Prepare for Menopause Like A Marathon: Your Body Will Thank You

menopausal woman finishing a marathon

Menopause is a marathon, not a sprint. You have the opportunity to enhance your health and well-being for the rest of your life. And, just like the 26-mile run, preparation for the “Menopause Marathon” is key to reaching the finish line. Focus on your body, mind, and spirit so you can prepare for menopause and feel your best during this natural stage of life.

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    Preparing for menopause

    Like running, it’s never too early to start training for the menopause marathon. For most women, the journey begins in their early 40’s, during the stage of perimenopause.
     
    In its entirety, the transition can last ten years or even longer.
     
    Symptoms may start early for some due to health events like cancer treatment, ovarian failure, or oophorectomy (surgical removal of the ovaries).
     
    Factors like race/ethnicity, culture, lifestyle, eating habits, geographic location, and socioeconomic status can affect your experience and the age of onset of symptoms.
     
    Heredity can also come into play, as it is common for women+ to have an experience similar to their mothers. 
     
    There is no way to know for sure which menopause symptoms you’ll experience and how long your symptoms will last. Who knows? You may be one of the small percentage of women+ for whom menopause is a non-event. 
     
    You can make (or maintain) lifestyle changes to increase the likelihood of optimally managing your symptoms. That way, you can control your symptoms rather than have your symptoms control you.
     
    Your future self will thank you for taking action now.
     
    When you train for a marathon, your body begins to know what to expect. You’re not shocked when your leg cramps and you learn how important it is to pace yourself, stay hydrated, and get enough rest.
     
    So, when you go through perimenopause, use that time to take steps that will have an overall positive impact on your health and well-being and also reduce the risk of conditions that become more common as your hormonal balance changes. And by doing so, many women+ find they get a big bonus with fewer and/or less severe and/or less frequent symptoms.
     
    The steps below can help you prepare for the marathon. 
     
    • Understand that menopause journeys are unique.
    • Assess your current lifestyle in areas like eating habits, physical activity, sleep, and stress. Make a conscious commitment to actions that science and research have proven will be of benefit.
    • Mind your mindset.
    • Build and strengthen your support system and friendships.
    • Research treatment options and understand the risks and benefits of hormone therapy compared to non-hormonal options such as integrative modalities like acupuncture.
    • Find a doctor who listens and is interested in helping to support you during this stage in your life. That may not be the PCP or OB-GYN who has always cared for you, as they may not have adequate training in managing menopause. Consider a menopause professional certified by The Menopause Society or a practitioner of integrative medicine who treats with a holistic perspective of the whole person.
    Now, let’s explore each one of these areas so you can take control early. After all, what do you have to lose? Even if you end up suffering greatly from menopause symptoms, you will be in better health – body, mind, and spirit – as you go through the journey to a vibrant living destination.
     
    If you experience bothersome symptoms, you’ll be better positioned to manage common challenges like weight gain, brain fog, insomnia, itchy skin, hot flashes, and night sweats.
     
    Menopause is the perfect time to invest in yourself! What you do today can impact how you feel both today and years from now.

    Menopause journeys are unique

    Menopause is a unique personal journey. The same is true for running. Some people breeze through a marathon while others barely crawl across the finish line.
     
    The Study of Women’s Health Across the Nation (SWAN) is a an ongoing study which has been unfolding over decades and evaluating women in midlife, including the impact of menopause. One finding is that symptoms can vary depending on race and/or ethnicity. The experience of women of color may differ significantly when compared to their white counterparts. They can also be seen between the various races as well as ethnicities within the same race.
     
    For example, hot flashes and night sweats were lowest in white and American women of Japanese and Chinese ethnicity. By contrast, Latinas, Hispanic, and African American women tended to have more hot flashes and night sweats. Global differences are also observed when you look at menopause around the world. 
    In a study in North America and Europe, menopause symptoms were more common in women from the U.S., UK, and Canada than in women living in Sweden and Italy.
    Why the difference? Lifestyle factors like eating habits, physical activity, a culture with a more positive perception of aging, and expectations about menopause.
     
    Factors like socioeconomic status, testosterone levels, preexisting medical conditions, and time of onset of your first period matter too. 
     
    A University of Pittsburgh study found women with less education were more likely to experience symptoms and the risk of symptoms was also greater for those who:
    • drank alcohol moderately or heavily
    • suffered from depression or anxiety
    • were obese
    • were in poor health
    • smoked
    If you’re going into menopause with underlying health conditions like diabetes, heart disease, obesity, high cholesterol, depression or anxiety, managing menopause symptoms may be more difficult. Those conditions may also be exacerbated during the hormonal transition.
     
    Prepare for this normal stage of life to help mitigate the potential negative impacts on your overall health and well-being.
     

    Lifestyle changes that help menopause symptoms

    Research indicates lifestyle choices, e.g., your stress level and eating and exercise habits, as well as tobacco and alcohol use, may contribute to the type of menopause journey you experience.
     
    In a pausitive health survey of women in all stages of menopause, a woman who had an ablation to help with uterine bleeding improved her symptoms by watching the foods she ate.
    “I wish I knew that what I was doing in my own lifestyle was impacting what was going on. I had to be reactive rather than proactive. If people knew about this before they ever get to perimenopause, they might be saving themselves potential problems, as far as the hormone imbalance or like heavy bleeding or hot flashes, and the like. It may not save them. It may decrease them, or it may prevent them altogether,” the woman explained.

    Manage stress

    The menopause journey can be stressful. Contributors include not only the symptoms themselves but also other life events that are common in one’s 40s and 50s, e.g., sandwiched between kids and elderly parents, career advancement efforts, empty nest syndrome, and the self-reflection that can be triggered during midlife.

    Stress can impact the entire body and your emotional health, as well. It can complicate or accentuate the symptoms you may experience.

    For those who may be at greater baseline levels of stress or carry a significant degree of chronic stress, the impact can be significant and literally take years off their lives. For example, studies show the “weathering” effect related to racism seen in Black women leads to earlier and faster aging and a biological age that is 2.6 years older than their chronologic age! In contrast, white women, who are not impacted by racism, have been noted to have a biological age that is 3.5. years younger than their chronological age. The overall impact is a 6.1-year biological age difference between Black and white women!

    And if you are biologically older, the onset of menopause may occur at an earlier chronological age, increasing the number of years of increased risk of conditions like hypertension, heart disease, and diabetes.

    Interestingly, a study produced through a collaboration between The FemAging Project and AARP found Black and Hispanic women had greater concerns about stress than other racial groups.

    Learning to manage your stress and working toward work-life harmony rather a perfect work-life balance are important not just to your menopause journey experience but your overall health and well-being, both now and in the future. Take time to notice when things are headed in the wrong direction, and make adjustments to help you get back on track.

    Practices like mindfulness, guided imagery, and the emotional freedom technique (EFT), also known as tapping, can help ease symptoms.

    In addition to developing coping skills and managing stress, other components of a healthy lifestyle – eating habits, tobacco and alcohol consumption, physical activity (level, type, frequency, and duration), getting enough high-quality sleep, having a network of support and a feeling of community – can all make a huge difference as you move through the menopause journey.

    Healthy eating during menopause

    Although no one diet reduces menopause symptoms the most, research from the Women’s Health Initiative suggests one low in saturated fat and high in fruits, vegetables, and whole grains can lower your chance of experiencing night sweats and hot flashes — symptoms experienced by 75% of women.
     

    For some, caffeine, alcohol, and spices become problematic, serving as a trigger for hot flashes. And there are also foods to avoid to help manage symptoms. 

    Maintaining a healthy weight is important at any time, but even more so during the hormonal transition when weight gain is common. Besides the increased risk of conditions like diabetes, metabolic syndrome, hypertension, and cancer, women+ who are obese have been reported to have more intense/severe and frequent vasomotor symptoms (VSMs) like hot flashes, night sweats, and palpitations. In turn, more challenging VSMs can result in problems with sleep which can lead to fatigue, worsened brain fog, and possibly a potential increased risk of dementia in the future.

    There’s anecdotal evidence from women worldwide demonstrating the impact eating habits can have. You can use some of that healthy eating evidence to improve your journey. 
     
    In China, only 10% of women experience hot flashes; in the United States, 75% of women over 50 do so. Why? Some studies suggest the difference is related to a diet that is more commonly plant-based in Asian countries. 

    Dietary changes can help not only with menopause but the aging process as well. Studies suggest a Mediterranean diet can slow down aging and help protect against chronic conditions, the development of frailty, and premature death.
     
    The Mediterranean diet includes eating lots of vegetables, fruits, beans, lentils, nuts, whole grains, little/no meat and sugar, olive oil and other healthy fats instead of butter, and a moderate intake of fish rick in omega-3 fatty acids.
     
    It has also been shown to reduce the risk of cardiovascular disease in women by 24% in those who are adherent to that pattern of healthy eating habits.
     
    Learn how to make better eating choices based on your individual nutrition profile and health goals and to achieve and maintain a healthy weight in a sustainable way.
     
    This time of life is a great opportunity to explore a variety of eating pattern that can help you use “food as medicine.”
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    Menopause marathon

    Exercise during menopause

    The benefits of physical activity are well established:
    • more sustainable weight management and lower risk of obesity
    • stronger bones and a lower risk of osteoporosis and associated fractures
    • stronger muscles, better balance, and a lower risk of falling
    • greater flexibility
    • greater emotional and mental health and better management of depression, anxiety, and stress
    • better quality sleep and greater energy and focus

    Incorporating physical activity into your life at the levels recommended (up to 150 minutes each week, depending on the intensity) can come in a variety of ways. It’s important to engage in activities you actually enjoy in order to make it easier to stick with it over time.  If you love going to the gym, great. But dancing, paddleball, boxing, golf, gardening, swimming, and walking all count and have different benefits to offer.

    For example, a recent study has shown that yoga can help against the development of frailty as we age. It increases two factors associated with less frailty and increased longevity – walking speed and the ability to rise from a chair.

    Remember to include a combination of exercises – cardio/aerobic, strength training, balance, and flexibility. Studies have also shown that the equivalent of 10,000 steps per day is not needed to reap maximum benefits. The sweet spot seems to be between 6000 and 8000 steps, at which point the positive impact tends to plateau.

    If you have not been active for a while, then you’ll need to gradually increase your activity level over time. And keep in mind, some physical activity is better than no activity. Even 10 minutes a day can make a difference.

    Be sure to check with your healthcare practitioner before embarking on an exercise regimen to identify together what might work, precautions you might need to take, and any areas on which you should focus more than others.

    Healthy eating and adequate physical activity are a powerful combination at any age. As you move through perimenopause, menopause, and beyond, leverage your lifestyle choices to make things easier. Healthy eating and physical activity are also a big part of putting yourself first. There’s no better time than midlife to invest in you!

     

    Pay attention to your sleep

    More and more research points to the importance of getting enough high-quality sleep and the negative consequences when we don’t.

    Besides providing rest for our bodies, sleep helps clear our minds of clutter, seals memory, helps to maintain our cognitive abilities, and reduces the risk of dementia. Studies show it also impacts our longevity. Five factors of quality sleep were shown to make a difference when it comes to helping to prevent premature death.

    The five factors were:

    1. having a sleep duration of seven to eight hours a night
    2. having problems falling asleep no more than two times a week
    3. having problems staying asleep no more than two times a week
    4. not using sleep medications
    5. feeling well rested after waking up at least five days a week

    The research showed that “out of all deaths, 8% could be attributed to poor sleep patterns.” Women who scored well in the five areas had a life expectancy that was 2.4 years longer than those who did not.

    Unfortunately, many of the symptoms women+ experience during the menopause journey can make getting enough high-quality sleep challenging – hot flashes, night sweats, stress, fatigue resulting in less motivation for physical activity, depression and anxiety, and muscle aches and pains. And if you fall into habits like caffeine for energy or to stay awake and alcohol to help go to sleep (temporarily and followed by disruption from awakening later in the night) all can negatively impact your ability to sleep well.

    In turn, poor sleep can make menopausal symptoms worse – hot flashes, irritability, depression, and brain fog.  And sleep issues can lead to weight gain due to hormonal disruptions involving leptin and ghrelin. Leptin signals satiety (feeling full), and poor sleep can lower leptin levels. Ghrelin increases appetite, and sleep issues can increase ghrelin levels.

    Chronic stress can also lead to increased levels of the hormone cortisol, which signals the body to conserve energy and translates into the body holding on to fat.

    There are many steps you can take to help you get enough high-quality sleep:

    • sleep hygiene (e.g., regular bedtime every day, room temp set to 66 degrees, no blue light devices, a bedtime routine to signal the body it’s time to sleep, no large meals/caffeine/alcohol late in the day, no exercise 3 hours before bedtime)
    • binaural beats
    • tryptophan containing foods, e.g., turkey, cheese, milk
    • tea – chamomile, decaf green, lavender, passionflower, valerian
    • tart cherry juice
    • gentle yoga or yoga nidra
    • cognitive behavioral therapy (CBT)

    Make a change for the better with your mindset

    Your mindset can have a significant impact on your menopause journey. 

    As the name “menopause” suggests, you may benefit from hitting the pause button during this natural stage of life. Reflect on who you are and the changes you want to make to improve your health and increase your sense of well-being.

    In our survey of women+ in all stages of life, one woman took advantage of her heightened self-awareness to turn this life change into a positive force.
    “Menopause can be a rebirth or rediscovery of who you are as a woman. It doesn’t have to be an ending but a new beginning for women. Standing up for themselves, coming into themselves, their power, their self-worth. A time of rediscovery,” she explained.

    Her view is one that is commonly seen in some cultures, like the Mayans in Mexico, in Nigeria, Indigenous women in Canada (Maori and Koori), and the Mosuo in China. And the Japanese word for menopause, “konenki,” means a time of renewal and energy.

    In another study, the Yale doctor who led the research found menopausal symptoms were less of an issue in countries where older women are considered wiser and are more highly regarded in general. In countries where phrases like “old age” are attached to the life cycle of women, symptoms were often more pronounced.

    Menopause can also be a time of deep personal reflection.
    “They learn to have a greater awareness of how all the stuff that happened in their lives comes to a head. And they’re doing a reflection on what all that was, and what they won’t put up with in their lives, and what they’ll change and start taking care of themselves and to not worry about taking care of others,” she explained.

    Ways to shift your mindset during menopause

    Taking steps to prepare proactively will help you weather the challenges menopause may throw your way.

    Emotional strength when symptoms start will help you finish the race even stronger. 

    Give yourself a head start in the menopause marathon by taking these steps now:

    1. Life is changing, so avoid comparing your current reality to “how I used to be.”

    2. Recognize your journey is unique and be open to the possibility you may emerge healthier, happier, energized, and more confident and content with the road ahead.

    3. Think beyond traditional medicine, even if you’ve never considered alternative options. Now is a great time to broaden your horizons and explore non-hormonal techniques like acupuncture, mindfulness, meditation, journaling, practicing gratitude, guided imagery, tai chi, yoga, qigong, herbal medicine, and massage.

    4. Be open to trying new things. What may not work for someone else may work for you. There is no one-size fits all approach for the menopause journey. 

    5. Use humor. Laughter is often the best medicine. Don’t forget to tap into it.

    6. Build and strengthen your support system and friendships.
    diverse group of women laughing and preparing for menopause

    Change your mindset with humor

    On many days, laughter and friendships can be the best prescriptions. The comical show “Menopause The Musical” puts a humorous spin on this life change and the sisterhood many women+ may reach at some point in their lives. 
     
    For many women+ in our survey, their friends offered the most guidance and support, and they leaned on them, sometimes more than on their spouse/significant other.
    “I rely on my girlfriends,” one respondent explained. “Having someone who went through a similar surgery as I went through, that’s been very helpful. It’s like a pseudo support group even though it’s just the two of us.”
    Another woman said, “We can’t change that it will happen to us. Well, we can with chemicals. But, in my way, I could not,” explained one Ph.D. respondent.
     
    “It made me use my humor in a different light. It also made me aware of other women who may be experiencing that and have more empathy. I’ve seen it now.”
     
    Perspective and preparation will help you experience menopause as part of the flow and rhythm of your life. You’ll learn a lot about yourself and what you can handle during this new journey. You may experience things nobody told you. You’re not alone on this journey, though, pausitive health is here to help you make a change for the better.
     
    The time in life can be a journey to vibrant living. By viewing it as an opportunity to take a breath, explore possibilities, and really focus on you, at least as much as you do for others, you’re not taking on avoidable stress. You’re accepting menopause for what it is and can get ready to handle whatever may come your way. 

     

    Don’t let menopause stigma tell you how to feel

    The nurse who took pausitive health’s survey felt there’s a stigma associated with menopause in the United States.
     
    “Women go through the change, they’re moody, their sex drive changes, they’re empty nesters wrapped around in there or the cougar type of morphication,” explained a nurse in the survey.
     
    That’s starting to shift as there’s more emphasis on gender-specific healthcare with the rise of FemTech. But, the United States still has a long way to go.
     
    Think about how American society typically views menopause and aging in general. 
     
    While menopause is still not a mainstream topic in the American workplace, the UK is leading the way with changes in workplace attitudes and policies to support those going through menopause. There is also a program for employers to achieve a “menopause-friendly” workplace designation.
     
    Even if society catastrophizes this stage in life and often thinks of menopausal women as old and haggard, with little left to give, you do not have to buy into someone else’s mindset.
    woman talking to her doctor

    Find a team of professionals, including a menopause doctor

    While you can make lifestyle choices on your own, it’s helpful to work with a team, including a practitioner you trust and one who is a true advocate for you.
     
    One survey respondent who was a nurse practitioner found that type of relationship with her family doctor.
     
    “He was really good about basically assisting or guiding you if you were a medical-based kind of person, or were OK with medicine, he would steer you in that direction. But, if you were more of a natural type person, he was OK with that too. And would assist you in that way,” she commented.
     
    She said her doctor respected her knowledge.
     
    “He also respected the fact that I was in the medical profession, and I kind of knew my body. If I was way off base, of course, he would say so, but a lot of the time, if I wanted to try this or that, he was OK with that,” she explained.
    Her experience is often not the norm, though.
     
    When a friend had a shocking but not surprising experience with two male doctors, we knew women+ needed pausitive health and deserved a change for the better!
     

    Finding a doctor who specializes in menopause

    There’s a general shortage of healthcare professionals, made worse by the COVID-19 pandemic. It includes internal medicine, family practice, and OB-GYN physicians, the specialties (along with urogynecologists) with which women+ interact for guidance and treatment during the menopause journey.
     
    Unfortunately, medical school and residency training programs often do not provide sufficient preparation for many physicians to gain the requisite experience and expertise to optimize the care experience for women in menopause.
     
    A Johns Hopkins-led study showed a concerning “training gap” with doctors.  In a study of OB-GYN residents, 70% would like formal menopause training, but only 20% receive it. 
     
    The Menopause Society expands the spectrum of practitioners (pharmacists, nurses, and psychologists) with the knowledge base needed to help address the potential challenges of care.
     
    You can check if there is a Menopause Society Certified Practitioner (MSCP) near you using their ZIP code search tool.
     
    And with the acceleration of virtual care options, if you can’t find someone who is a good fit for you in your area, you may be able to find a practitioner who is available via telehealth.
     
    Change is also happening at various medical centers, including Northwestern Memorial Hospital in Chicago. Although it took some convincing to make it happen, the hospital created the Center for Sexual Medicine and Menopause. AARP reports when the center opened, its schedule filled quickly.
     
    The center takes a holistic approach to treating menopause, looking at a woman’s health profile. There are specialists in everything from cardiology to psychotherapy. The multidisciplinary team helps individualize treatment based on each woman’s needs.
     
    There are other care options, including both functional medicine and integrative medicine practitioners.
     
    The nurse practitioner in the survey believes menopause management requires focusing on the root cause of a woman’s symptoms. While she didn’t benefit from this approach during her menopause journey, she knows it works, giving women another alternative to HT.
     
    There’s also a push to make menopause training a requirement for residents at Northwestern, no matter their specialty, since menopause can impact your entire body and your emotional health. And if you already have underlying health conditions, menopause can also affect those problems.
     
    So, ask your doctor about their training and experience with treating menopause. If you don’t feel your current healthcare provider has the expertise you need, you can check to see if there is a MSCP (The Menopause Society certified doctor) in your area. Choose one who specializes in menopause management and approaches treatment holistically.
     

    Menopause treatment options 

    The term “menopause” is reported to have been first coined by a French physician in 1821.
     
    Despite what can be significant differences in symptoms from woman to woman, there is often a one-size-fits-all approach to treatment in the Western world. Hormone therapy (HT), which is generally considered the most effective treatment for symptoms like hot flashes and night sweats and therefore may reduce the risk of dementia related to those symptoms, plays a big role in the options available to address symptoms during the menopause journey. However, for those who can’t use HT, don’t want to use it, or have an interest in exploring other options first, it’s important for women+ to be made aware of other possibilities that may be an alternative or complement to HT. 
     
    While the nurse practitioner who took our survey made menopause a time of rediscovery, that advice didn’t come from her doctors.
    “There’s just more of the things women don’t want. Like here’s the pill you can take, or here’s the procedure we can do. And that’s usually where it ends with providers when we don’t want to get into hormones. That’s the conventional way they’ve been taught. And that’s not what a lot of people want,” she explained.
    You may need to research other medications to treat menopause as well as non-hormonal modalities like acupuncture, music, nutrition, and herbal remedies. Also, advocate for other options in your discussions with your healthcare practitioner if you want to include them in the approach you’d like to take during your menopause journey.
    woman looking at map

    Menopause roadmap

    Menopause is so much more than just a series of hormonal transitions.
     
    Just like with a marathon, knowing where you’re going and how you’ll get there will make it easier to make it through this stage of life.
     
    Become a healthcare rebel, focus on preventive and self-care, and recognize the power you possess to manage your menopausal symptoms and improve your overall health and well-being.

    Preparing for menopause

    Be proactive. Ask questions and avoid a one-size fits all approach.

    Educate yourself about your options - lifestyle changes, non-hormonal techniques, hormones, and other medications.

    Get the latest recommendations regarding hormone therapy (HT) if it is a consideration for you. There are a lot of factors to consider, and the treatment algorithm is complicated.

    Find a practitioner with whom to collaborate, who you trust, who really listens, and who has the skills to help address the myriad symptoms women can face during this time in their lives.

    Finally, establish a support system. Just like in a marathon, you need people cheering you on. Find people who inspire and motivate you. While your healthcare practitioner is an essential member of your team, so are friends and other “runners” in the menopause marathon.

    Many women in our surveys benefited greatly from discussions with other women and leaned heavily on their friends.
    “We learn from each other and other women all the time as far as their experience. And always be cognizant that everybody’s experience is their experience and is unique to them,” one woman said.
    Be kind to yourself, and make room in your schedule for “me time.”
     
    And remember, it’s never too early to start training for the menopause marathon. The better prepared you are, the easier your road will be. You CAN cross the finish line as a winner!
     
    Take action now to make a change for the better!
     
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