- 1 Definition
- 2 Types of Menopause
- 3 Clinical Exam
- 4 Longterm Effects of Menopause
- 5 Management
- 6 Medical Interventions
- 7 Resources
- 8 References
Natural menopause occurs when there is a complete, or near complete, ovarian follicular depletion of a female's ovaries and loss of ovarian follicular activity, resulting in the permanent cessation of her menstrual cycle. It occurs at a median age of 51.4 years and the months and years leading up to this are called peri-menopause. Menopause before the age of 40 years old is considered abnormal. The transition into and through menopause can have various physical, psychological, and social effects on a woman's life,  and the ability to cope with these changes can be impacted by socioeconomic status, income, level of education, work-life, and social relations.
Types of Menopause
Also known as a spontaneous progressive decline of the menstrual cycle due to the decline of ovarian function, the average age is between 40-51 years of age.
- Premature menopause: cessation of ovarian function before the age of 40. Females who experience premature menopause have a greater probability of developing early mortality and morbidity rates.
- Artificial or surgical menopause: permanent cessation of ovarian function due to surgical intervention, or medical treatment like chemotherapy or pelvic radiation therapy.
- Delayed menopause: cessation of ovarian function after the age of 51.
Symptoms of menopause and peri-menopause:
|Vaginal dryness and/or Sexual dysfunction||
|Joint pain/ arthritis Musculoskeletal pain/arthralgia||
Stages of Reproductive Aging Workshop (STRAW) is a staging system developed from data from multiple longitudinal cohort studies. This system is considered the gold standard for assessments with menopausal women and includes criteria for the reproductive years, the menopausal transition, perimenopause, final menstrual period (FMP), and postmenopause based upon bleeding patterns, endocrine findings, and symptoms. The STRAW system is used mainly in research, however, it may be helpful in the clinical setting for patients and clinicians to assess fertility potential, contraceptive needs, and the potential need for hormone therapy.
|Late reproductive years||May begin to notice changes in her menstrual cycle (ie. a shorter cycle)|
|Early menopausal transition||Marked by increased variability in menstrual cycle length|
|Late menopausal transition||Marked by the occurrence of amenorrhea of 60 days or longer
Characterized by increased variability in cycle length and extreme fluctuations in hormonal levels
|Early postmenopause period||Corresponds to the end of “perimenopause,” a term still in common usage that means the time around menopause|
|Late postmenopause period||Symptoms of vaginal dryness and urogenital atrophy become increasingly prevalent at this time|
Longterm Effects of Menopause
Physical Therapy Intervention
As part of the healthcare team, physiotherapists should be aware of the menopausal process and the symptoms that can come along with this transition. Many of the symptoms and health concerns described above can have a negative impact on women's health and overall quality of life. It is crucial to be able to identify symptoms in menopausal women through individualized assessments and provide appropriate management strategies, such as exercise and pain management, or referrals to other healthcare professionals when needed.
Sexual health may be negatively impacted by some of the issues stated above. Simple, non‐hormonal interventions for sexual dysfunction are often overlooked. Several studies show that education on vaginal lubricants, moisturizers, and dilator use (as needed) can have a positive impact on sexual health. Pelvic health physiotherapists are well-positioned to assist patients with this.
- Weight-bearing exercise:
- Low impact weight-bearing activity such as walking, Tai Chi, and yoga.
- High impact weight-bearing activity such as jogging and vibration platforms.
2. Resistance and Strength Training Exercise:
- Examples include weight lifting, swimming, cycling.
Physical activity and exercise have been shown to have reduce the risk of osteoporosis, cardiovascular disease depression and obesity.
Osteoporosis and Bone Density
Studies show that physiotherapists are able to assist in providing guidance around exercise and exercise prescription in this population.(ref) However, not all exercises have the same osteogenic effects. Resistance exercise has a stronger osteogenic effect, and for exercise to be effective its mechanical load should exceed that of activities of daily life.
To obtain the best results, a combination of exercises that include both resistance and weight-bearing exercises is the best choice to optimize strength and function. Resistance exercise affects muscular loading whereas weight-bearing exercises have a mechanical loading effect on bone.
The mechanisms in which exercise impacts bone density is still not clear but research suggests that exercise increases the activity of osteoblasts and inhibits osteoclast activity. Enhanced bone strength increases the cross-sectional area due to mechanical loading, which in turn increases bone resistance. A systematic review encompassing only randomized controlled trials, conducted by Howe et al. (2011), examined the effectiveness of exercise interventions in preventing bone loss and fractures in postmenopausal women, and they found that exercise was a safe and effective way to prevent bone loss in this population.
Additionally, higher levels of participation in physical activity were independently associated with lower weight, waist circumference, and risk of substantial weight gain.
Regular and gradual aerobic exercise programs can improve cardiorespiratory endurance and decrease the risk of CVD. Some research suggests that exercise increases levels of high-density lipoproteins (HDL), decreases low-density lipoproteins (LDL) and TAG (define?), and controls hypertension, which in turn improves cardiovascular health.
Exercise therapy has the ability to relieve some symptoms in persons with depression when compared to participants without clinical depressive symptoms.
Research shows an increase in levels of brain-derived neurotrophic factor (BDNF) in the depressed population, however, this did not result in an improvement in depressive symptoms. The mechanisms in which exercise impacts depression is not clear.
Regular exercise programs show to increase metabolic rate and energy expenditure, promoting the loss of abdominal fats.
Exercise in the water allows for a reduction of stress on muscles and joints. Aquatic therapy could be a good alternative for women who experience pain due to stress on joints.
Benefits of Aquatic Therapy
- The Bouncy effect protects joints from the stress of exercise that in turn relieves joint pain from conditions like arthritis.
- Improves general blood circulation and reduces swelling.
- Provides a comfortable environment for strengthening exercise programs
- Improves cardiorespiratory capacity and endurance.
- Can help to improve balance.
Physicians or a Registered Dietitian/Nutritionist can advise on the dietary needs of women going through menopause. Vitamin D and calcium supplements may benefit this population, however, a dietician or a naturopathic doctor should be consulted when determining supplementation.
Low caloric diet (calculated according to each individual's total calorie intake) with exercise shows to be most effective for weight loss and loss of abdominal fats. Van Gemert and colleagues (2019) looked at an exercise program involving 4hrs/week, 60 minutes/day exercise varying between resistance and endurance exercises.
Patients should discuss treatment options with their physician and healthcare team. This may include menopause hormone replacement therapy to aid with the issues listed above. Hormonal replacement therapy (HRT) may be a supportive method includes estrogen with progestin, for example, Resveratrol (phytoestrogen) has been shown to positively affect improvements in cognitive decline and cerebrovascular function.
Psychological Intervention: Connecting with other women going through menopause or speaking to a therapist may add extra support for menopausal women.
American College of Obstetricians and Gynecologists: Menopause Resource Overview
For further information on managing menopause, please refer to this presentation by Dr. Kathryn Macaulay
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