#5.2 Physical Limitations to exercise in midlife

In the previous sections I have highlighted that, with the changes we experience as a woman going through menopause, we may now feel less able to do, physically, what we did before.

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It may be that you are ready to explore new challenges either instead, or as well as, what you did previously. Or that you wish to make a start on a new exercise plan. At this stage of our life, if we listen to them, our bodies will guide us.

Creating a balanced approach to exercise is, I believe, crucial to maintaining physical fitness whatever age we are but it is particularly important for women in midlife.

Unfortunately, we can be faced with some barriers as to what our body is happy to do, especially during our perimenopause when we tend to be noticing the effects of hormonal changes. We may not be able to be that leaping, energetic woman we were in our youth but with a bit of exploring we are able to be much more than that!!



As oestrogen declines our periods and menstrual cycle are likely to change. We may experience heavier loss, more regular periods, months without one then two close together or lighter periods. Let’s face it, they can be a nuisance at any time, we often feel lethargic, tired, experience aches and pains and generally feel rubbish. This will definitely not inspire us to jump about as we may normally do! You may experience less control over your bladder which is certainly a turn off to exercise!

Whatever goes on with your cycle as you go through the perimenopause, if it affects the way you feel it is better to change things up. Some lighter exercise or making time for some mindful disciplines and relaxation could make you feel better. It can also help if you know you suffer with a change of mood at the time of your period. So give yourself permission to change things up and choose things that will make you feel better rather than battle on and end up exhausted!

As we age our joints, our bones, muscles, tendons and soft tissue tend to change. This is partly hormone driven and is also part of the ageing process.

Increased inflammation, less hydration and lack of movement are contributory factors to pain and discomfort that may prevent “the want” to exercise. We can be put off by feeling discomfort when we move. However we then enter a cycle of reduced movement which unfortunately equals more discomfort and pain! We need to work with the changes and take action to ensure we maintain muscle tissue, good bone health, well- hydrated connective tissue and our mobility.

Here is a short guide to the changes that happen in menopause and beyond and how we can work with these changes to ensure good musculoskeletal health.

Our joints may stiffen due to less lubrication from synovial fluid and we may experience wear and tear that gives us pain. Cartilage may wear and spinal discs become less plump therefore provide less cushioning. We may develop some osteoarthritis (wear and tear) and experience pain as a result. In midlife there seems to be an increase of back pain, knee pain and neck pain. There are many contributory factors including wear and tear.

How can we help ourselves?
• Maintain regular movement and exercise within a comfortable range at a comfortable level
• Include strengthening exercises so that your muscles correctly support your joints
• Ensure you stay hydrated
• If need be, change your activities to reduce wear & tear and increased pain
• Maintain a healthy weight to reduce further or increased stress on your joints
• Seek help and advice from a specialist, DO NOT LIVE WITH PAIN!

As we have discussed in the bone health section, our bone health can deteriorate as we age and as oestrogen declines. For more information refer to the BONE HEALTH SECTION which will give you a comprehensive guide to maintaining good bone health.

Our muscles may shorten and tighten (and therefore often weaken) through repetitive lifestyle patterns and over time this creates muscle imbalance, possibly leading to pain and discomfort. We can lose the ability to perform simple everyday tasks because we naturally lose muscle density. However we will lose even more strength if we are not working to maintain it. Muscles may feel much stiffer and have restrictive movement if they are not well hydrated.

How can we help ourselves?
• Strength training will help to maintain muscle tissue and function
• Practice mindful activities such as Pilates or Yoga
• Ensure you stay well hydrated
• Move more and in as many directions and ways as possible
• Try not to stay in one position too long. If you have to, get up and move at regular intervals
• Improve your posture
• Practice stretching and releasing regularly
• Also practice relaxing your muscles, this is as important as working them!
• Have a regular massage if you can!

Tendons and ligaments are the structures that attach muscles to our skeleton. The decline of oestrogen has an affect on the production of collagen fibres which make up a large part of these structures.

Our tendons and ligaments become more vulnerable as we age. They become stiffer and less mobile, therefore more prone to injury. Tendonitis becomes more common which causes pain and can prevent participation in activities.

There seems to be more occurrence of tennis elbow, shoulder tendon issues, Achilles tendon issues and wrist tendon issues, all which can be debilitating and annoying!

How can we help ourselves?
• Ensuring you stay well hydrated
• Keeping tendons active through appropriate activities
• Eating adequate protein which helps build collagen fibres

Fascia is the connective tissue that encases just about everything in our body! It surrounds our organs, blood vessels, muscles, bones and provides a kind of framework for our body. It is present all the way from your big toe to the top of your head!

The health of our fascial tissue can affect your movement. If it is tight and “stuck” you cannot move as well and may experience pain. Made mostly of water (70%), collagen and elastin fibres it is important to keep the tissue hydrated.

In recent years fascia has become a very talked about subject and much research has been carried out. In a nutshell and without delving in too deep (and believe me this one can go very deep but I am not a fascia expert!) our fascial tissue benefits from movement, manual therapy and water.

There are many techniques and ideas for releasing stuck fascial tissue, using spiky balls, rollers and other massage tools which are all worth exploring but I believe that if you follow the rules of moving, stretching, hydrating and eating good “fascial healthy” foods you are a long way in to maintaining healthy fascia!

Let’s recap the best ways to help maintain good Musculoskeletal Health in menopause and beyond
• Avoid inflammation (remember this can be driven by excess sugar in the diet)
• Move more regularly
• Have a regular and appropriate exercise (this should include restorative activities)
• Stay hydrated
• Follow a well balanced diet (see my Nutrition section and Bone Health section)
• Avoid excess alcohol
• Reduce stress levels
• Improve sleep


Having continence issues because you are having problems with your pelvic floor muscles is a real turn off for exercising. We know that many women who experience this embarrassing problem avoid activities for fear of leaking or having uncontrollable wind incidents.

Another issue may be that you have a prolapse (most likely due to a weak pelvic floor) which may make exercising uncomfortable or a worry.
If this is you then most of these issues can be resolved with the right help and guidance.

DON’T FEEL YOU HAVE TO PUT UP WITH IT - We have a whole section dedicated to this so use the information and guidance available. I know it can be an embarrassing subject but there is help available.

Bloating, excess gas and an uncomfortable abdominal region can also be a turn off to exercising. Again, we do tend to suffer with more of this in our menopausal years. It doesn’t feel good to pull on a pair of lycra tights when you feel like this.

Digestive problems are linked to hormonal changes, a diet that isn’t suiting you, poor gut health, stress and many other reasons that you CAN control.

Many women find that they gain some weight in their menopausal years. Weight influences us both physically and mentally and is always a hot topic for women. Gaining weight can lead to a lack of confidence; feeling less comfortable while exercising; not knowing what to wear (that won’t show the extra pounds). A downward spiral of less exercise which then equals more weight gain.

A tough one to control but we can!
I don’t believe that women are destined to pile on the pounds in menopause, yes maybe gain a little extra weight quite possibly but unless there is a medical reason we should be able to maintain a healthy weight.
It can be hard work because we will, most likely, have to make some changes. However, as with so many other factors during menopause, we have to aim to take control.

Injuries are often unavoidable and will usually cause some disruption to your regular exercise plan. However, injuries can also occur due to incorrect technique while exercising or over training.

If you sustain an injury in midlife it often seems to take longer to heal, this is often due to the changes in our soft tissue as described in the section about musculoskeletal health. This is a time I would definitely suggest acting quickly as receiving treatment sooner rather than later will mean you will heal quicker. This will allow you to rebuild your exercise routine again. Always do this progressively so that you don’t end up back at square one.

Nutrition plays a large part in healing as does hydration, rest and rehabilitation.

As we know, sleep disruption is high on the list of menopausal symptoms, often driven by vasomotor issues such as night sweats. If you are exhausted you are unlikely to feel inclined to exercise.

This is when relaxation and mindful disciplines show their value. Instead of being hard on yourself and thinking you are failing, take time out to do something less strenuous that will aid sleep. This is a time you need to remember to be kind to yourself.

Of course, working on your sleep goes without saying but from personal experience I know how hard that can be!

Hormonal imbalances along with increased stress and contributory lifestyle factors can result in more regular and sometimes more migrane-like headaches.

No one feels much like exercising when they have a pounding headache! If you are getting regular headaches it’s always best to get checked out by your GP.

If you know your headaches are driven by stress and tension it’s a great time to explore some relaxation techniques. Tension in the muscles around the head, neck, shoulders and jaw can contribute to headaches so it’s especially important to learn to relax these. Take a moment now, check in with your jaw, is it relaxed? How is your posture? Is your chin poking? Are you frowning or screwing up your eyes? Are your shoulders tense? Check in regularly and I bet you will catch some of that happening!!
Whatever physical barriers you may feel you have to exercising, remember that so many are controllable and that this is a great stage of life to explore new options.

Let new challenges and activities light your fire and try not to see it as a failure that you have had to cease some activities.