There’s a hilarious sequence of events in Miranda July’s latest book, All Fours, in which the central character looks at a graph that shows how oestrogen goes off a cliff during menopause. Worried about what this might mean for her sex drive, she desperately surveys her older friends about their experiences, gathering anecdotes and wisdom in a valiant effort to be prepared for the onslaught.
But can you war game a good menopause? Many women in their 30s or 40s may be wondering, given awareness of this momentous life transition is finally a moment.
“And that’s good,” says Dr Karen Magraith, GP and past president of the Australasian Menopause Society, because “it’s always good to talk about menopause”.
Yet with more awareness, some women may feel trepidation about what to expect, and a whole industry has sprung up offering solutions and serums for their worst fears. Meanwhile, some women sit in denial or ignorance of what’s ahead.
With its array of potential symptoms, from hot flushes, fading libido and weight gain to mood swings, insomnia and foggy memory, the prospect can be daunting. But it doesn’t affect everyone in the same way – and much of what women experience in menopause is out of their control.
Regardless, some early adjustments before or even during perimenopause – a transition period that can last two to 10 years – can help soften the impact on our bodies, brains and relationships.
There are two ways women can prepare, Magraith says. “One is to get information, and the second one is get healthy.”
‘Women were angry’
In a 2022 survey of perimenopausal women to determine their attitudes and knowledge of menopause, lack of education was a key issue: “The women were angry that they had reached this point in their lives without any knowledge of how perimenopause would affect them,” wrote Joyce Harper and her co-authors. “They talked about their woeful lack of preparedness which made them feel disempowered and caused them to lose confidence in themselves and their bodies.”
Dr Michelle Woolhouse, an integrative health GP and author of the book The Wonder Within, likens menopause to adolescence. Remember the tumultuous teens, when our bodies unleashed those tiny but potent hormones on us – and our poor parents? These powerful little chemical messengers prepare us for reproduction, with another major spurt occurring during pregnancy and childbirth.
Menopause marks the end of this reproductive cycle, typically striking between ages 45 to 55. During this time, fluctuating hormone levels can make us question our sanity all over again.
So what can we do?
“The secret to a healthy menopause is all about lifestyle medicine,” Woolhouse says. “I am seeing more people coming in with the intention of being more proactive, which is fantastic to see.”
Get strong
To prepare for menopause, healthy lifestyle principles apply as much as ever, according to Dr Tamara Nation, a GP at the National Institute of Integrative Medicine. And, more than ever, this is the best time to act on them, Magraith says. In particular, she explains that menopause is a turning point for heart, cardiometabolic and bone health, so it makes sense to face this life transition with healthy habits and strength onboard beforehand.
As some women tend to put weight on around the middle as their bodies no longer need to prepare the hips for childbirth, this can have metabolic consequences which increase the risk of heart disease, elevated blood lipids and diabetes. Falling oestrogen levels can also cause bones to lose calcium, increasing the risk of osteoporosis.
Making dietary adjustments to include more vegetables and legumes and avoid sugar and processed foods is crucial. This also promotes a healthy gut microbiome which preliminary research suggests may be important in facing menopause.
“It doesn’t have to be really complicated,” Magraith says. “Eat as much whole food or home prepared food as possible.” For bone health, ensure an adequate intake of calcium and vitamin D.
Magraith recommends Healthy Bones Australia as a resource and, in general, says perimenopause could be a good time to visit your GP for breast, cervical and bowel cancer screening, and ask to have blood pressure, lipids, fasting blood sugar and other heart health indicators checked.
The importance of exercise can’t be overestimated. “Ramping up exercise prior to menopause can be great for a whole lot of reasons,” Magraith says. “It really is helpful for general health as well as mental health.” It can also have positive effects on sleep quality in perimenopausal women, Nation notes.
While any exercise is good, weight-bearing exercise and resistance training are particularly important for healthy bones. Maintaining muscle mass is vital, Woolhouse says, which can help reduce falls, manage blood sugar levels and support metabolism. She recommends a combination approach including resistance training, yoga and walks in nature.
Having said all that, Magraith has an important caveat.
“Overall, she says, “there is a large element of unpredictability regarding severity of symptoms. One common fallacy is that if women have a healthy lifestyle they will sail through menopause.”
The extent of hot flushes and night sweats may have some genetic influence, and, although menopause onset isn’t reliably predictable, early menopause can run in families, according to Woolhouse: “It is worth finding out details from your mother and grandmother.”
An empowering life transition?
It has been long been recognised that changing hormones can affect mental health, and stress can increase symptoms such as hot flushes, heart palpitations and insomnia, Woolhouse says. “The changes during this time can cause stress and stress amplifies the symptoms,” she says. “It is both the chicken and the egg.”
Having already learnto manage stress will stand women in good stead when symptoms hit, using techniques including mindfulness, physical activity and connection with nature. Some women become more vulnerable to depression, which Nation explains has a complex relationship with psychological resilience, social connections and general health – and these are all factors in addressing it.
Developing healthy social connections can help prepare in other ways as well. Increased tiredness, poor sleep and mood swings could all impact relationships at home and work, and reduced libido, vaginal dryness and painful intercourse might make intimacy less appealing. “Relationships are vital at any stage in a woman’s life,” Woolhouse says, “but having support of caring people during this time can help ease the uncertainty. Opening up both conversation and awareness of the common signs and symptoms help women and those who love them become tuned to their changing needs. This allows them to seek support early.”
Despite healthy lifestyle changes, some women might still struggle – even during perimenopause – and could benefit from medical help. Surveys suggest over a quarter will have moderate to severe symptoms. As Magraith points out, you don’t have to be a superwoman. “Occasionally I see in my clinic someone who’s been struggling away for years, and women tend to feel that they’ve just got to keep going and keep all the balls in the air.” If you’re having a hard time, help is available, including hormone therapy to buffer the symptoms.
Ultimately, the experience varies widely and involves more than just hormones. A menopause series in The Lancet proposes an “empowerment” approach which would help make the lead-up to perimenopause a more positive prospect, giving women more control and confidence.
The authors write: “Rather than focusing on menopause as an endocrine deficiency, we propose an empowerment model that recognises factors modifying the experience, in which the patient is an expert in their own condition and the health-care worker supports the patient to become an equal and active partner in managing their own care.”
The medicalised, disease-based view of menopause, they say, overlooks potential positive effects such as better mental health with age and freedom from menstruation, menstrual disorders and contraception.
Reframing menopause can help alleviate anxiety about it, by viewing it as an empowering life transition that offers an opportunity to grow emotionally. “It is a time when a woman … transforms from the fertile years into the wisdom years,” Woolhouse says.
“The menopause transition is one of the powerful experiences in a woman’s life,” she adds. “It is a time for reverence and respect for her body, her fertility and her intuition and wisdom. In Chinese medicine it is referred to as the ‘second spring’. Spring is all about growth, vitality, colour, expansion and abundance.”
