Menopause Management

Navigating the journey of menopause can often feel like steering through uncharted waters. We cover the various aspects of managing menopause to empower you to make guided decisions.

Specifically, mindset and environment show how these can be shifted to increase confidence and embrace menopause as a liberating and fulfilling time in your life. Diet and lifestyle, and exercise and activity, provide practical strategies that can be implemented on a daily basis.

The importance of sleep and recovery is explored, along with sleep hygiene. Employment is covered and why challenges should be discussed openly to facilitate a comfortable, healthy and productive work environment. Social and intimate relationships, as well as sexual health, is explored with strategies for improvement.

Many of these strategies can help manage menopause symptoms, however, treatment and guidance from a healthcare professional is still required.

To learn more about treatments, visit the Menopause Treatment page, and for treatments for specific symptoms, visit the Symptoms of Menopause page.

To learn more about how to prevent impacts of menopause, visit the Prevention & Safeguarding page.

The journey through menopause is influenced by a woman’s mindset and environment, highlighting the profound mind-body connection. In other words, the mind and mental processes are influenced by the health of the body. As such, your mindset affects your mood, confidence, mental state, physical health, and more.

During menopause, women can develop a negative mindset because of physical, cognitive and psychological symptoms, appearance changes associated with hormonal changes and aging, the end of their reproductive years, and life stressors such as employment pressures and caregiving responsibilities.

Talk therapies like cognitive-behavioral therapy (CBT) as covered in Menopause Treatment, play a pivotal role in shifting your mindset. It equips women with coping strategies and techniques to address symptoms, reshape negative thoughts, and transform dysfunctional emotions, thereby positively influencing feelings and behaviors.

Sensory-based therapies include art, dance, music therapy, and visualization or guided imagery, help express feelings that might be hard to verbalize, and treat emotional and psychological symptoms.

Stress-reduction and management introduce several health benefits due to the detrimental effects stress has on the body, as well as direct and indirect menopause symptom management. Elevated stress levels can exacerbate menopause symptoms, such as hot flashes, disrupted sleep, and mood swings.

There are several stress-reduction strategies to incorporate into your everyday life. These include mind-body exercises, mindfulness practices, and self-understanding.

Mind-body exercises include yoga and Tai Chi, which combine physical postures, breathing exercises, and meditation to enhance physical and mental well-being. Mindfulness practices like meditation, breathing techniques (deep abdominal breathing, pranayama, and pursed-lip breathing), and body scan exercises can help manage anxiety, stress, fluctuating moods and emotions, and promote relaxation.

Incorporating mindfulness into everyday activities like eating, moving, walking, running, exercising, and even cleaning, can help increase awareness and shift your focus to the present moment.

On being in the present, even when thinking about the past or future, you are inherently in the present, as these thoughts occur in the present moment. However, not being in the present becomes detrimental when such thinking diverts your focus and attention from your immediate surroundings, affecting your ability to engage fully with the present.

Self-understanding, awareness, responsibility, and acceptance can form a powerful foundation for navigating menopause, allowing for a realistic approach to symptoms, aging, and personal strengths and limitations. Monitoring and keeping track of triggers and symptoms can strengthen this foundation.

Adding to these mindset strategies is the importance of your physical environment.

A noisy, stressful, or hostile environment can undermine these strategies, whereas a setting that promotes a sense of calm, and has few stressors and triggers, can support a healthy mental state. This setting may involve listening to music, nature, or anything you find aesthetically or energetically pleasing. Your environment also extends to people, relationships, and healthy interactions.

Choosing to shift your mindset and environment can help you increase confidence and embrace menopause as a liberating and fulfilling time in your life, free from the concerns of menstruation and conception.

Dietary and lifestyle considerations are not only important for menopausal weight gain, they are important for overall health and wellbeing, as well as symptom management. Being overweight can be a risk factor for several health conditions and exacerbates existing health conditions and menopause symptoms. A nutrient-dense diet rich in vitamins and minerals is an effective way to manage weight, address nutrient deficiencies, and manage symptoms.

From perimenopause on, many women find they need to eat differently, less frequently, and smaller amounts than they did prior, to maintain their bodyweight.

They find their metabolisms have changed, and the carbohydrates and sugars their bodies once tolerated become a thing of the past. Age-related reduction in muscle mass, strength, and function (sarcopenia), and hormonal fluctuations resulting in a slower metabolic rate, contribute.

Some also notice new food intolerances and foods that trigger menopause symptoms such as hot flashes. Some follow low-carbohydrate diets like Atkins, Ketogenic or Keto, and Paleo, and others follow zero-carbohydrate diets like Carnivore and Lion.

Changes that support hormonal, body composition (including increased abdominal, or visceral, fat often called menopause belly or meno belly), and metabolism changes, include diet, fasting, caloric intake, and lifestyle changes.

What, when and how much you eat and drink underpins good health and nutrition.

First, what you eat and drink, your diet, is typically the main focus.

Consuming a low-carbohydrate, including sugar, high-quality protein diet with nutrient-dense foods that contain Omega-3 fatty acids, vitamins A, C, D (ergocalciferol (D2) and cholecalciferol (D3)), E, and K, B vitamins, macrominerals, or electrolytes (sodium, phosphate, potassium, magnesium, and calcium), microminerals or trace minerals (boron, iron (particularly heme iron), zinc, copper, iodine, selenium, and manganese), and antioxidants (beta-carotene, lycopene, lutein, and zeaxanthin), can help enhance the absorption of iron, combat mood-related symptoms, and support cognitive health.

Food options include eggs, bone broth, oily fish (herring, mackerel, salmon, sardines, and trout), shellfish, pork, poultry, and red meat, including organ meat like liver.

By restricting carbohydrates and increasing protein and fat in your diet, your body makes a physiological and metabolic shift to burn fat as fuel. This means instead of your body using carbohydrates, i.e., glucose as fuel to create energy when you ingest them, it breaks down and uses fat to create energy when your body needs it.

Your body is much more efficient at burning fat stores, i.e., build-up of acids called ketones.

Choosing food sources that are unprocessed, unrefined (like Himalayan, Celtic, and Kosher salt as they contain more trace minerals than table salt), grass-fed, organic, and free from genetically-modified organisms (GMOs), refined vegetable oils, and artificial sweeteners, can support gut health, protect against oxidative stress, and reduce inflammation.

These sources may act as menopause symptom triggers as well as salicylates (naturally occurring chemicals found in fruits, vegetables, processed and GMO meats, and alcohol), goitrogens, lectins, phytates, oxalates, dairy, caffeine, foods very hot in temperature, and acidic, salty, spicy, and sugary foods.

Additionally, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) may be effective in managing menopause symptoms and gut health.

Foods that support hormonal health include phytoestrogens like coumestan found in red clover sprouts, isoflavones found in soy-based foods, lignans found in flaxseed, and stilbenes found in the skin of grapes. Probiotics like yogurt, kefir, and fermented vegetables like kimchi and sauerkraut, and prebiotics like tofu, tempeh, and miso support gut health. Seaweed (nori, kelp, kombu, wakame), fish (cod, tuna), shellfish (oysters, shrimp), dairy (milk, cheese, yogurt), eggs, and beef liver are all rich in iodine and support thyroid health.

Many of these foods are available in supplement form as included on the Menopause Treatment page.

Staying hydrated with purified (free from contaminants, impurities, and undesirable substances) water can help manage dehydration (which can exacerbate symptoms), keep skin, organs, and other bodily functions hydrated, suppress appetite, boost metabolism, and remove waste from the body.

Reducing alcoholic and caffeinated beverages, particularly at night, can be beneficial, and choosing herbal teas such as chamomile, can support sleep. Many of the dietary supplements that support menopause symptoms are also available in tea form. Some teas include green (and matcha green), black cohosh root, ginseng, chasteberry tree, red clover, dong quai, valerian root, and Ginkgo biloba.

Second, when you eat and drink is also important.

Fasting can provide the body and gut-microbiome with a necessary break from the digestion process. Intermittent fasting is based on eating and fasting during regular time periods, as after many hours without food, the body exhausts its sugar stores and begins to burn fat, called metabolic switching.

For example, you might eat two-meals, without snacking, during a 6-hour window (preferably no later than 4 hours of retiring), and fast for 18-hours, called the 18/6 protocol. When fasting, no food or caloric beverages such as coffee with milk are consumed, and sufficient macrominerals or electrolytes are maintained.

Another approach is eating regularly for five days during the week, and then restricting calories to one single low (500-600) calorie, meal on the remaining two days of the week, sometimes called the 5:2 protocol.

Intermittent fasting may some time for your body to adjust, and practices can be tailored to meet your needs and lifestyle. Fasting is effective in reducing oxidative stress and inflammation, losing weight, reducing blood pressure and heart rate, lowering cholesterol, improving cardiovascular health and memory, and providing overall protection against chronic inflammatory diseases.

Third, how much you eat is crucial for weight management, health, and overall wellbeing.

Among the three macronutrients: fat, protein, and carbohydrate, fat has the highest energy density, providing 9 calories (37.7 kilojoules) per gram, compared to 4 calories (16.7 kilojoules) per gram for protein and carbohydrate.

The denser the food (in terms of calories per gram), the higher the overall calorie count. This is why diets rich in fats can quickly result in excess calorie consumption, potentially leading to obesity. However, the issue is not fat itself, but the excess consumption of calories.

The common mentality of preferring a full plate leads to higher total calorie consumption, especially with calorie-dense foods. Recognizing this, obesity can be seen more as a result of overconsumption.

This highlights the importance of mindful eating, understanding the energy content of different foods, and keeping caloric intake at a minimum based on body weight, body composition, energy needs, risk factors, and overall health.

During menopause, making specific lifestyle changes can affect symptom management and overall health.

Limiting neurotoxins (substances that are toxic to the human nervous system), such as heavy metals like mercury (found in heavy fish and other sources) and arsenic, ethanol which is alcohol, fluoride found in soil, water, foods, and oral hygiene products, and organophosphates found in pesticides and insecticides. Additionally, caffeine and cigarette smoke are neuroactive substances. Smoking can lower estrogen levels, lead to dehydration, impair circulation, and contribute to dry mouth, as can caffeine.

Choosing a diet and lifestyle that supports your overall and hormonal health can help reduce symptoms, prevent exacerbation of symptoms, and enhance your quality of life.

Exercising regularly and being active is important at any age, and becomes even more important for menopausal and aging women. The age-related reduction in muscle mass, strength, and function (sarcopenia) can contribute to weight gain, alongside reduced estrogen levels, increased food intake, decreased physical activity, and a reduced metabolic rate.

Regular physical exercise and activity helps reduce stress hormones, such as adrenaline and cortisol, and increase blood flow and circulation in the body. It can help boost mood, manage weight, increase flexibility, strength, and bone density, reduce risk of diseases like cardiovascular disease and osteoporosis, manage menopause symptoms including musculoskeletal pain, keep the body toned, promote sleep, improve sleep quality, and reduce sleep disturbances.

Physical exercise is a personal endeavor based on goals, preferences, and health status, and has multiple dimensions, including intensity, frequency, duration, and mode.

Intensity refers to energy expenditure, which is an indicator of metabolic demand, or how hard your body is working during physical activity. Intensity can be measured in various ways, including by heart rate, perceived exertion, or specific metrics like the amount of weight lifted or the speed of running. Common terms for intensity levels include low, moderate, high, or vigorous.

Frequency refers to the number of sessions in a time period such as a week, for example three sessions per week.

Duration refers to the length of time in minutes or hours of each exercise session, for example, a 30-minute cycling session.

Mode refers to the category and type of exercise, for example endurance (or aerobic or cardiovascular) such as cycling, strength (or resistance) such as weight training, balance such as Tai Chi, and flexibility such as stretching. These exercises can be completed alone, with a partner, in a group, as a team, or with guidance from a personal trainer, physical therapist, or other resource.

Physical activity involving movement of your body requiring energy encompasses house chores such as cleaning, yard work such as gardening, mowing, raking, and sweeping, carrying groceries, boxes, or furniture, and climbing stairs, inclines, or hills. This is also called non-exercise activity thermogenesis (NEAT) which is energy expended for activities other than sleeping, eating, or physical exercise.

Physical endurance exercises increase fitness and include walking, running, cycling, swimming, aqua aerobics, rowing, skipping, plyometric exercises like box jumps, aerobic classes, and circuit training.

Strength training exercises include overhead press, chest press, flyes, push-ups, squats, lunges, deadlift, calf raises, rows, dips, bicep curls, triceps extension, plank, and abdominal curls, which can be beneficial for sarcopenia.

Balance exercises include Tai Chi, standing alternate knee raise, single leg stand, heel-to-toe walk, sit to stand, side leg raise, and calf raises. Balance and flexibility exercises promote physical stability. Flexibility exercises include Pilates, yoga, pelvic floor, or Kegel exercises, and stretches include neck rotation, neck stretch, full-body, side bend, standing quad, calf, and knees to chest.

Pelvic floor exercises help strengthen pelvic floor muscles and manage genitourinary syndrome of menopause (GSM) symptoms. Yoga, Tai Chi, and Pilates are body movement therapies and mind-body exercises that combine physical postures, breathing exercises, and meditation to enhance physical and mental well-being.

Low-impact exercises that reduce strain on joints and muscles include those that are water-based like swimming and aqua aerobics, walking, cycling, yoga, Tai Chi, stationary lunges, bodyweight squats, dumbbell farmer’s walk, resistance band training, and dumbbell and machine weight exercises for all body parts.

High-intensity and high-impact exercises like plyometrics when performed under supervision using correct form and technique, can help slow bone resorption and increase bone formation potentially reducing the risk of osteoporosis.

Cold therapy (cold showers or ice baths, cooling sprays, and cool packs or ice packs) following exercise can help boost mood, increase immunity, improve circulation, reduce inflammation, prevent muscle soreness, and relieve localized pain.

During physical exercise and activity, it is important to consider environmental factors. Avoiding extreme temperatures and staying well-hydrated, with adequate macromineral or electrolyte balance, can enhance exercise effectiveness, comfort, and safety.

The importance of restorative sleep and recovery for mind and body repair is a necessity for optimal health, wellbeing, and both healthspan and lifespan.

Restorative sleep helps maximize immunity, prevent illness, reduce inflammation, stiffness and swelling, control insulin levels, stabilize body weight, regulate hormones, manage moods, maintain focus, and manage symptoms associated with menopause. Sleep is also essential for cognitive function, synthesizing memories and emotions, recuperating from physical exertion and daily stresses, and regulating vital bodily functions such as metabolism.

Our sleep/wake cycle, encompassing the hours we are awake and asleep, is governed by two vital mechanisms: Sleep Homeostasis (also known as sleep pressure) and the circadian rhythm (your body clock). Sleep pressure signals when the body needs rest, while the 24-hour body clock dictates the timing of this sleep. For deep, restorative, and uninterrupted sleep to occur, these two processes need to synchronize. If they don’t, they can exacerbate menopause symptoms, affect mood, and day-to-day functioning and productivity.

Avoiding alcohol, smoking, caffeine (from coffee, non-herbal teas, energy drinks, etc.), or any other stimulants within four hours of retiring, can help promote the healthy accumulation and sensation of sleep pressure.

Sleep products, devices, and dietary supplements like chamomile extract (Matricaria chamomilla), Gamma-Aminobutyric Acid (GABA), 5-Hydroxytryptophan (5-HTP) (Griffonia simplicifolia), magnesium, and melatonin, may encourage deep sleep.

Employing sleep hygiene practices can boost or reset your circadian rhythm and get melatonin levels on track. Melatonin is a natural sleep hormone that signals your body to prepare for sleep. It relies on light exposure through your eyes to regulate sleep/wake cycles.

Sleep hygiene practices can be employed before, during, and after sleep.

First, before sleep includes avoiding unstructured napping during the day, and stimulants as mentioned above within four hours of retiring.

Other things to avoid within this time frame include physical exercise, vasomotor triggers such as acidic, salty, spicy, and carbohydrate heavy including sugary foods, eating (preferably fasting for 16 hours between your last meal and breakfast), high fluid intake to prevent sleep disruptions from needing to urinate, and bright unnatural light and blue light from electronic devices, which may include dimming bright lights or wearing blue-blocking glasses with orange lenses.

Following a pre-sleep ritual and regular sleep schedule is the foundation to deep sleep.

A pre-sleep ritual may include reading a printed book, magazine, or article, having a warm shower finishing with 3-4 minutes of cold water, reflecting on the current day, planning your next day, writing in a journal, and removing any visible clock faces to prevent clock-watching anxiety.

A regular sleep schedule may include retiring and rising at the same time, even on weekends, within a 30-minute window, aiming for 6-7 hours of sleep.

Second, during sleep includes sleeping in an environment that is comfortable (bedding and clothing), cool (optimal temperature control), dark (using block out blinds or blindfolds), quiet (using earplugs or white noise machines), and device-free (turned off and in another room), to promote deep and restorative sleep.

Optimal temperature control is particularly important due to menopause symptoms affecting sleep such as vasomotor symptoms like nights sweats, GSM symptoms like urinary incontinence, anxiety, and stress, and sleep disorders such as sleep apnea.

Specifically, using fans or air conditioners, using cotton sheets, wearing light cotton nightwear, and changing any wet clothing or bedding from night sweats immediately to prevent subsequent cold flashes, can help promote uninterrupted sleep. Additionally, sleeping on your back or side can help aid digestion, reducing heartburn and reflux.

Third, after sleep includes using an alarm to wake up, staying in bed if you wake up before the alarm, exercising (preferably outside) first thing in morning or during the day (and not within four hours of retiring), and following a post-sleep ritual.

A post-sleep ritual may include making your bed, reflecting on your sleep, revisiting your day’s agenda, writing in a journal, and getting 20-30 minutes of sunlight early in the morning. On sunlight, this should be immediately after rising without wearing sunglasses, making sure not to look at the sun directly. This helps to reset your circadian rhythm and limit any ultraviolet (UV) damage.

Prioritizing all stages of sleep and recovery is paramount in managing menopause. It not only aids in physical and cognitive restoration, it also contributes to mental and physical health and wellbeing. Lastly, medical tests may be required for any suspected sleep or health disorders affecting sleep.

Women’s’ experiences with menopause and their symptoms extend to their employment settings and responsibilities, and social interactions.

Employment settings and responsibilities may include being employed or self-employed, having paid or unpaid (including volunteer) work, being a homemaker or caregiver, and being a board or committee member.

Social interaction includes friendship, support, special interest, exercise, and sporting groups, and other environments where social interactions take place.

First, menopause symptoms can influence how you experience your work environment, and specific job responsibilities may intensify these symptoms. This can result in varying degrees of discomfort and challenges, affecting your productivity and potentially leading to increased absenteeism and presenteeism.

These challenges can include physical and psychosocial elements.

Physical elements include inadequate ventilation and temperature control, exposure to toxins and chemicals, access to rest areas and toilets, and ergonomic factors affecting health and productivity.

Psychosocial elements include working hours, breaks, lack of management support, work stress, organizational culture, and work/life balance.

Discussing challenges openly with employers is required to make any adjustments, complete risk, and workplace assessments, and support a comfortable, healthy and productive work environment and experience.

Second, during menopause and aging, social interaction becomes increasingly vital in managing symptoms and enhancing overall well-being.

You may notice a decreased interest in activities and social gatherings you once enjoyed, including hobbies, sports, and spending time with friends.

This change can extend to challenges in maintaining relationships and even daily routines due to menopause symptoms like hearing difficulties, memory impairment, or urinary incontinence. However, maintaining social connections, participating in cognitively stimulating and enjoyable activities, including once that make you laugh, using memory aids like reminders and lists, can help reduce anxiety and stress levels, combat isolation, and provide a sense of purpose and community.

Additionally, engaging in open conversations about menopause provides emotional support and valuable insights.

Doing what it takes to create a comfortable, healthy and productive work environment, and keeping socially and cognitively stimulated can help manage menopause symptoms, including mood swings, overwhelm, stress, and memory impairment, and improve your quality of life.

Navigating relationships and sexual health during menopause, and aging, is pivotal for overall well-being.

The various symptoms of menopause can place strain on relationships with spouses, partners, children, parents, other family members, colleagues, friends, and acquaintances.

This strain can extend to the bedroom and be further exacerbated by GSM symptoms on sexual (low sex drive (low libido), orgasm and sexual arousal difficulty, and painful sexual intercourse (dyspareunia)), urinary (urinary tract infection (UTI), kidney infection (pyelonephritis), and urinary incontinence), and vaginal (dry vagina, vaginal tear, and pelvic organ prolapse (POP)) dimensions.

Challenges in relationships and sexual experiences may present as anger, boredom, impatience, irritability, distractibility, low-self-esteem, withdrawal, decreased intimacy, and feelings of isolation and rejection. Often, spouses and partners can bear the brunt of these expressions, as they are the ones you spend the most time with and feel the most comfortable around.

Preparation, adaptability, and open, honest and early communication are key in managing these challenges, including any previous unresolved issues, and can help mitigate strain, foster understanding, and enhance overall experiences.

In addition to preparation, adaptability, and communication, several strategies can help improve relationships.

First, accepting any hormonal, physical, and psychological changes associated with menopause and aging, and their subsequent impacts.

Second, treating and managing symptoms indirectly or directly impacting your relationship.

Third, helping your spouse or partner understand the changes you are experiencing by telling them directly, and directing them to resources such as the Men’s Section on this site.

Additionally, asking them what their needs are and how you can support them is very important in any partnership. And in scenarios where additional help is required, counseling, couple therapy, or sex therapy, may assist as covered on the Menopause Treatment page.

While a decrease in the amount of oxytocin in the body occurs during menopause, sexual activity releases oxytocin and endorphins, hormones that help to decrease feelings of pain, reduce stress, boost mood, and promote feelings of wellbeing.

A number of strategies, in addition to preparation, adaptability, and communication, can lead to more fulfilling sexual experiences.

First, making lifestyle adjustments such as reducing alcohol, caffeine, and smoking consumption which can exacerbate menopausal symptoms, impact the endocrine system, and hinder blood circulation, affecting vaginal lubrication.

Second, treating and managing symptoms indirectly and directly affecting your sexual experiences, such as Hormone Replacement Therapy (HRT) in the form of low-dose vaginal products. This includes anything affecting your partner, such as Testosterone Deficiency Syndrome (TDS), erectile dysfunction (ED), prostate disease, low libido, and premature, delayed or retrograde ejaculation.

Third, minimizing anxiety and stress through mind-body exercises like yoga and Tai Chi and mindfulness practices like meditation and deep breathing.

Fourth, prioritizing affection and intimacy outside of the bedroom by kissing, hugging, touching, holding hands, maintaining eye contact, spending time together, and participating in activities you both enjoy.

Fifth, creating an ambience for sexual experiences, including playing music, having dimmed lighting, using candles, diffusing essential oils, and removing any visible distractions.

Sixth, sexual experiences can be enjoyable with or without intercourse, for example, masturbation (autoeroticism or autosexuality), foreplay, and massage.

Seventh, protect against infection by having protected sex using condoms, avoiding products that irritate the vaginal area, keeping your vaginal area dry, wearing cotton underwear and loose clothing to help your vagina and vulval area breathe, and urinating and drinking purified water following sexual intercourse to flush out bacteria before it travels up the urethra.

Products that may irritate the vaginal area include scented soaps, toilet paper, or sanitary products, as well as douches, which are devices used to wash the vagina.

Last, changes around sexual intercourse can be highly impactful. By practicing patience, being open to different paces and positions, role playing, and fantasies, sharing what feels indifferent, pleasurable and painful, and using products and devices, can help improve the sexual experience.

Products include vaginal and warming lubricants to decrease discomfort and increase sexual pleasure, topical creams to dilate blood vessels, increase blood flow and oxygen, and arousal oils to warm the clitoris and increase stimulation during sexual intercourse and masturbation.

Devices like vibrators and sex toys can help increase sexual pleasure, and vaginal dilators can relax tight vaginal muscles, improve natural lubrication, and re-strengthen weak pelvic floor muscles.

To learn more about sex and menopause, visit the Guide to Sex Around Menopause.

Menopause and aging do not signify the end of deep, enjoyable, and healthy relationships, or satisfying, diverse, and healthy sexual experiences.

Many women in fact have better relationships and sex lives than they did before menopause as they become more confident in themselves, develop different perspectives, and have different life responsibilities.

From adjusting your mindset and environment, to implementing changes in diet, lifestyle, and exercise routines, along with understanding the significance of sleep and recovery, this section has covered the essential areas to support you in managing menopause, and experiencing it as a positive time in your life.

The importance of maintaining a productive employment environment and healthy social and intimate relationships, including sexual health, has also been highlighted.

While these management strategies offer valuable tools for symptom management and overall health and wellbeing, consulting healthcare professionals for personalized treatment, management, and advice is crucial.