How to protect your health and wellbeing during perimenopause

"It's a myth that we are all empty nesters and have the time to contemplate our second spring," says Catriona Courtney, a performance and lifestyle nutritionist. "I was very miffed when my GP mentioned the word menopause just as I had given birth to my fourth child. My youngest boy was born at age 43. My first thoughts were, how can I be facing menopause when I'm in the throes of nappies and the mayhem of four children under seven?"

With no clear starting or ending point, menopause comes with no directions and often no warning. While perimenopause will show helpful clues as to the direction your body is going in, this long road can span up to 10 years towards menopause, which is diagnosed retrospectively 12 months after your last period. Learning how to protect your health and wellbeing during this time is essential to remain empowered during this stage of life, something which Courtney, of elev8nutrition, feels very passionate about.

“Around age 45, I started noticing some changes,” she says. “I now know that I am in the intermediate stages of early perimenopause. However, seven years ago, it was new information to me that perimenopause could start any time from the late 30s to early 40s. I knew from my nutrition background that I would need to think about bone and cardiovascular health, but the other possible symptoms, I had no idea!”

Courtney, who ran an ultra-marathon recently, consulted with a menopause specialist to be proactive about her options and what she needed to do right now in this transition. As a sports nutritionist, she is very aware of the importance of nutrition and exercise in maintaining her physical and mental wellbeing.

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“One other myth,” she says, “is that in midlife we don’t want to do well and be confident in our exercise, participate and perform to the best of our ability. As a sports nutritionist, I looked for the information available regarding the physiological changes happening to active women in menopause and how it may impact our exercise and nutrition. Females are in general understudied with only 6 per cent female-focused research but looking for information for active women in 40s and 50s is seriously limited.”

As a runner and conscious that muscle and bone health are important, Courtney ensures exercise plays a part in being proactive in managing this transition and her changing physiology. “I have seen a huge change in my recovery time (more joint pain and aches), and I’ve adjusted my training so that I get more rest,” she says. “Frequency of exercise is greater and the volume lower (most of the time except when training for an ultramarathon!). I also noticed changes in my sweat rate. I’ve adjusted how much I drink and use more electrolytes and functional hydration during the day; otherwise, I get dizzy spells and dehydrated. What’s worse is, I feel my thirst perception has decreased. Maintaining hydration can be a struggle.”

As someone who white water rafted down the Zambezi, solo travelled around the world, and bungee jumped, Courtney has found how she manages stress and worry to have significantly changed. “I need more downtime, and crazy multitasking is next to impossible,” she says. “Worrying more does bother me. I have found meditation has been really helpful and has also benefited my sleep, but my focus and brain fog is a struggle. This is probably the most worrying. I have a genetic link to dementia, with both my parents suffering from dementia and Alzheimer’s, and this scares me a little. It manifests itself as forgetting words, dates, names and events. When the family are bombarding me with questions, I can feel that my brain is not coping so well.”

Recognising symptoms

Trying not to multitask and resting helps alleviate these perimenopausal symptoms of brain fog, but it continues to impact Courtney throughout this transition. Taking steps to recognise how symptoms affect daily life and being proactive about managing them is the first step in acknowledging this stage of life and not allowing menopause to take over your life.

This is a message routinely promoted by Catherine O'Keeffe, founder of the Menopause Success Summit. "This is the time in your life when you want to be well informed with knowledge," she says, "to understand what is happening in your body and know the choices you have to support yourself through the menopause chapter."

It can be challenging to uncover precisely when menopause-related changes begin, as so many of the symptoms of menopause are similar to other conditions. It can be an arduous and stressful matter of ruling everything else out before embarking on a journey of navigating the symptoms of menopause.

“We know one-third of women will experience challenging symptoms,” says O’Keeffe, “and indeed, this figure may well be higher than currently recorded. The psychological aspects of menopause can wreak havoc on many peoples’ lives if you are not aware of the hormonal change that your body is going through.”

O’Keeffe tells us that knowledge creates empowerment, which takes the fear out of the unknown. Managing lifestyle changes such as diet and nutrition while finding exercise we enjoy are simple ways to target symptoms.

Exercise and weight management

“Food is essential in the menopause years,” says O’Keeffe, “and is a key part of thriving through these years. Regardless of what treatment route you opt for [HRT, acupuncture, herbs, etc], this is the time when you really want to pay attention to incorporating good wholesome food into your diet. Regular bowel health is key, so a diet with fruit, vegetables, nuts and seeds as well as foods containing protein will support you during these years.”

Weight management is an additional factor for most people at some point in this transition. Understanding that it is a multifaceted approach is vital. “It takes changes in food habits, exercise, energy and motivation to keep on top of your weight at this time,” says O’Keeffe. “What can happen for many is that the tiredness and exhaustion you may feel means your food choices may not be as healthy as before, you may feel too tired to cook, and you may grab more processed foods to fill the gap.”

Exercise throughout perimenopause and menopause can ease the transition by relieving stress and enhance quality of life. But what exercise is best for menopause? “Exercise that you enjoy!” says O’Keeffe. “Let it be any exercise that makes you smile and even better if it can be weight-bearing exercise. These forms are excellent as not only are you exercising your whole body, but you are also providing active engagement and nourishment to your bones which we know is extremely important in these years, particularly in relation to future-proofing your bone health. The key is to make it a daily habit in your life.”

“Think of the perimenopause years as your opportunity to future proof your health for when you hit 80 or 90,” says O’Keeffe. “As we are living longer, these are the years that offer the opportunity to enhance our health for living well into the later years.”