From night sweats and fatigue to dry skin and hair, women experience a variety of symptoms during menopause that might come as expected or as a total surprise. We sat down with Vhi Clinical Lead for Women’s Health, Dr Fiona Belton, to ask questions about the changes women can expect during menopause and how they can prepare their bodies both physically and mentally.

Menopause is thankfully less stigmatised than it once was, with more resources and education available for women than ever before. When it comes to symptoms of menopause, there are the ones we’re all familiar with: hot flushes, sleep disruption, fatigue, and low mood. But there are a variety of other possible symptoms, some that Dr Belton says women expect and some they didn’t realise were menopause symptoms at all.

What are the changes women don’t always expect during menopause?  

Skin, hair, and nails might be affected during menopause, becoming drier and thinner than before. Dr Belton also describes a change that’s discussed less; the sense of aging. With menopause comes fatigue and feeling less energised, and this shift in energy levels can be difficult for some women to adjust to, making them more acutely aware of getting older. Another symptom of menopause that Dr Belton finds lots of women don’t expect is vaginal dryness. Vaginal dryness can make intercourse painful and impact libido (sex drive), which is a lesser-known side effect. Treatment with vaginal oestrogen (also called local oestrogen) can help with vaginal dryness, so make sure to speak to your healthcare provider if you’re dealing with it.

Urinary tract complications such as incontinence (the unintentional passing of urine) or the sensation of needing to pass urine more frequently are also possible and spoken about less when it comes to menopause. They are caused by the drop in oestrogen (a female hormone that plays an important role in many functions of a woman’s body) experienced during menopause. The decrease in oestrogen can cause some women’s vaginal walls and urethra (the tube that women urinate through) lining to thin. Again, treatment with vaginal oestrogen can help with this so it’s best to speak to our healthcare provider if you are experiencing symptoms.

Does menopause really cause weight gain? 

There are a couple of things at play when it comes to menopause weight gain. Dr Belton explains that as we age, muscle mass can decrease for both women and men; but the drop in oestrogen that occurs in menopause can also cause a decrease in muscle mass. Muscle mass is linked to our metabolism ― metabolism is how our bodies turn food into energy/burn calories, and a higher amount of muscle is linked to a higher metabolism. If someone loses muscle mass and sees a slowing of their metabolism off the back of this, they may find they gain weight easier than they used to.

In addition to this, many women will see their weight distribution change during menopause. Instead of carrying weight on their hips and thighs, they might start to carry weight around their tummy or waist. This is because the distribution of fatty tissue changes to a more central pattern on the body during menopause.

These changes in weight and muscle mass are common and can be expected during menopause. It’s important to remember this is normal, and generally, healthy behaviours like regular exercise, a balanced diet and sufficient sleep will help manage potential weight and muscle mass changes and positively impact your overall wellness.

How can women prepare physically for menopause?

If you have good physical health, you will want to try to maintain this as best you can. If you feel that your physical health could improve, you can take lots of steps to do so, both before and during menopause. To achieve this, Dr Belton shares the basics to address:

• Regular exercise. 150 minutes of moderate exercise per week is recommended for adults aged 18-64. Ideally, this will be a blend of aerobic exercise and muscle strengthening exercises that increase your heart rate and cause you to break a sweat. Find a routine and intensity that works best for you and your lifestyle.
• A healthy diet. Dr Belton recommends a Mediterranean-style diet rich in plant-based foods, vegetables, fruit, beans, pulses, seeds, fish, healthy fats such as olive oil, lean meat (1-2 times per week), and red meat (1-2 times per month). Try to minimise your intake of processed foods.
• Sufficient sleep. 7-9 hours per night is enough for most people to feel refreshed the next day.
• Maintaining a weight that is healthy for you.
• Have your blood pressure and cholesterol checked.
• If you had diabetes during pregnancy you are at an increased risk of developing diabetes in mid-to-late life, so it’s important to be checked regularly for this.
• Ensure your cervical smear is up to date.
• Inform your GP if there’s a history of breast cancer in your family so that you can discuss screening with them.

How can women prepare emotionally for menopause?

Equally as important as maintaining good physical health is maintaining strong mental health. One of the best ways we can maintain good mental health, according to Dr Belton, is to manage stress. This can be difficult, as the age at which the menopause transition occurs can be a time of high stress and change in life; children are growing older and perhaps starting secondary school or college; our own parents are becoming more elderly and could require some care; or we might be transitioning into a more senior role at work. It is a time of lots of change where women’s needs and health can often be secondary to their other priorities, but it’s important to look after yourself holistically.  

Learning to recognise and manage stress can set women up well for menopause. Good ways to manage stress include:

• Maintaining social connections: seeing friends and family that you enjoy spending time with.
• Spending time on things you enjoy ― having an interest that is just for you.
• Meditation and mindfulness.
• Exercise.
• Yoga.
• Massage.
• Counselling.

How long before menopause is it best to begin preparing your body?

You can’t know exactly when your menopause journey will begin, but you can roughly estimate. It’s often in the mid-to-late 40s, up to the early 50s, that the symptoms of perimenopause start. Dr Belton says there is no hard-and-fast rule for when women should start preparing their bodies for menopause; rather, she feels that reaching middle age is a good time to evaluate our health and lifestyle. It’s important to make efforts that will give you the best quality of life from middle age on. It’s a good idea to take stock of your health regularly, at any age, to safeguard your quality of life for the future.

Can bone density be impacted during menopause? Are there any measures women can take to combat this?

The drop in oestrogen that occurs during menopause can cause a decline in bone mineral density in women. This makes menopause a risk factor for osteopenia, which is the thinning of the bones. To combat this, weight-bearing exercises such as running and walking are a good port of call, as is resistance training (resistance training involves pushing or pulling against the resistance of an object, including your own body weight). It’s also important to get enough calcium, vitamin D, and protein in our diets to support bone health. Sources of calcium include milk, cheese, and other dairy, green leafy vegetables, nuts, tofu, sardines and tinned salmon, bread and anything made with fortified flour. Oily fish, red meat, liver, egg yolks and supplements are good vitamin D sources. Meat, eggs, milk, fish, nuts, cheese, peas, beans and lentils are all sources of protein.

What should women keep in mind when starting menopause?

Something that’s vital for women to keep in mind, according to Dr Belton, is how menopause is a very natural transition that all women go through. While it is natural, that doesn’t make it any easier, and it’s good to acknowledge how difficult it can be and to “cut yourself some slack. Some women can put pressure on themselves to do so much at home, at work, and for others; menopause can make it a bit harder to juggle all those things, so don’t be hard on yourself if it feels more difficult.”

It’s also important to ask for help when you need it, because you don’t have to suffer while going through menopause. Equip yourself with knowledge on what you can do to help with your symptoms; this can feel like a relief in itself. Remember that your healthcare provider can give you options and guidance on finding the best treatment for you.

This content is for information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Always seek advice from your GP or an appropriate medical professional if you have concerns about your health, or before commencing a new healthcare regime. If you believe that you are experiencing a medical emergency call 999 / 112 or seek emergency assistance immediately.

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