Emma Hogan (EH): You’ve done a huge amount of work researching the complexities of menopause and spoken to hundreds of women about their experiences. What do you wish everyone knew about how to negotiate it?
Niki Bezzant (NB): “The first thing is – it’s not a deficiency or disease and there’s nothing scary or taboo about it. Perimenopause and menopause is a normal natural life stage that is experienced by everyone with ovaries (or who has had ovaries). And it’s not forever, we do come out the other side.
I’ve learned that many women tend to suffer in silence, feeling isolated and like they were the only ones struggling with the changes, which is really surprising and sad. While no one has the same experiences of menopause, there are many things in common, and we can share a lot to help others.”
EH: How can exercise transform your menopause experience?
NB: “Throughout my research, exercise came up again and again as being beneficial for dealing with many of the symptoms of perimenopause and menopause. Firstly, exercise is beneficial for your mental health. It’s a great mood booster and there’s good research showing how it can help alleviate things like anxiety and depression, which can regularly crop up in mid-life and in perimenopause. Exercise is also a good sleep booster, and sleep is so very important. If you’re not sleeping – which happens a lot to women during this time of their life – it can really be a downward spiral that makes everything worse. And exercise is really good for helping to alleviate hot flushes; there’s evidence showing how more active women have fewer and less severe hot flushes.”
EH: Exercise also helps manage your muscle mass. Why is this so important?
NB: “There’s a strong hormonal link between estrogen and muscle mass. Estrogen helps protect our muscles and keep them strong. As estrogen drops over the transition, we tend to lose muscle mass, and we lose it at a faster rate than men do. It’s really important for us to do strength training at this time and keep it up as we age. Strength training is what we need to maintain muscle mass, and that does lots of good things. It protects our bones and joints, and it helps us to maintain lean body mass and manage weight.”
EH: On top of strength training, what other types of exercise will help through perimenopause and menopause?
NB: “A mix is important. Doing activities to get your heart rate up is good, doing strength training is good, and then doing some more relaxing activities is good as well. It’s also the perfect time to get into the habit of doing a bit of balance and stability-based movement – because if we don't train things like balance, we tend to lose it as we age.”
EH: Let’s talk weight gain during menopause …
NB: “A bit of weight gain and weight redistribution is common during menopause. Weight gain is not necessarily caused by menopause, but weight redistribution (where we get more fat around the mid-section) is driven by our changing hormones. To a certain degree it can’t be avoided, but keeping your muscle mass up as much as possible can help manage it.”
EH: Googling ‘menopause’ you find plenty of quick-fix weight-loss diets. What’s your advice to women keen to embark on new dieting regimes during menopause?
NB: “There are lots of diets marketed at women in menopause, and I think we need to be wary of these. While in some cases weight loss may be good for your health, dieting can be quite stressful and we don’t want to be stressing ourselves unnecessarily, because there’s an association between stress and worse menopause symptoms.
Instead, we can use perimenopause and menopause as a window of opportunity to establish great health habits that help us to be healthy and vibrant as we get older. We’ve got 30-50 percent of our lives left after this transition, so it’s really important to take action to start some really good habits that will leave us feeling great for that second half of our lives.
It’s all about quality food over quantity. Keep an eye on your portions, prioritize whole foods, eat healthy vegetables and plants … all of the things that we know, but tend to forget. It's an important time to make sure we get good quality protein (because it helps with our muscles). You don’t have to go crazy with shakes and bars and stuff, just eat plenty of healthy, protein-rich foods. And fiber is also really important for us women as we get older, particularly for our gut health. And if you’re prioritizing fiber then you’ll naturally be eating lots of plants, so that’s a win-win.”
EH: What should you cut from your diet during menopause?
NB: “Alcohol is not our friend during this time of our life (or at any time really). As we age, we lose the ability to metabolize alcohol, and it’s also thought that declining estrogen contributes to this too. This means alcohol affects us much more severely and we have worse hangovers (I have personal experience of this and have now become a very moderate drinker because alcohol just doesn't agree with me). Alcohol also exacerbates all those symptoms of menopause. It’s bad for sleep, it’s bad for hot flushes, it’s bad for your mental health. With this in mind, reducing your alcohol intake really is a good thing to try. Cutting back on caffeine and reducing sugar is also a wise move. And cutting out ultra- and highly-processed foods is a no-brainer.”
EH: Research shows physical activity is a great treatment. But it's not the only option. In your book, you talk about how HRT is not as scary as we once thought.
NB: “Exercise can help remarkably, but it won’t cure everything. If you’re struggling with severe symptoms and it’s interfering with your quality of life then that’s the time to seek professional help. In the past, many doctors were reluctant to prescribe HRT, saying it's bad for you, but such thinking is not based on the most up-to-date information. Many women I’ve spoken to say HRT has been life-changing. It’s shown to be a really useful treatment for a lot of things – especially the hot flushes, mood disturbances, and vulva and vagina discomfort.
And listening to your body is so important. Not all issues can be pinned on perimenopause or menopause, so don’t skip straight to assuming any weird changes are down to menopause. Anything weird, get it checked!”
EH: What should women in their 20s, 30s, 40s do to prepare for menopause?
NB: “I don’t want future generations to be like my generation – I’m Gen X and we’re just reaching menopause without a clue about what to expect. For Millennials and younger, now’s your opportunity to learn about it. I truly believe that knowledge is power and if you know what to expect, you feel more empowered.
Whatever your age, I encourage you to take action to really look after your health now. My impression is, the healthier you are going into menopause, in most cases the better the experience you’re going to have. When you are already eating well, have a good exercise habit, are looking after your mental health, not getting too stressed, sleeping well, and not drinking too much … then when things start to go wonky during menopause you’re going to be able to cope better.”
EH: And it’s not just women who need to be taking action?
NB: “Yes, it’s not just a women thing. Everyone needs to understand perimenopause and menopause. I’d love to see more people in the fitness industry on top of the latest insights too. I know it’s often not easy for a mid-life woman to open up to a young male trainer and say: ‘Hey, I’m a perimenopausal woman and I need you to understand what my body can do and what it can’t do’. We may need a bit of extra care, attention, and tailoring of things so that we can perform to our best – and enjoy our exercise. So it would be great for people of all ages and genders to have an understanding of this stage of life.”
You can learn more by reading Niki’s book This Changes Everything: the honest guide to menopause and perimenopause.
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Niki Bezzant is a multi-award-winning writer, speaker, thinker and commentator. Specializing in health, wellness and nutrition, Niki has built a reputation for translating complex science into simple, accessible messages everyone can understand.