Glen Pyle, PhD
Glen Pyle is a Professor of Biomedical Sciences at the University of Guelph and an Associate Member of the IMPART Investigator Team Canada Network at Dalhousie Medicine.

Glen Pyle, PhD
Glen Pyle is a Professor of Biomedical Sciences at the University of Guelph and an Associate Member of the IMPART Investigator Team Canada Network at Dalhousie Medicine.

The saying “an ounce of prevention is the best cure” is a frequently repeated mantra in medicine. While prevention is a great strategy for many health conditions, menopause – and its associated health risks – is unavoidable for women.

What is menopause?

Menopause is a natural phase of life for women where menstrual cycles stop. For most women menopause starts around the age of 50. In addition to the loss of fertility, menopause is associated with a large decrease in estrogens produced by the ovaries. While estrogens are most commonly known as important hormones for reproduction, they have impacts on all systems of the body. With a loss of estrogens the risk for a number of health conditions rises in menopausal women.

What are the health risks after menopause?

After menopause the risks for cardiovascular disease, osteoporosis, and neurological problems all increase, as do a number of other health concerns. These changes impact the quality of life for women by affecting things like memory and mobility. Some health issues like stroke or heart attacks are associated with an increased risk of death.

Cardiovascular disease risks

For most of their lives women have lower rates of cardiovascular disease than men. But after menopause the risk for cardiovascular disease rises to equal or even exceed levels seen in males of the same age. In fact, cardiovascular disease is the leading cause of death for women and the rate rises in women over 50.

The increased risk of cardiovascular morbidity and mortality is driven by a number of menopausal changes including increased LDL-cholesterol and decreased-HDL cholesterol.

After menopause, the risk for cardiovascular disease in women increases to that seen in men.

What can be done to reduce the health risk associated with menopause?

At one point hormone replacement therapy was touted as a panacea for these challenges, but inconsistent clinical trial results caused women to largely abandon the therapy, except for very specific instances.

As hormone replacement therapy fell out of favour, women and their healthcare providers searched for alternatives to reduce the risk of cardiovascular disease, dementia, and osteoporosis. According to recent studies, exercise – an old and little used therapy – may be just what the doctor ordered to reduce the health risks associated with menopause.

Benefits of Exercise during menopause

Aerobic exercise and resistance training reduce risk factors for heart disease

Sedentary, overweight, postmenopausal women saw a decrease in LDL-cholesterol levels after a 12-week exercise program. Women who participated in an aerobic exercise plan saw the most significant benefits.

Even resistance exercise can positively impact cardiovascular risk in postmenopausal women. A 6-year, randomized clinical trial found resistance exercise slowed the increase in body fat that normally occurs in sedentary postmenopausal women. Another showed resistance exercise decreased metabolic syndrome severity, a chronic condition that increases the risk of cardiovascular disease. A recent pilot study of 55 postmenopausal women found 15-weeks of resistance training had beneficial effects on cholesterol profiles. Together these studies show weight-lifting 2-3 times a week has significant benefits for cardiovascular health in postmenopausal women.

Woman working arms with dumbells at the gym
Resistance exercise slows down body fat accumulation, decreases metabolic syndrome severity and improves cholesterol profile in postmenopausal women.

Exercise after menopause lowers blood pressure

Before menopause, women have lower rates of hypertension than men, but by age 65, 75% of postmenopausal women have high blood pressure – a rate that exceeds that of men.

A review of 7 studies found that combined aerobic and resistance programs helped to prevent or reverse mild to moderate hypertension. Exercises included moderate intensity stair climbing, circuit training, and Taekwondo, 3 times a week for up to 12 weeks.

Exercise after menopause slows down bone loss 

Osteoporosis is a degenerative bone condition that impacts up to 70% of women by age 80. Osteoporosis decreases mobility, increases the risk of bone fracture, and can indirectly increase the risk of death because of the decreased ability to exercise, or even from complications associated with bone fractures.

Regular walking has some benefits for bone density, but the effects due to this singular activity are generally small. However, regular exercise programs (more than twice a week) show more significant benefits in slowing the development of osteoporosis in post-menopausal women.

A review of 96 studies involving 77 different walking programs found benefits for bone density in post-menopausal women, along with a number of positive effects on menopause-related issues including cardiovascular risk; obesity; and mental health.

German researchers reviewed 74 studies that investigated the potential benefits of strength training in postmenopausal women. Both resistance and weight bearing exercise improved bone mineral density in postmenopausal women. While the benefits of strength training on bone health were clear, the studies found that only exercise programs started early in menopause were effective. Waiting until after 60 years of age limits the benefits on bone density.

Exercise after menopause reduces inflammation

Menopause is associated with an increase in inflammatory markers. While it might seem good to have higher immune system activity for defense against infections, high levels are potentially unhealthy. High levels of inflammatory markers are linked to numerous chronic health conditions including metabolic syndrome, type 2 diabetes, and cardiovascular disease.

A review of 32 studies including 1510 postmenopausal women found aerobic, resistance, and combined exercise programs decreased inflammatory markers like C-reactive protein. A reduction in inflammatory markers is linked to a lower risk of cardiovascular disease.

A woman using a jump rope on an urban bridge.
Aerobic, resistance, and combined exercise programs reduce inflammation and slow down bone loss.

Exercise improves quality of life in menopausal women

Regular exercise improves many physical and psychosocial challenges of menopause including insomnia, fatigue, irritability, pain, and mobility. These improvements not only decrease the risk of disease, they can also improve quality of life.

For many women exercise is a social activity that decreases isolation and helps maintain or even improve mental health. Postmenopausal women who had moderate to high levels of physical activity experienced fewer depressive symptoms and were more satisfied with life than women with low levels of physical activity.

Flexibility is a critical trait to help maintain daily life and reduce the risk of falls. Daily stretching will help to improve and maintain flexibility, and more structured activities like yoga contribute to flexibility while also helping strength and balance

But exercise is not a cure for all elements of menopause. The ability of exercise to decrease vasomotor symptoms – the cause of ‘hot flashes’ – is much less consistent, and there is not strong evidence to show that exercise is an effective tool to alleviate this issue.

60 years old woman at the beach
Exercise improves quality of life in postmenopausal women by lowering fatigue, improving insomnia, reducing pain and improving mobility.

How much exercise is needed to see benefits in post-menopausal women?

Recommendations for aerobic exercise are activities that increase heart rate to 120-130 bpm for 30 minutes, 5 days a week, or a target heart rate of 140-150 bpm for 20 minutes, 3 days a week.

Strength training should be done on two non-consecutive days a week, with 10-15 repetitions of each exercise at a 60-70% of the maximum weight. Activities should be varied to involve different muscle groups during the session to provide a balanced workout and decrease the risk of injury.

Exercise recommendations during menopause

While exercise has clear benefits for people of all ages, there are some risks that increase with age. The risk of falling or having a cardiovascular event like a heart attack, angina, or stroke increases with age.

Anyone starting an exercise program should start with low levels of activity and gradually increase intensity, duration, and frequency over time. Significant discomfort, pain, or injury are signs that intensity is too high and the activity levels should be decreased.

For those with risk factors or pre-existing conditions, a healthcare provider should be consulted before starting an exercise program to determine the types and level of activity that are safe and effective. They can also help to set realistic and attainable goals, which increases the likelihood of success.

The best way to start an exercise program is to integrate physical activity into everyday life. Exercise can be as simple as taking a brisk walk at lunch or playing tennis at a local park. More social activities like dancing, playing a team sport, or taking a class at a fitness club can offer the added benefits of social engagement.

Making exercise a part of normal, daily life ensures that it is done regularly and picking an activity that is enjoyable makes it more likely that exercise is seen as a desirable activity, not something that should be dreaded.