Energy and Fitness in Menopause

What is Fatigue?

It’s common to say you are tired or need a more energy to get through the day. But fatigue is more than feeling tired from a rough week or a few late nights. It’s a deep feeling of persistent exhaustion, leaving you feeling weak, mentally, emotionally and physically drained, unable to cope with life and work and take care of yourself and your loved ones.

I know this, because I’ve been there myself. For a long time, I didn’t understand what was happening until, at 47, I was diagnosed with Chronic Fatigue Syndrome (CFS). Also called myalgic encephalomyelitis (ME), with one of the components being persistent fatigue.

After some diagnostic testing, I discovered I had elevated antibodies to the Epstein Barr virus. It was such a relief knowing this because now I could set about targeting my nutrition and supplements to support my healing journey. The rest is history, and I feel 110% better now.

Why Does Menopause Cause Fatigue?

Hormones don’t only affect your periods, but also nearly all the other processes in your body. This includes mood, sleep, metabolism, sexual function, immune system and energy levels. It can help to think of them as messengers that tell your body what to do and when to do it.

Small changes to these hormone levels can trigger unwanted symptoms, with the main culprits during menopause being oestrogen and testosterone – hormones that help your body make energy. When they’re not functioning efficiently, we can feel exhausted physically and mentally.

Alongside these changes, if you aren’t eating or sleeping well, living a sedentary lifestyle or have chronic inflammation, you are more likely to experience menopause fatigue. Other causes to consider are low iron and ferritin levels, thyroid issues, low vitamin B12 levels, insulin sensitivity and post-viral fatigue.

How To Tackle Menopause Fatigue

First, it’s worth booking in with your GP to assess your health holistically. Simple lifestyle changes can also help you regain your energy and feel like your usual self again, such as:

1. Fixing your diet - help boost energy levels by getting more antioxidants from cocoa powder, green tea, artichoke, flaxseeds and herbs. Help balance blood sugar levels with sugar-free breakfasts like eggs, sardines, and green veggies, or toasted tempeh, within an hour of waking.

2. Get moving - this may be the last thing you want to do when suffering from fatigue. But it can make a big difference to how you feel, even if you can only walk for a few minutes at a time. This will help to boost your mood and help to reset your hormones.

3. Start a bedtime routine - encourage a good night’s sleep with healthy sleep habits. Start by taking a warm bath or shower, drinking herbal tea and perhaps curling up with a book. Do some relaxation exercises or Qigong, then climb into bed.

4. Find time to relax - stress can make matters worse when it comes to menopause fatigue. I suggest making time for a ‘sleepcation’ to help, where once a month you spend 12 hours in bed. Use essential oils, get cosy with lots of cushions or anything else that makes you feel good. Avoid blue light, listen to a podcast or just sleep.

5. Consider targeted supplements - taking high-quality supplements can help with your energy levels. I’d recommend Coenzyme Q10, Vitamin C, B complex or N-acetyl cysteine (NAC), but find what works for you.

Why Walk?

During my menopause season I have been walking to feel connected to the environment and with myself. There have also been times when I’ve walked to switch off, step out of the world or make sense of my situation.

Sometimes I walk to find inspiration, mull over a problem, or engage in my surroundings. At other times I walk because I don’t know what else to do. I don’t always know how to manage my mood or quiet my mind.

Understanding the reason why I walk has given me a renewed sense of purpose, and the option to pick and mix them to suit my perimenopause symptoms helps me feel more in control.

My Favourite Walks

An awe walk: when I’m overwhelmed, it can be hard to focus on anything. However, during an “awe walk”, Bryan E. Robinson explains, you can consciously move your attention outward instead of inward creating ‘a self-transcendent sense of wonder and reverence in which you feel a part of something larger than you.’ This helps me find perspective.

A meditative meander: saying affirmations, such as ‘I am present, I am calm’ or walking in time with your breath helps create mindfulness, which can help settle a menopausal mind and find some calm in the chaos.

A wonder wander: in menopause, my mind sometimes feels muddled, and answers/solutions to problems or creative inspiration can be hard to find. According to a Stanford Study by May Wong, walking improves creativity by 60%. So, why not try setting an intention heading out?

A walk break-breather: walks don’t need to be long and are perfect for taking some time out when you’re feeling overwhelmed with life, and shorter walks can fit into the busiest of schedules.

A moon walk: if you’re struggling to sleep during menopause, evening walks can offer a different perspective on familiar settings. You can track different moon phases and their specific benefits using moon apps too.

A whimsy walk: brain fog in menopause can make it hard to focus, so without too much thought, I put one foot in front of the other and go where my feet take me. You never know what you might discover about yourself and the world around you.

A barefoot walk: walking barefoot for 20 minutes in your garden, local park, beach or a canal tow path (my personal favourite!) is a grounding experience that can help ease menopause symptoms.

An energy-burn walk: if I’m having a hot flush it doesn’t matter if I get hotter and sweatier, so I use them to power my walks - sometimes brisk, sometimes slow, but the fresh air and exercise always helps them pass.

A lethargy-lift walk: in contrast, when I’m fatigued it’s hard to find the energy to do much, but I can always find it for a single step… then another and then one more. I feel re-energised after getting out and the first step is all you need to start with.

A socially connected walk: social bonding raises oxytocin levels, which can help minimise menopause symptoms, such as mood swings. It has also been shown to help alleviate chronic joint and muscle pain. What better excuse do you need for a ‘walk and talk’?

A walking book club: I’ve added this extra one as it unites my favourite hobbies: walking and reading! If there aren’t any walking book clubs near you, why not start your own?

Navigating Early Menopause

Exercise can be one of the best things you can do for your health. For me, it has been vital for both my physical and mental health, as I navigate being pushed into early menopause at 43, having had chemotherapy for just under four months over the summer of 2020.

This came after a triple negative breast cancer diagnosis that April. At the time, I was just 41. I’ve always been sporty and active, somewhere between vegetarian and vegan since I was nine, and I’ve never smoked. But as I’ve learnt all too-well, cancer does not discriminate.

Following surgery and two weeks of intensive radiotherapy, I was given the ‘all-clear’ later on in the year. At the start of 2021, I was determined to go at life at full pelt once again. I’d lost my hair, was out of shape, and wanted more than anything to get back to ‘me.’

Discovering Strength Training

I found an amazing local personal trainer in London, Jordan Holtom, who was willing to train me for 45 minutes a day, five days a week. A humble, caring and knowledgeable New Zealander, he combines a calming manner with the skill of motivating you to push yourself hard. Really hard.

We spent the first few months doing a lot of cardio in a quiet corner of Battersea Park, with a little strength training built in. But increasingly, as the weeks went by, strength training became my ‘go-to’ and once the gyms re-opened I moved my new passion indoors.

I started doing three 60-minute strength-focused workouts a week, following programmes from Jordan who kept track of my progress. Even though I’ve only taken up this type of training later in my 40s, I’m now a very regular fixture at The Gym Group, Battersea, and I’m lifting heavy.

Feeling Stronger

I’m eating more carefully, reducing the amount I drink, prioritising sleep and having therapy to help manage menopause symptoms like tiredness, mood swings and brain fog. But thanks to strength training, I’m also living life with renewed energy and I’m stronger than I’ve ever been.

Dr Aishah Iqbal, also a PT and weight loss coach, says: “As we go through menopause, bone mass decreases, increasing the risk of osteoporosis, which weakens bones. This is due to the decline in oestrogen. Muscle mass is also on the decline for all of us as we age. But strength training can help maintain and build muscle, reducing the risk of falls and fractures.”

“The key is focusing on exercises which put some strain on your muscles (in a good way), such as squats, lunges, deadlifts and chest presses. Not only do they help strengthen muscles, but they also help develop strength in movements you might find yourself doing during the day.”

New to Strength Training?

If you’re feeling nervous about picking up weights for the first time, keep it light and easy. Try a drop-in class at your local gym, and if you can, get a PT or instructor to help guide you through the exercises, equipment and right number of reps. This can help it feel less overwhelming.

It can also be helpful to remember strength training is not only about lifting weights. Physiotherapist, Becky Sessions, says: “There’s plenty to be gained by doing an online class or home workout home, using just your body weight. Even activities like going up and down stairs, carrying shopping, or heavy gardening, can help build strength.

Dr Folusha Oluwajana, a portfolio GP and personal trainer, adds: “Regular strength training has been shown to reduce the risk of developing conditions such as cardiovascular disease, hypertension and diabetes. It’s also an effective tool for helping manage anxiety and low mood.”

For me, regular strength training has helped me cope with the trauma and fallout of my diagnosis, as well as navigating menopause and at times, symptoms of both anxiety and depression. It continues to be a big part of my journey as I work on moving forward with my life.

Finding What Works for You

Women grow up with the narrative that their value is linked to their physical appearance, so it’s natural to lose some confidence when physical changes appear. According to menopause coach and educator Catherine O’Keeffe, “Menopause can be a deeply psychological time, with many women experiencing an impact on their self-confidence and self-esteem”.

I’m perimenopausal but have been lucky not to have experienced a lot of symptoms.  However, I’ve noticed my confidence disappearing at the same rate as my collagen, so I’ve tried to flip my focus from how my body looks to what it can do.

I lived in Spain for a year, and I’ve always been fascinated by flamenco dancing: the passion, the vigour, the colour and the noise.  However, I never gave learning it any real consideration. It was one of those things I thought I’d always watch from the sidelines but never do. It was the wake-up call of the pandemic that made me realise “if not now, when?”

Going For It

I took the plunge and signed up for Zoom-based lessons at Taller Flamenco, a dance school based in Seville.  I have passable Spanish and I decided I may as well take lessons from experts in ‘the home of flamenco’. I was assigned Lourdes Recio, a highly experienced dancer who has studied under some of the flamenco masters like Manolo Marín.

At first, I was so awkward and embarrassed that I couldn’t even look at myself in the mirror as I danced. However, as the weeks went on, my skills, and my confidence, improved! When I eventually visited Seville, I arranged an in-person lesson with Lourdes and she arranged a short choreography that I could learn in two hours, based on the Tango of Triana. 

She told me this particular type of flamenco is all about being brazen and dancing “sin verguenza” (without shame or embarrassment).  By the end of our time together, I managed to point, strut and look in the mirror without falling over laughing. Not only was I taking on a new challenge (in my second language), but I was feeling good about just doing it.

The Benefits of Dancing in Midlife

Several studies have indicated that dancing can have profoundly beneficial effects on not just physical health, but brain function and even self-esteem.  A report published by the Australasian Menopause Society indicates that “dancing improves cholesterol levels, physical fitness, self-image, and self-esteem in postmenopausal women” and research suggests that dancing can hugely improve sedentary women’s mental health and quality of life.

Midlife is a time of profound physiological change, but with it comes great wisdom, self-awareness and an opportunity for growth. For me, I've found learning to dance has been life-affirming and more than anything, I'm having fun, proving you're never too old to learn new things. The gamechanger was understanding that being perfect isn’t the point; being present in the moment is.

Yoga is a is a holistic form of movement that consolidates the mind, body, breath and emotions. It can ease our symptoms of the menopause, make us feel better about ourselves and about the world around us.

How Does Yoga Fit in With Midlife?

When we think of yoga, we think of the words “gentle and slow”, but that is in relation to other forms of exercise. Yoga is not exercise. Yoga is movement, breathing, stillness and awareness: all of which give you a whole body and mind experience that other forms of exercise don’t. And because it’s an experience, it helps midlife women reassess their place in life. It helps them connect back to their passions and interests which had to be put on a back burner for years to pursue careers, raise children and make their way in life.

As for yoga being “gentle and slow” as a form of movement, this is exactly what midlife women who have not exercised in a while, need to ease back into exercise. Movement and exercise in midlife are important for so many reasons. Let’s explore how the decline in oestrogen in menopause affects the female body and how movement can help:

1) Menopause weakens bones, which can lead to osteoporosis: a condition where bones become thinner, frail and break easily. Osteoporosis negatively impacts our quality of life. Movement and exercise help keep bones strong.

2) Menopause causes a loss of muscle mass. Muscle mass impacts how the body burns calories. The combination of a slower metabolism (the rate at which the body burns calories) due to aging and the tendency of the menopausal body to hold onto fat means that some women gain weight in midlife. Through movement and exercise, we can maintain a level of muscle mass that helps the body burn calories more effectively.

3) Another benefit of yoga in midlife is its ease of access. It requires no equipment (a yoga mat is not compulsory, a carpet will do just as well), it uses your body weight as resistance and, thanks to the boom in online yoga, it can be done from the comfort and privacy of home.

Breathing techniques: most breathing techniques are calming and cooling which easily and quickly help to counteract the hot flushes or feelings of anxiety experienced in menopause. When feeling low or fatigued, energising breathing techniques can boost our mood and energy levels.

Meditation: with so much happening within us and around us in midlife, meditation is that haven of awareness and introspection which helps us keep the events in our life in perspective. Difficulty sleeping is another symptom of the menopause that many women struggle with. Meditation done before bedtime quiets the mind and lowers blood pressure setting us up for a restful sleep.

Asanas or yoga poses: we move in yoga by flowing from pose to pose to improve our agility, coordination and to tone our body. Or we can choose stillness in a pose to improve our balance, extend our range of motion, and strengthen our bones and muscles. In both cases, yoga poses are gentle on achy joints which is something many midlife women experience.

There is another aspect to yoga that not many people are aware of: you don’t need to spend a lot of time doing yoga to reap its benefits.

It’s not necessary to do a weekly hour-long yoga class if you don’t have the time for it. Yoga can easily be incorporated into daily life whether at home or when out. It can be done anywhere and anytime.

For example, cool down a hot flush with a quick and effective breathing technique. Do a balancing pose to clear the mind and feel refreshed. Release the day’s tension and sleep better with a number of yoga poses that will ease mind and body into relaxation.

Tree pose: it’s a standing balancing pose and we balance on one leg. This strengthens the muscles and bones of the standing leg and hip, which helps to prevent osteoporosis. It quiets a busy mind because, to balance, we can’t focus on anything other than balancing.

In addition, tree pose strengthens the parts of the brain that deal with balance and agility. This is important because we become more susceptible to falling as we age. Having good balance and being agile helps reduce the chances of falling and the risks associated with it.

Mountain pose: it is both a standing and a seated pose. It uncurls the spine, shoulders and chest. All of which curl forward naturally as we age. Mountain pose helps us avoid the stooped forward posture of aging. It also lifts the rib cage which gives the lungs space so that we can breathe better and more deeply.

When this happens, our immune system is boosted, and the brain gets more oxygen which can help with brain fog. Mountain pose also gives space to the digestive organs so that they can do their job more efficiently. Women in menopause complain of digestive issues and mountain pose can certainly help, as can the next pose.

Child’s pose: this is a restorative pose, and it is a good one to do before bedtime because it releases tension from the body and quiets the mind.  It is a gentle lower back and thigh stretch and, depending on the placement of the knees, an effective hip opener.

It’s perfect for anyone who spends a lot of time sitting. The placement of the arms, either stretched forward or beside the body, stretches different parts of the spine which resets the nervous system and brings the body to a state of calm. The forehead on a mat or cushion is pressing on an acupressure point which also calms the nervous system.

For 45-year-old Ange Brennan, cold-water swimming has been “absolutely life-changing”. Before taking it up, Ange suffered from hot flushes, night sweats, low moods and debilitating joint pain. She describes the moment she hits the water as ‘euphoric’ and ‘magical’. Her joint pain has vanished. “I used to not be able to open my left hand properly, but now I can, and I haven’t had a steroid injection for it in two years. I’m sleeping better, I don’t get oppressively hot anymore and I feel more energised. It really is transformative.”

This month marks a year since Natalie Sydey, aged 53, started dipping. She’s been perimenopausal for around five years and is adamant cold water alleviates the brain fog. “I’ve been struggling with feeling I’m not very good at my job. If you’ve been a capable woman who has made her mark in a male-dominated industry you want to hold onto that, but you start to doubt yourself when your head is all over the place.”

She’s in a much better place after acknowledging her diagnosis. Now taking steps to make her day-to-day a little easier, she says she wishes she’d had a better understanding of how menopause would affect her earlier in life.

Natalie isn’t alone in her ardour for cold water therapy. It seems pandemic-induced pool closures inspired thousands of people to take it up.

According to The Outdoor Swimming Society, soaring numbers of people across the globe now regularly immerse themselves in water below 15 degrees for the good of their mental health. I could wax lyrical about the joy of it as a wild swimmer myself, but it appears to be having an extremely profound effect on women going through menopause, with many reporting radical results because of it.

“I’m not surprised at all.” says OBGYN Dr Nuti Bajekal. “In menopause, your body is very sensitive to temperature fluctuations, so by exposing yourself to cold water you’re building up resistance to stressors that your body is subjected to when your hormone levels drop.

Scientifically it makes sense, but do we have all the evidence? Not yet, but that doesn’t mean we dismiss it. If it helps, you don’t have to wait for the science to catch up, do it. Just do it sensibly.”

Exercise and diet are hugely important for any ailments, it’s not any different for menopausal symptoms adds Dr Nuti. She believes an amalgamation of western medicine and holistic remedies like cold water swimming is our best armour for getting through this stage in life. “Nobody knows your body better than you, you’re the best advocate for yourself. It’s not one or the other, you mustn’t feel shame for choosing to use medication.

Equally, just because you’re taking HRT doesn’t mean lifestyle approaches aren’t important. You’ve got to work out what works for you.”

Incredibly, cold water therapy is enabling many women to feel ‘normal’ again. I was shocked to learn of the tribulations many women face when getting to the end of their periods, but less shocked to find that in true warrior-woman style, most are hunkering down, trivialising their endurances and soldiering on as best they can. It’s baffling that even in the 21st century menopause is still taboo.

The shroud of secrecy is even more embedded in cultures of ethnic minorities. It’s not helping anyone and although it’s slowly being demystified, it’s clear we have a long way to go.