Why menopause is the 'ideal' time to start exercising and how you can manage your symptoms

By Kate O'Halloran, ABC

Claire O'Meara was in her late 40s when she started experiencing a range of symptoms that made her think she was "dying of something really rare".

Naturally fit, O'Meara, now 61, had spent most of her adult life as a physical training instructor in the Army.

On weekends, she ran half marathons for 'fun', while she represented the Defence Force in the national touch footy championships.

But almost overnight, O'Meara says she was "stopped dead" in her tracks.

"I had no motivation, and no energy," she explains.

"I would try to go for a run and everything hurt … I'd get to 500 metres and I was just exhausted, short of breath and puffing."

But no matter how much she suffered, O'Meara continued "flogging herself", worried that she was putting on weight.

"All of a sudden I was like a bloated toadfish," she says.

"I'd weigh myself from one day to the next and my weight would fluctuate anywhere between two and five kilos because of the amount of fluid I was retaining."

Eventually, O'Meara made the call to see a doctor.

"I remember writing a list of all the things that were wrong with me and saying to my husband: 'I must be seriously sick.'"

O'Meara had recently moved to a farm in Bangalow, 20 minutes from Byron Bay. The GP she booked in to see was Dr Jane Reffell, an expert in women's health.

Dr Reffell told O'Meara she might be going through perimenopause, defined as the period of time leading up to your final period, and characterised by a range of hormonal changes.

But O'Meara remained in denial.

"Not for a second did I associate those symptoms with perimenopause," she says.

"I was like, 'no, no, I've always been young and fit and now you're telling me that I'm turning into an old woman?'"

It was the start of a steep learning curve for O'Meara, who admits she had "never given any consideration" to a chronically under-funded and under-researched time in women's lives.

"I just imagined that my periods would stop, which would be great," she says.

"I knew Mum used to get hot, sweaty and grumpy, but I thought that was probably it … I had very little awareness."

Women 'ashamed' and 'embarrassed' of menopausal symptoms

20 years ago, Dr Reffell took the gamble to open a clinic dedicated to women's health in Bangalow, in the Northern Rivers of New South Wales.

Unsure if the demand would be there, she quickly filled her books, before, over time, she began seeing menopause patients exclusively.

"There's huge demand," she says.

"It's not like I advertise as a menopause doctor, so it's just word of mouth.

"What that shows is that women are talking [about menopause] … whereas 15-20 years ago, no-one talked about it.

"It was basically a taboo subject. A lot of women feel quite ashamed and embarrassed going through menopause, and many don't even realise what's happening."

Dr Reffell says menopause can be defined one of two ways, with an average onset of 51.2 years, and a typical range of 45-55 years.

The first is the medical definition, in which menopause refers literally to your last period (the pause of the menses). This can be established once you have not had a period for at least one to two years.

The second definition, which Dr Reffell prefers, refers to the two to 10 year timeframe leading up to, and after, your final period (including peri- and post-menopause).

During this time, women experience a dramatic shift in the production of two key hormones, estrogen and progesterone.

As Dr Reffell explains, during the reproductive phase, women receive regular, cyclic and 'high' levels of estrogen monthly. They also experience a boost in their progesterone levels after ovulation.

By contrast, menopause is defined by a "withdrawal" of estrogen, and the decline of progesterone, which can lead to wide-ranging symptoms.

"The body really has to adjust, because you've got hormonal receptors all over the place, including the brain, gut, heart, joints and skin," Dr Reffell explains.

"That's why the range of menopause symptoms is so huge."

In fact, the Australasian Menopause Society lists no fewer than 21 symptoms characteristic of menopause, including, but not limited to, those related to emotional health (such as mood changes, anxiety and depression) and physical symptoms (including muscle and joint pain, as well as fatigue).

"Often these changes are put down to depression and anxiety, and they're given anti-depressants, rather than having their hormonal changes addressed.

"Women can be feeling pretty bad by the time they come to see me."

Menopausal Hormone Therapy helped O'Meara manage symptoms

Dr Reffell says O'Meara's symptoms put her in the category of the 15-20 per cent of women who "have a very hard time" during menopause.

"It's important to remember that 15-20 per cent of patients don't have problems with menopause," she adds.

Another 60-70 per cent will experience some symptoms and may need strategies to deal with them.

But Dr Reffell says anyone affected should be seeking medical attention.

In O'Meara's case, her symptoms were so disruptive to her quality of life, Dr Reffell recommended Menopausal Hormone Therapy (MHT).

MHT, which can be taken as tablets, patches or gels, provides a low-level dose of hormones (usually a combination of estrogen and progesterone) and has been shown to safely and effectively improve menopausal symptoms.

In O'Meara's case, it was a 'game-changer'.

"I started to get better sleep, and as my sleep improved, so did other things," she says.

"I started to get my confidence back, and to feel better about myself.

"As my mind got a bit clearer, instead of being reactive, I was able to sort of think, 'OK. Let's think about this and how we can attack it.'"

Slowly but surely, she took up running again, trying to pace herself and adjusting her own high expectations.

"I had to learn not to be an all or nothing person, and that was really hard," O'Meara says.

She also took the time to think about her goals, re-visiting 'bucket list' items like completing a university degree and taking up triathlon.

Never one to do things by halves, O'Meara enrolled in an exercise science degree (with a research specialisation in sport and menopause) and joined a triathlon club in Byron Bay.

More recently, she has turned to IronMan triathlons, coming second in her age group in May last year, and qualifying for the World Championships in Nice.

While she acknowledges her transformation has been "extreme", she hopes others can take solace from her journey.

"It can be really, really hard to get up and out the door, but I used the rule of ten minutes. So I'd say, I have to go for ten minutes, and after ten minutes, if it's not working, then I can stop. But normally I find that after ten minutes, I'm feeling better, I'm in that zone, and that in turn benefits my mental health.

"It's important to find something you love, even if it's swing dancing, salsa or hiking … just do it, because you'll reap the benefits from it. And it's never too late to start."

Strength training, exercise key to managing bone density changes

Dr Reffell agrees that menopause can be the perfect time to begin an exercise program if you have previously been inactive.

This is because the drop-off in estrogen can cause bone density changes (including increased bone loss), leading to a greater susceptibility to osteoporosis.

Menopause is also associated with loss of lean muscle mass, otherwise known as 'sarcopenia'.

"We know for your bones and muscles that it's really important you do some weights," she says.

"So we recommend strength training once or twice a week, but also 'impact' work like skipping, and improving your balance [which becomes an issue as you age]."

And for those who have been active, like O'Meara, Dr Reffell says it's important to continue exercising, while also being gentle with yourself.

"If you don't use it, you really will lose it after menopause," she says.

"You might not have the stamina that you had before, or the strength, and you might injure more easily, so it's about taking all those things into account and working with your body, but not stopping.

- ABC