Lessons from Menopause: My Story, Advice and How Physiotherapy Can Help
October is Menopause Awareness Month, and in recent years there has definitely been more talk about perimenopause and menopause. More than there was 15 years ago, even more than there was 5 years ago! It’s a hot topic right now, and rightly so!
It’s important that women feel comfortable talking about what they are feeling during this time of life. Being able to share with their doctors, their family and friends is a crucial step in getting the support they need. That is why this blog is more personal: to share my journey through perimenopause to post menopause that started about 15 years ago.
In years past, this topic, well, anything related to menstrual cycles, seemed taboo or uncomfortable to talk about. It’s nice to see that this is changing and will hopefully make women feel more comfortable to talk about symptoms they are experiencing rather than feeling that they are “going crazy”.
My Menopause Timeline: A Personal Journey
I just entered the last year of my fifth decade and have been in post menopause for at least 8 years (it could be longer as I was never very good at tracking my menstrual cycle…).
When I look back, symptoms of perimenopause started showing up at least 15 years ago!
At that time, symptoms of menopause were just not discussed. At all. I didn’t even really think about it either, other than looking forward to not dealing with the hassle of a period every month.
In the past five years or so, I have learned so much more about perimenopause and menopause.
As a woman and a physiotherapist I began reflecting on my own experience and asking:
- What might I have done differently knowing what I know now?
- What did I do well?
By sharing my experience, I hope other women will feel more comfortable to have open conversations with their doctor, family and friends to create a support system that works for them.
Early Symptoms I Didn’t Recognize
In my early to mid 40’s I started to experience perimenopause symptoms, although I didn’t realize it at the time.
Hot flashes and night sweats, which seem to be the symptoms most commonly associated with menopause, were not a big deal for me.
I recall a few occasions when I felt warmer than usual when treating a client but nothing so severe or often that made it a problem for me. There might have been a few times that I had to change my pajamas in the middle of the night due to night sweats but it was rare.
Looking back now, I recognize that I was experiencing more of the cognitive, sleep, mood and mental health issues.
The Menopause Foundation of Canada has published a Menopause symptom tracker outlining physical symptoms, cognition and sleep symptoms, genitourinary and sexual health symptoms and mood and mental health symptoms.
I would have loved to have had a list like this 15 years ago to be more aware of the wide range of symptoms that a woman might experience during perimenopause and menopause.
Cognitive and sleep symptoms can include;
- Brain fog
- Sleep disturbances
- Forgetfulness
- Concentration issues
- Short term memory challenges
- Poor word finding
- Slower processing speed
Well I think I ticked all those boxes!
At some point I was convinced that I was going to have early onset Alzheimer's disease. I had significant trouble finding words at times, when calling out to my kids I would go through everyone’s name including the dogs before I got to them. Occasionally, I just had to ask them their name.
I really just thought I was going crazy.
I have struggled with sleep since I was a teenager with regular episodes of insomnia throughout the years and during this time the sleep issues just got worse. Worsening Restless Legs Syndrome (which I have had since my early 20’s) also didn’t help my sleep.
Mood and Mental health symptoms can include;
- Anxiety (nervous, stressed)
- Depression
- Low mood
- Feeling not yourself, low confidence
- Mood swings
- Low motivation or energy
- Crying spells
- Panic attacks
- Irritability
- Anger
My kids were in their pre-teen and teen years when I was in my 40’s.
I attributed many of the symptoms I was feeling in this area to the challenges of dealing with 2 teenage girls and a pre-teen boy.
In my early 40’s I was also busy opening a new physiotherapy clinic, all 3 of my kids were playing rep basketball, along with some other activities or sports. It was a chaotic time.
We all know that during teenage years and pregnancy that emotions are “volatile” or erratic due to hormonal chaos. We recognize this and support women during those phases of life. Perimenopause hormonal fluctuations are very similar (I am sure that many of you can relate to the range of emotions of a teenage girl), but often without the same understanding and support.
And yes - I was living with 3 teenagers at the time, but looking back, I can’t help but wonder if that was only part of the story. Thank goodness for a supportive and patient husband!
Hormones and Life Stress: A Nasty Combo
In our 40’s and 50’s, many of us are at the height of our careers and may also be caring for aging parents, and dealing with unruly teenagers.
This adds a huge load of emotional and physical stress - right when our estrogen and progesterone levels can be fluctuating wildly.
Physical symptoms can include;
- Hot flashes/night sweats
- Period changes
- Body and joint aches
- Fatigue
- Headaches and/or migraines
- Skin and hair changes
- Heart palpitations
- Dry eyes
- Dry mouth and/or dental complications
- Weight gain and changes on body fat distribution
- Changes in body odour
While I did experience some hot flashes and night sweats, they were not a significant issue for me. What I did notice was the weight gain and change in body fat distribution.
All of a sudden I was gaining weight and increasing clothing sizes seemingly every year in my mid 40’s. It felt like it came out of nowhere. I tried to explain it away by the fact that I had experienced an injury (more on that later) at age 40 that changed how I trained. But it didn’t fully make sense, and no matter what I did to change my diet or exercise, nothing seemed to change. Eventually the weight gain leveled out, but I was living in a very different body than in my 20’s and 30’s.
The Injury that Shifted My Training
In my early 40’s, I experienced a hamstring injury doing some soccer drills during a conditioning session I was hosting for my daughters soccer team. (Note to self: Don’t do running drills on wet grass without cleats - even if your kids beg you.)
The outcome wasn’t pretty. A nasty fall that led to walking difficulty for weeks and lingering limitations in my training for a long time to come.
Despite having the knowledge and tools to address my injury, life got in the way - my kids' busy schedules and a busy growing clinic took priority over full rehab (a mistake I often see clients make). As a result, every time I tried to ramp up my training, symptoms flared up.
Prior to this I was training for marathons and pre children I was an avid triathlete. Exercise and movement was always (and still is) a big part of my life and routine. While I remained active, the intensity of my training was much reduced. Due to time constraints I did not always prioritize strength training which had always been a staple of my fitness and training program. 
Could these changes have contributed to the change in my body composition along with the hormonal changes of perimenopause? Quite possibly.
Did the changes in resistance training impact the length of time to recover from my hamstring injury? Most definitely.
Did my stress levels of dealing with a busy household of 3 active teenagers along with a busy clinical practice impact my healing? Probably.
The Musculoskeletal Side of Menopause
Due to the hormonal changes, our response to stress and inflammation shifts during perimenopause and menopause.
The musculoskeletal syndrome of menopause is now well known, and identifies that the risk of musculoskeletal (joint and tendon) pain is much higher for peri- and post-menopausal women than for those who are pre-menopausal.
While my hamstring injury was the result of an ill fated decision, I also recall experiencing plantar fasciitis with no clear reason and periods of time with significant joint stiffness, particularly in the mornings. That left me feeling like an extremely old woman. I know this is a common experience - it’s a complaint I hear from clients all the time.
When I was going through all this, there was no discussion that these symptoms could be related to the changes of menopause.
It just left me feeling like I was falling apart. I was fortunate to have the knowledge and tools to help address these issues but that didn’t decrease my frustration with my body.
Genitourinary and Sexual Health Symptoms
While I was fortunate enough to not really experience many of these symptoms, it is important to be aware of them as many women do experience them.
- Vaginal/vulva dryness, itching, burning
- Painful sex
- Urinary incontinence/leaking urine
- Urinary urgency
- UTI’s
- Low libido
- Sexual arousal issues
Many assume these symptoms are just a consequence of aging so don’t do anything about it. However, we do know that there is good evidence for Pelvic Health physiotherapy to address these issues.
Building a Support Team
Although menopause wasn’t openly discussed when I went through it, it’s finally becoming a mainstream conversation, especially on social media. This is both a blessing and a curse: more awareness but also some misinformation.
The symptoms and challenges experienced during perimenopause and menopause will vary for each individual, and so, people will need different types of support in varying areas of their life.
While I have always prioritized movement and exercise into my daily routine, I felt that there were areas of my life that I needed more help and support.
In my early 50’s I started experiencing more gastrointestinal issues and my sleep and restless legs symptoms seemed to progressively worsen. Lack of sleep has far reaching effects on our bodies and I finally decided to enlist more help as I wasn’t prepared to resort to sleeping medication.
I met with a naturopath about 5 or so years ago.
While I knew a lot about nutrition, something had clearly changed for me and needed some tailored advice. A lot of information can be gathered online but I felt it important that I had a trained health professional help me navigate this information and make a plan that was appropriate for me and my body. There are so many recommendations of supplements on social media and it was helpful to have someone with knowledge of the research to help sort out facts from fads.
It was also my naturopath who suggested I start progesterone to help with my sleep.
I was initially skeptical (due to outdated fears about HRT), I took the suggestion to my doctor and had a discussion about the risks and benefits and she then prescribed both estrogen and progesterone.
For me, this has made a big difference in my sleep. I still struggle with restless legs which can have a negative effect on my sleep but it is much better!
With the help of my naturopath, I re-evaluated my diet - especially my protein intake and overall food intake.
Many women in their 50’s and 60’s grew up with the idea of needing to restrict calories to maintain or lose weight. This did not do us any favours and may contribute to feelings of fatigue and lack of progress in our fitness pursuits. Many of us are likely under fueling! It is now known that Relative Energy Deficiency syndrome (RED’s) is not just an issue with athletes but can be a problem for anyone.
I also began working with a Counsellor/Psychotherapist.
We need to remove the stigma and shame around mental health and make it easier for people to talk openly with others about their feelings and struggles and enlist help when needed.
For me, having a neutral sounding board helped me process stress, grief and overwhelm, and to set better boundaries. Like many women, I was constantly on the go (sometimes out of necessity and sometimes because ... .I am not sure why….). Sound familiar?.
The stress of this busyness can also have far reaching effects on our bodies.
Learning how to manage it, and maybe learning to say no can go a long way. This is a lesson I am still trying to learn.
Advice to my Younger Self (and the Next Generation)
- Prioritize time for YOU. We can’t care for and support others if we don’t care for ourselves.
- Establish good lifestyle habits (diet, exercise, stress management) in your 20’s and 30’s that you maintain for life.
- Really be critical of whether you are eating as well as you think you are and whether you are getting the right amount of exercise.
- Make sure to include resistance training in your exercise plan!
- Start conversations about menopause earlier -with your mother, aunts, sisters, friends, and of course your doctor.
- Normalize rest and recovery and don’t push through fatigue and burn out.
- Advocate for yourself in medical settings. Ask a lot of questions
- Learn about HRT and what the implications (risks and benefits) are for YOU.
- Build a support team
- Family doctor
- Physiotherapist (Pelvic Health Physiotherapist if needed)
- Naturopath or Dietitian
- Fitness specialist (could be a physiotherapist or kinesiologist)
- Psychotherapist/Counsellor or Psychologist
You don’t need to see everyone all the time, but surround yourself with knowledgeable, trustworthy professionals who can support you through this chapter of your life.
How Physiotherapy Can Support You During Perimenopause and Menopause
While many think of physiotherapy as something you do after an injury, it can also be very valuable for women as a proactive measure at this time of life.
Physiotherapy can help with many aspects of menopause.
Musculoskeletal health
Hormonal changes can impact bone, joint and tendon health, often increasing pain, stiffness and injury, and an increased risk of Osteoporosis.
A physiotherapist can:
- Assess and treat joint pain, stiffness and movement dysfunction
- Design personalised strength and mobility programs
- Help manage conditions such as plantar fasciitis, frozen shoulder or tendonitis, which are more common in this age group.
- Design programs that are safe for those living with Osteoporosis
Strength Training Support
Resistance training is really important during and after menopause to help maintain muscle mass and bone density.
Physiotherapists can help women:
- Learn safe and effective strength training techniques
- Build programs tailored to their goals, injuries and energy levels
- Maintain function, independence and vitality
Stress, Sleep and Recovery
I have seen in my clients and experienced in myself how stress, sleep and fatigue can derail motivation.
Physiotherapists will help you to:
- Develop movement strategies that fit your energy level
- Address physical symptoms that may be affecting sleep
- Incorporate nervous system regulating tools (ie: breathing, gentle movement)
Pelvic Health Physiotherapy
Menopause can bring changes to bladder function, pelvic pain and sexual health.
Pelvic Health Physiotherapists are trained to help with:
- Urinary leakage and urgency
- Prolapse symptoms
- Painful intercourse or vaginal discomfort
- Core and pelvic floor training
Holistic, Personalized Support
A physiotherapist's role goes beyond just injury rehab. A physiotherapist acts as a guide, coach and teammate in your health journey
You Deserve to Feel Strong, Capable, and Supported
Menopause is not an ending - it’s a transition to a new beginning.
With the right knowledge and support, it can be an opportunity to refocus on your health and create lasting change for the next phase of your life
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Miriam Mulkewich is a registered Physiotherapist and co-owner of Fit For Life Physioterapy. In addition to her training as a Physiotherapist, Miriam is a Pilates and Yoga instructor and avid runner! Miriam is passionate about helping women thrive through the menopause transition, helping them feel their best so they can do the things they love. |