
Exercise choices (ideally something you enjoy so it isn’t a chore)
Stress reduction (stress is a major risk for weight gain)
Sleep due to its relationship with two appetite-regulating hormones but I appreciate this comes with a caveat - how can you achieve good sleep which is often affected during menopause? (5). More on this below.
5. Myth: The best option for getting through menopause is Hormone Replacement Therapy (HRT)
This is a personal choice, naturally, but it may also depend on whether you are in a high risk category, i.e. if you have experienced hormone-related cancer such as breast cancer you may find your GP does not recommend HRT as it may increase the risk of it returning.
Whether you decide to pursue the HRT route or not, there is much you can do to support your overall wellbeing! Bar the usual suggestions of a healthy diet, regular exercise, stress reduction, avoiding smoking and excessive alcohol consumption, other things to consider are ‘tend and befriend’ aka spending time with others for connection and support, supplements and herbal solutions if you prefer the natural route, and spending time building a deeper connection to your body and mind, which is where Yoga Therapy comes in.
The Role of Yoga Therapy in Menopause
Yoga therapy (YT) is a person-centered approach offering a cohesive system of breathwork, mindfulness practices and yoga postures to enable women to build a toolbox of practices to support their wellbeing, develop their ability to self-regulate and nurture the relationship between their mind and body. The benefits of these practices are explained below.
How Therapeutic Yoga Practices contribute to helping Menopausal symptoms
Menopause can be an incredibly stressful time, concomitant with other midlife challenges. Much of what Yoga Therapy offers is focused on stress reduction and therefore reducing the risks associated with it. For example, practices such as focussing on and controlling the breath in specific ways, builds a resilient nervous system by positively affecting physiology such as heart rate, blood pressure and stress hormone release. Other benefits of therapeutic yoga include reducing inflammation (which oestrogen helps regulate), mitigate the risk of cardiovascular disease which is associated with menopause and improves immune system functioning which is impaired through chronic stress.
Movement and mindfulness practices develop proprioceptive and interoceptive awareness leading to a more embodied sense of self. This is important for women who feel withdrawn, lack confidence, are uncomfortable in their own skin and often don't feel like themselves at all. Paying attention to how their body moves and breathes can improve feelings of confidence and self-worth.
Mindfulness also focuses on barebones, present-moment experience, encouraging women to observe symptoms objectively vs subjectively. This helps to build emotional resilience by cultivating the ability to notice when sensations become overwhelming without dropping into habitual reactive states, e.g. reducing the intensity of the response to uncomfortable sensations such as hot flashes.
Building physical strength through yoga postures can be beneficial for reducing the risk of osteoporosis, preventing excess weight gain, and staving off increased cholesterol levels and type 2 diabetes. Restorative yoga, meditation and slow breathing initiate parasympathetic arousal which may soothe aches and pains, reduce inflammation, improve sleep quality, and reduce excess release of stress hormones. Another important aspect of movement and brain function is to challenge the brain by taking the body through different movements, balancing postures and transitions that require focus and attention.
In fact, all of the above helps to strengthen structures in the brain linked to emotional regulation, memory and learning, and facilitate neuroplasticity. Neuronal pathways weaken if they are not being subjected to new learning experiences necessary to temper cognitive and neurodegenerative decline, therefore it is crucial for the brain to learn new skills.
As a Yoga Therapist, I have seen these practices transform my patients time and time again.
By Lindsey Brown
Yoga Therapist
www.liveyogatherapy.com
References:
Keep an eye out in 2024 for a Yoga Therapy and Menopause course from Lindsey. If you are a Yoga Teacher or Health Professional and would like to explore a journey into becoming a yoga therapist, you can find out more here. To find a Yoga Therapist in your area, see our directory here.