Strength Through Menopause

For women going through hormonal shifts, exercise is key to protecting current — and future — health

With more people than ever living to 100, some women will spend more than a third of their lives postmenopause. But menopause brings hormonal changes that adversely impact muscle and bone strength. Exercise plays a major role in protecting against those losses.

That’s important because each year, one-third of people over the age of 65 falls, according to the Centers for Disease Control and Prevention. Falls can lead to fractures, disability, and an increased risk of morbidity. Worldwide, 1 in 3 women over the age of 50 will experience an osteoporotic fracture in her lifetime, according to recent statistics from the International Osteoporosis Foundation.

Debra Stern, a licensed clinical social worker and marriage and family therapist, says she always ate healthy and exercised almost daily. She enjoyed rollerblading, bicycling, and downhill skiing. When she hit menopause in her early 50s, unexpected weight gain compelled her to make changes to her nutrition and exercise habits.

“I knew I had to kick it up a notch if I was to stay healthy,” she says. “I realized I needed to be even more conscientious about not only what I ate, but the quantity of food so I could maintain a healthy weight, and of course I had to make sure I didn’t become complacent about my exercise routine.”

Each woman experiences this transition in her own way; some breeze through it, and others experience difficult symptoms that may impact their ability to sleep, exercise, or even work. Perimenopause — the shift leading up to menopause — can start in one’s 30s and is marked by a steady decrease in estrogen, progesterone, and testosterone.

“Women lose a dramatic amount of sex hormones, which affects every part of their body,” says Kristi DeSapri, MD, the founding physician of Bone & Body Women’s Health, a specialized mid-life women’s health practice focused on menopause and bone health.

Estrogen is the primary hormone in decline, and that loss affects every body system, including bone density and strength. “We lose about half a kilogram of muscle mass every year after the age of 50. From 40 to 70, we lose 8% of muscle mass, and after 70, it’s 15%,” DeSapri says.

“Women can lose 10% to 20% of their bone mass through the menopause transition,” DeSapri says. She recommends a DXA (or DEXA) scan for every woman at midlife. The scan measures bone density and can test for osteopenia (low bone density), osteoporosis (a condition causing weak and brittle bones), and risk of bone fractures. Risk factors for these conditions include being female, Caucasian, or Asian; a lower body weight; and a family history of osteoporosis. Certain medications can also contribute to bone loss, so check with your physician about any medications you’re taking.

Stern was diagnosed with osteopenia in her 60s. Her doctor advised her to increase weight-bearing exercises. “The last thing I wanted to do was work out harder, but once I did, I started feeling better,” Stern says. “As a therapist, I also know the connection between mood and exercise.”

An early start for focus on bone and body health

Therese Clementi, a physical therapist and certified orthopedic manual therapist with Rush Physical Therapy, says she wishes that women would start exercising in adolescence. “Bone density is at its peak in one’s 20s, so you want to be optimizing that. We want to maintain our weight and feel good, but most important is bone health.” Exercise plans should include resistance training to build strong muscles and bones.

If you’ve never had an exercise plan, or it’s not part of your lifestyle, there are gains to be made at any age. Clementi, who is also a licensed Pilates instructor and personal trainer, says to start easy with a slow progression. Begin with exercises that use your body weight, such as squats, and progress to heavier weights. Research shows that lifting weights you are comfortable with at higher speeds and in all directions is more impactful.

Pilates, yoga, weightlifting, and doing things around the house all count. But you need to work your way up from lifting cans of peas to make progress in building bone density and muscle strength.

DeSapri says that an ideal exercise plan combining aerobic exercise, impact and resistance, posture and balance, and stretching is challenging in people’s busy lives. But it’s important to prioritize because in menopause, she says, “Our metabolism slows, and there is more insulin resistance.” So in addition to weight-bearing exercises, DeSapri recommends 50 minutes of moderate to intense aerobic exercise three times a week.

Trust yourself as you go. “Go to a class; join a gym,” Clementi says. “There’s plenty of content on the internet. If you are really out to sea, hire a trainer, if you can.”

A 2018 study published in The Journal of Bone and Mineral Research found that a style of exercise called high-intensity resistance and impact training improved bone health and physical function in postmenopausal women with osteopenia and osteoporosis. There was no increase in spine injuries, and the program improved bone density for these women.

At age 62, Stern underwent hip replacement surgery. “It was devastating to get this diagnosis [of arthritis],” she says. “But the doctor was so encouraging with stories of others.” Within nine months, Stern was back to skiing and bicycling. “It was hard to believe that I’d be back out there doing the things I loved to do.”

Stern turned 70 this year. While she counts rollerblading as more of an activity from her past, her five-day a week routine includes going to the gym, biking, kayaking, stand-up paddle boarding, skiing, hiking and, of course, weight-bearing exercises.