Menopause and Exercise Physiology
- Curtis Allderidge
- Mar 26
- 4 min read
We all know someone who's currently going through menopause or are post menopausal whether it be our Mum, Grandma, Sister, Daughter etc.
As a male I had no idea what menopause was until my Mum started experiencing all the symptoms and I noticed how much they were impacting her sleep, weight, mental health, and quality of life.
I have the pleasure of regularly seeing menopausal and post menopausal women here at the clinic and to be honest, they make up a majority of my clientele - it was about time I made up a blog post regarding menopause and explain why exercise is a must for this population!
Menopause: is defined as the definitive cessation of ovarian activity without pathological or physiological cause and is diagnosed after 12 months of amenorrhea (World Health Organisation, WHO).
Menopause is divided into two phases: perimenopause (the period from the first onset of symptoms to the arrival of menopause) and post menopause (up to approx. 64yrs of age).
Menopause begins at around age 50 on average for most females. Its onset can be caused from natural age-related changes or artificially induced as a result of surgery (hysterectomy or oophorectomy), or as a side effect of treatment for cancers.
Common symptoms include:
Hot Flushes
Night Sweats
Insomnia
Fatigue
Arthralgia
Musculoskeletal Pain
Anxiety
Depression
Weight Gain
Altered Mood
Brain fog
Symptoms can range from very mild to severe but they often interfere with a woman's quality of life. The most common form of treatment is hormone replacement therapy (HRT) which is generally considered a safe and effective approach but there is evidence suggesting that in can increase the risk of having a stroke and developing breast cancer, especially in those aged >70yrs. (1)
Essentially what happens is the ovaries stop producing estorgen and proestrogen but because the female body relies on these hormones for bone mineral density, muscle mass, fat distribution, and metabolic rate, they now all begin to see negative changes.
Why do low estrogen levels cause bone low (lower bone mineral density)?
Increased bone breakdown: estrogen is responsible for triggering apoptosis (cell death) in osteoclasts (cells that break down bone). without enough estrogen, osteoclasts have a longer lifespan and break down more bone tissue.
Decreased bone formation: estrogen stimulates osteoblasts (cells that build bone). when estrogen levels are lower, less osteoblasts are active.
This causes an imbalance in what we call "bone turnover" so more bone is being broken down than built effecting the body's ability to maintain calcium within the bones (bone mineral density).
Why does low estrogen cause muscle atrophy (sarcopenia)?
Estrogen plays a key role in muscle protein synthesis in females (in males its testosterone), which we class as an anabolic hormone (building hormone). When estrogen is low, the body's ability to maintain muscle is significantly effected and muscle degradation is greater than synthesis.
Why do lower estrogen levels cause weight gain?
Estrogen influences metabolic rate; less estrogen equals less calories burned.
less muscle mass due to lower estrogen; less muscle quals less calories burned.
fat distribution changes; rather than storing it on hips/thighs the body will begin to store more fat around the midsection.
This results in an increase in insulin resistance, reduction in insulin sensitivity, and increased weight gain = metabolic syndrome.
This is where exercise comes into play!
Exercise makes for a great supplementary treatment and in some cases even an alternative to HRT, particularly for those unable to use HRT. Exercise regulates the endocrine system (hormones) including estrogen levels, improved cardiovascular health, reduced cholesterol levels, and decreased central adiposity - all of which counteract the effects of the decline in ovarian function. (2)
Not only can exercise make a substantial difference, modifying dietary intake can also play a crucial role in improving symptoms associated with menopause.
Exercise is known to assist and relieve symptoms of:
Irritability
Sleep quality
Fatigue
Hot Flushes
Insomnia
Arthralgia
Headaches
Anxiety
Depression
Brain Fog
Staying active and preforming a regular exercise program a not only assists with the symptoms mentioned above but exercise is proven to increase and/or maintain bone mineral density, decrease cardiovascular risk factors, maintain a healthy bodyweight, increase muscle mass and strength, improved quality of life...the list is endless!
Exercise Prescription:
A target of 150-minutes per week of moderate intensity aerobic exercise, or 75-minutes of vigorous exercise, and 2 non-consecutive days of resistance training per week is recommended and are the weekly minimum requirements for adults.
Pelvic floor strengthening (for urinary incontinence or pelvic organ prolapse), balance, impact, and power exercises should be included in an exercise program for women going through menopause or are post menopausal.
A great exercise fact sheet for those interested: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://exerciseismedicine.org.au/wp-content/uploads/2022/02/EIM-FactSheet_Menopause_Prof-2022.pdf
References:
Rozenberg S, Vandromme J, Antoine C. Postmenopausal hormone therapy: risks and benefits. Nat Rev Endocrinol. 2013 Apr;9(4):216-27. doi: 10.1038/nrendo.2013.17. Epub 2013 Feb 19. PMID: 23419265.
Philip AE, Singh H, Nanjundiah SY, Samudrala PC, Theunissen W, Robinson J, Banerjee I. Impact of Exercise on Perimenopausal Syndrome: A Systematic Review of Randomized Controlled Trials. Cureus. 2025 Mar 19;17(3):e80862. doi: 10.7759/cureus.80862. PMID: 40255746; PMCID: PMC12008710.
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