If the title of this article almost made you switch off and move on, I hope you’ll re-think and stay with me here. Menopause is a women’s health concern, but it doesn’t only affect women of a certain age. It affects society as a whole. Women work, have families, have partners, have parents, fulfil multiple roles. And doing so whilst navigating the hormonal maelstrom that is the menopause can significantly impact on their work, relationships, health and wellbeing. As with many other female health conditions, women are often shamed into silence, worried about speaking out and receiving poor information from healthcare providers. The great news is that the plight of women experiencing the symptoms of menopause and peri-menopause, has been more visible in the news today, thanks in no small part to the work of key figures who have been pushing for changes. In England, the Ministry for Health published its ‘Women’s Health Strategy’ in July/ August 2022, (which you can read in full here) appointing Professor Dame Lesley Regan as a Women’s Health Ambassador for England.

The strategy points out the key challenges facing women experiencing menopause symptoms as:

• A lack of information about the menopause and peri-menopause.
• The difficulty in receiving a diagnosis as both women and health-care providers often miss key signs leading women to incorrectly receive treatment for depression (for example) instead of being given access to hormonal therapy.
• A reluctance on the part of health-care providers to prescribe HRT due to over-emphasis of the negative effects over its benefits, and
• A lack of support for women at work.

There are countless resources out there for anyone going through the menopause. My aim here is just to signpost a few facts and point out how Pilates can help women both through this rocky patch of life and to prepare for it.

What is the Menopause?

According to the Menopause charity, Menopause is officially reached when a woman hasn’t had a period for 12 months in a row. The average age of women reaching the menopause in the UK is 51. However the charity point out that there is a lot of variation in this timeframe. Furthermore, for some women, the change may be sudden, due to surgery or illness.

The Perimenopause is the period of (on average) 4 years that leads up to the menopause and is accompanied by irregular periods, hot flushes, brain fog and tiredness. These symptoms are the result of changes in hormone levels as the ovaries slow down and the hormones they used to produce (oestrogen, progesterone and testosterone) fall drastically, leading to a period of re-balancing as the body adjusts to this radical change.

As women on average live into their 80’s, this leaves a significant period of their lives post-menopause. So it’s important to see this change as the beginning of a new phase and ensure that women receive the support they need to continue to live fulfilling lives.

Why awareness is important?

Many women are inclined to brush-off their symptoms of peri-menopause as simply the result of daily stress, leading them to avoid seeking medical advice or support. However the impact on their lives can be significant, especially in work situations where many women feel under pressure to keep up with an unforgiving work culture.

As my colleague Grace Lilly-White from CentredMums points out in this podcast produced by the Pilates Foundation, many women today are hitting the peri-menopause and menopause at a time in their lives when they are juggling busy careers with looking after young children and in some cases also caring for older parents. Lilly-White notes that as women are coming into motherhood much later than they had previously, they are often facing this onslaught of hormonal changes whilst feeling ‘depleted’ and, often, before they are fully rehabilitated from having children (which in itself is worth a whole other blog post).

How does the hormonal maelstrom impact on exercise?

At a hormonal level, the symptoms that women experience during the peri-menopause/ menopause, are the result of a fluctuation initially brought about by a fall in Progesterone. This key hormone, which plays a vital role in pregnancy, also manages Oestrogen levels. When Progesterone drops, it leads to an initial surge in Oestrogen before this too drops. Oestrogen plays a vital role in bone health, joints, cardiovascular health and brain function. Testosterone also drops leading to a lack of energy and loss of muscle tone. The menopause charity point out that as a result of these hormonal changes, post-menopause women are more likely to develop:

- Osteoporosis (low bone density which can lead to bone fractures)

- Arthritis (leading to painful joints)

- Weight gain, (which puts women at risk of type 2 diabetes)

- Depression and Dementia, resulting from the loss of protective hormones.

How can Pilates help?

I know that Pilates is not a magic bullet, and certainly cannot fix or completely allay these symptoms, but I genuinely feel that it can help both to support women going through and after the menopause, as well as preparing women in the lead up to it. And here’s how:

1. Increasing body awareness and working on alignment to reduce joint stress and strain.

I work with clients to encourage greater body awareness and work through alignment. No matter your age, there’s a good chance that you have developed movement habits that reduce the efficacy of muscles supporting joints, leading to gradual stress and strain. Increasing awareness of these habits can be very empowering. I know that the thing that really gets to women is the sense that they’re somehow at the mercy of their biology, like they cannot help themselves and are not always taken seriously by the medical profession. Working holistically allows us to not only identify habits and patterns that may be causing joint strain, but also to unlock them.

For example: Knee pain can be a common problem. By becoming aware of knee tracking, and developing more ankle and hip mobility and stability, we can help people to stay on their feet, which means they’re more likely to head out for a walk and keep generally active, reducing their chances of weight gain, depression and low bone density.

2. Maintaining muscle strength and coordination.

With lower levels of testosterone post-menopause, it becomes increasingly harder to maintain muscle strength. This affects both men and women over the age of 60, however maintaining muscle strength is one of the ways that women can reduce the impact of lower hormone levels post-menopause. This is a fact that many cardio-focused fitness regimes seem to ignore. You need strong muscles in order to move and you can only build and maintain muscle mass through a resistance-based movement programme. Now, I know that many people may think that Pilates is not resistance focused enough, however again I feel this comes from poor understanding of the technique. Whenever you are using muscular effort against load, that is resistance. In the Pilates matwork repertoire, we often work against the body’s own weight to create that load.

For example: Take the standard Ab Prep. We interlace the fingers and place the hands behind the head, creating a kind of hammock with the arms so that the weight of the head can drop back into them. Then we bring the abdominals into play as we allow the ribs to soften into the ground, bringing the head off the floor. This is resistance work for the abdominals, as they are working against the load of the head. Poor technique can often lead to compensation patterns such as the pulling on the delicate structures of the neck (a common problem with Pilates routines), which is why it’s so important to work mindfully. I notice that new joiners to my classes often think that going fast and furious into an abdominal curl increases the ‘burn’ factor. But actually that is only encouraging a momentum-over-muscle approach, which is likely to just cause strain, without using the muscles. Furthermore, by working with the coordination of different arm and leg patterns, we encourage a whole body awareness that maintains neuro-muscular connections.

In addition to this focus on ‘using muscles instead of momentum’, we incorporate resistance elements into classes through the use of bands and small weights, and of course the equipment work uses the elastic resistance of springs which is a whole other approach to resistance.

3. Working with breath reduces anxiety and stress that can massively impact on general health and wellbeing.

Breath is one of the core principles of Pilates. The co-ordination of breath and movement is both a mindfulness exercise, allowing us to drop into our movement/body and focus, (rather than letting our brains keep surging through the day’s stresses at a million miles an hour), and a technical anchor. It deepens our connection to our muscles. Without the breath-to-muscular engagement, movements remain shallow and have minimal impact. If you shake in a movement sequence, this is because you have this connection, it is not because your muscles are weak, it’s because they are working! (I have a story to tell about this, but I’ll hold on to that for another time). So breath becomes a keystone both to anchor our attention and to increase the effectiveness of our practice. But breathing, most obviously, lowers levels of cortisol, the stress hormone, which disrupts sleep and increases inflammation. So those moments of dropping into breath can be hugely beneficial for all sorts of health conditions, many of which are the result of trying to remain functional as working adults.

4. Maintaining Bone Strength.

The loss of bone density that results from lower levels of oestrogen can massively impact on women’s lives post-menopause. This is because it makes us more likely to develop osteoporosis and therefore vulnerable to fractures that can significantly reduce movement and independence. However the ways that Pilates can support/ prevent this from becoming a problem differ according to age groups:

• Pre-menopause

The important thing for younger women to note is that bones are like a bank. The more you build up your bone density (or deplete it) through lifestyle choices before menopause, the less (or more) likely you are to develop osteoporosis when you’re older. And those lifestyle choices include nutrition, weight bearing exercise and sleep, amongst others. For the average pre-menopausal woman, Pilates can be beneficial in maintaining strength and flexibility and reducing injuries that might stop women from weight bearing exercise (such as ankle strain, knee injuries or hip injuries). If you are experiencing any kind of pain that is stopping you from going for a walk or run, then you need to address this now, pre-menopause. Physio can treat the cause of pain and Pilates can help rebuild stability and mobility to get you back on your feet.

• Post-menopause

The key to maintaining bone density is to do weight-bearing exercise such as walking and lifting weights. Post-menopause it’s important to incorporate balance, strengthening and a lot of foot-work. Looking after your feet is absolutely key to keeping you on your feet, so using a massage ball and strengthening the arches of the feet is even more important. The interesting thing is that I find I’m often having to coax my clients in this age group into doing standing work or resistance work. Part of the reason for this is that it often causes pain due to underlying inflammation. It’s so important to communicate pain and adjust alignment and resistance levels to ensure that you are not over-doing it. Often it is those underlying alignment issues that are causing the inflammation, so working on alignment first is important, before adding load.

• Osteoporosis

If you have received a diagnosis of either ostepeania or osteoporosis (no matter your age) you need to avoid all flexion of the spine, ie: don’t round the back when you bend forwards. Studies have shown that flexion increases micro-fractures within the spine. However, back-bending (lifting the back off the ground when lying face down) has been shown to reduce fractures. The reason is that it compacts the trabecular bone in the vertebral bodies, making them more dense. Osteoporosis has become increasingly common and is affecting younger age groups too. From a Pilates perspective, it does require some adjustment to the regular Pilates repertoire (you shouldn’t be doing any roll-downs for example) however, with the large numbers of people joining classes with disc-related conditions, (where forward-bending is also contraindicated) there’s absolutely no need to feel self-conscious about needing to adapt. Osteoporosis is worth another full blog post of its own, but if you have concerns about it, do speak to me before your next session.

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I have to admit that before now, I hadn’t really given it much thought. If anything I was slightly in denial about it (surely it’s a long way away??) It was whilst listening to this podcast with India Rakusen interviewing her mum about her experiences of menopause that I realised that it was just around the corner for me and that I’d never even thought of doing some research into how I might prepare myself. I hope this has been a start. As someone who has not yet experienced these hormonal changes I am staggered by what so many women experience, often silently and with a fitness oriented society that is constantly focused on beating women for not pushing themselves enough. It’s easy to see, from the symptoms and resulting conditions, how women can be put off from regular exercise, due to sore joints, a lack of energy, feelings of inadequacy and low mood. Unfortunately, this only brings about a vicious cycle: the less women move, the worse their symptoms get. Which is why I make this point, that it’s up to all of us, men and women, to support those going through the menopause, to recognise the symptoms that might indicate the change and to encourage women to seek the support they need, rather than expecting them to just push through.