Menopause: Management of Menopausal Symptoms

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How Do I Manage Menopausal Symptom? Great Question!

The first menopausal symptom we will be talking about is “Hot Flash”

Hot flash is one of the most typical menopausal symptom. With the hot flash symptom, you may experience sudden feeling of heat and sweating, especially over your face and neck. The cause of hot flash has not been investigated well yet, however it’s been predicted that it is caused by the decrease in level of the female sex hormone called ‘Estrogen’. The intensity of hot flush differs from person to person, and the duration may also vary from 5 to 11 years

If the intensity of hot flash isn’t severe, small changes in daily life may help alleviating the hot flash menopausal symptoms. The first thing that I want to inform you about is the ‘Hot Flash Trigger’ that may induce hot flash.

Typical triggers are:

• Hot foods and drinks
• Alcohol/liquor
• Drinks with caffeine
• Smoking
• Excessive stress

These are the most common triggering factors. However, it may vary from person to person and you can have totally unexpected triggers other than those listed above. You may think “Would these triggers be really affecting my hot flash symptoms?” However, I urge you to carefully consider these factors as you may find it to be a critical step in finding ways of alleviating hot flashes. Occasionally, OB/GYN physicians and women’s health physical therapist will recommend menopausal women to write “hot flash diaries”. By writing down all the details such as intensity, activities when hot flash occurs, foods eaten, dressing styles, stress level, and the mood state, hot flash diaries may help you to systematically comprehend the triggering factor(s) and its pattern. If you are interested in writing hot flash diary, check out this link to bottomLineInc.com, sharing free hot flash diary that you can download! https://bottomlineinc.com/health/menopause/to-stop-hot-flashes-keep-this-diary

Things that can be applied in daily lives, other than avoiding triggers are:

• Wearing clothes in layers. Wear clothes with good ventilation in layers and whenever you feel the hot flash, you may take off the outer wear.
• Prepare some items that may reduce body heat. Examples include cold water, cooling spray or ice packs, etc.
• When you feel a hot flash coming on, try slow diaphragmatic breathing. Breathe in very slowly through your nose into the inner stomach, and then, breathe out slowly through your mouth. Keep the pace of 5 to 7 breathes per minute.
• As explained above, stress can be a risk factor that can cause hot flash symptoms. To relieve stress, it is highly recommended to exercise regularly and participate in hobbies that you can enjoy.
• In order to alleviate insomnia or night sweat caused by the hot flash symptoms:
  • Wear light sleepwear with good ventilation.
  • Take blankets in layers, so whenever you feel a hot flash, you may take off one at a time.
  • You may place cool ice packs below the pillow so that whenever you feel hot flash, you may flip the pillow so that the cool side is facing you.
  • Try slow diaphragmatic breathing. Diaphragmatic breathing can help you with relaxation.
• According to a study, women with obesity are more likely to experience hot flash. In order to prevent exacerbation of hot flash symptoms, it is very important to maintain your healthy weight by exercising regularly and having well-balanced diet

The second menopausal symptom is ‘osteoporosis’

Osteoporosis is one of the most frightening diseases that causes bones to become weak and brittle. It worsens the quality of life of people and may become a huge causing factor for osteoporosis-related fractures. According to the statistics, one-third of women over 50 years old with osteoporosis experience a fracture and one-half of women over 60 years old with osteoporosis experience a fracture sometime in their lifespan. Most of the fractures occur in wrists, spines, waist, and pelvis.

What are some ways to prevent osteoporosis?

A good exercise for osteoporosis would be exercise that is good for bone formation.

Let’s have a look at some exercises that may speed up this process.

Weight Bearing Exercise

• First of all, it’s recommended to perform short exercise movement with multiple repetitions that may give mechanical loading in ‘various directions’. Multidirectional exercise exerts the loading force in multiple directions including forward/backward, left/right as well as diagonal directions. The mechanical loading doesn’t necessarily mean you need to perform weight training. Weight bearing exercise can be done with your own body weight without any weights. However, in order to induce bone formation, the intensity of exercise should be above the level that you can get from average daily activities you are doing and it should be done regularly and consistently over the period of time to see bone formation effects.
• In case you are using weights or dumb-bells during the exercise, you should begin with lighter ones and gradually build up the weight over time.
• Of course, it may depend on what kinds of exercise you are doing. Some of the weight bearing exercises which may meet the above categories include aerobic dance, Zumba dance, tennis, and jogging. It is recommended that you perform the exercise (any of above exercise) regularly for 40~45 minutes 3~4 times a week to help with bone formation process.

Resistance exercise

• Muscle contraction and relaxation can help to promote bone formation and increase bone density. One study done with menopausal women found that the regularly performed resistance exercise of the lumbar extensor (your back muscles), significantly lowered the incidence of osteoporosis related vertebral fractures.
• Resistance exercise not only helps to increase bone density, but also refine your ability to keep an upright posture (good balance!). Which in turn, will reduce one’s fall risk.
• Resistance exercise can be performed with bare hands, dumbbells, weights, resistive bands, sports equipment, etc. It is recommended to do 8-10 times per set and 2-3 repetition each time.
• Examples of resistance exercise movements are scapular retraction exercises with dumbbells, back muscle strengthening exercises, and walking sideways with a resistive band around both knees.

Whole Body Vibration Exercise

• If you find it difficult to do weight loading exercises or resistive exercises, doing whole body vibration exercise can be an another option. You may find this machine in fitness center or physical therapy clinics. According to particular study, the vibration transmitted to the bones and muscles through the vibration machine may stimulates neuromuscular tissue, and indirectly triggers bone formation.

Postural Exercises

• Postural exercise involves stretching of tightened and muscle strengthening of weak muscle. Postural exercises help in strengthening of muscle power and improves postural stability. Keeping the up right posture also helps in preventing low back pain and osteoporosis related fractures caused by falls.

Dietary habits to prevent osteoporosis

Making a good food choice and having a healthy diet is crucial in preventing osteoporosis. In order to have a healthy diet habit, you must:

• Regularly eat the foods with plenty of calcium. Recommended consumption of calcium is 1,200mg for adults and 1,500mg for adult above 65 years olds.
• Vitamin D is a necessary nutrient for calcium to be absorbed in the body. It is recommended for adults to take 1,000IU of vitamin D per day. This can be filled by having 15 minutes of sun exposure or comsming a dairy products(milk, yogurt etc).
• Excessive consumption of protein (greater than 6 oz), salt, caffeine (greater than 300mg), and over-drinking may interfere with calcium absorption.

The USDA has published a guideline called ‘Choose My Plate’ to provide dietary guideline to help public to making a healthy food choices. It categorizes and sizes foods from vegetable > grain = protein > fruit, and specifically indicates which foods can be consumed more often and which should be avoided for caloric balance and overall health. It is not directly related to the prevention of osteoporosis. However, it can be a good starting point to make a wise food choice. And of course, having a healthy diet habit is very important in providing necessary nutrients in your body and eventually in preventing osteoporosis or progression of osteoporosis.

The third and last menopausal symptom is cardiovascular disease

To learn about management tips of cardiovascular disease in menopausal women, It’s important to understand the risk factors of cardiovascular disease and finding way to reduce those risk factors. We will walk through these typical risk factors and way to eliminate those factors in daily life.

• Overdrinking

Women’s bodies do not produce as much of an enzyme that can digest the alcohol compared to men. In other words, alcohol can not be digested well and stays inside your body for a longer period of time. For this reason, excessive alcohol consumption may damage cardiac tissue, increase blood pressure and lead to cardiovascular disease.

• Increase in cholesterol level

Women’s LDL(bad cholesterol) level rises overtime. When you have regular consumption of butter, margarines, meats rich in fat, and dairy products (except low fat / fat-free), cholesterol levels will rise even higher. This may eventually increase the risk of cardiovascular diseases. In order to reduce the LDL, you should try to eliminate the foods contains transfats and start consuming more foods with fibers.

• Diabetes

Women with diabetes are 5 times more likely to experience heart attack and angina than women without diabetes. Especially, women with high blood pressure or high BMI are more vulnerable to diabetes. As mentioned above, obesity is one of the biggest factor that may result in diabetes. Therefore, it is very important to maintain healthy weight to prevent diabetes.

• Obesity

Obesity can lead to high blood pressure, stroke, heart diseases, and diabetes. Unhealthy diet habits and lack of exercises may result obesity and can become a reason for getting a coronary heart disease.

• Smoking

Smoking increases the possibility of getting heart attack and angina. If you are smoker, your heart may beat faster than non smoker and blood vessels constrict due to the chemical in cigarette. Thus smoking can actually interfere with blood circulation in your body. Specifically, the chemical called “nicotine”in the cigarette may create blood clots and can lead to heart attack or stroke.

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Exercise for Coronary Heart Disease

Key idea in strengthening your heart muscle is to regularly participate in aerobic exercises. An aerobic exercise gradually supplies the blood and oxygen to strengthens muscle of the heart. Aerobic exercise also helps to decrease level of cholesterol and blood pressure. Most common aerobic exercises are walking, jogging, swimming, and dancing. It’s recommended to perform aerobic exercise 5 times a week, 30 minutes(or more) per session. If you have been consistently doing aerobic exercises in last 3 months, you may adjust the duration, frequency, and intensity to achieve higher intensity exercises. If you are first time in trying aerobic exercise, it’s recommended to start from the lower intensity.

Lastly, how can physical therapy help with these symptoms?

Physical therapy can help with management of menopausal symptom. Physical therapists at BreakThrough are trained to educate women on the management of menopausal symptom. Your physical therapist will perform an evaluation including extensive history, physical exam and objective testing and measuring to better understand your primary concerns whether that is about your osteoporosis or cardiovascular health. Obtaining information through this evaluation process enables the physical therapist identify risk factors of your concern and movement dysfunctions that can be addressed through the physical therapy treatment. Additionally, your physical therapist will guide you through the individualized exercise that can help you to manage those symptoms. If you have any further questions, please give us call at 408-736-7600 or complete our contact us form. It will be our pleasure to assist you.

References

North American Menopause Society. (2002). Management of postmenopausal osteoporosis: position statement of The North American Menopause Society: Retracted. Menopause, 9(2), 84-101.

Huntoon EA, Schmidt CK, Sinaki M. Significantly fewer refractures after vertebroplasty in patients who engage in back-extensor strengthening exercises. Mayo Clin Proc. 2008;83(1):54-7.

80 Gomez-Cabello A, Ara I, González-Agüero A, Casajús JA, VicenteRodríguez

G (2012) Effects of training on bone mass in older adults: a systematic review. Sports Med 42: 301-325.

Khona, N. N., Maiya, A. G., Acharya, K., & Samuel, S. R. (2017). Correlation of physical activitiy level with bone mineral density, cardio-respiratory fitness and body composition in post-menopausal women. International Journal of Physiotherapy, 4(1), 6-11.

Metcalfe, L., Lohman, T., Going, S., Houtkooper, L., Ferriera, D., Flint-Wagner, H., … & Cussler, E. (2001). Post-menopausal women and exercise for prevention of osteoporosis. ACSM’s Health and Fitness Journal.

Mehta, J. N., & Mishra, D. (2013). To Measure the Cardiovascular Parameters in the Pre & Post Menopausal Women after Physical Activity. Indian Journal of Physiotherapy and Occupational Therapy, 7(4), 78.

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By Hyunhye Lee, PT, DPT