Exercise during menopause could reduce hot flashes, study says
By Carina Storrs, Special to CNN
Published 9:02 AM EST, Wed January 27, 2016
Menopause 411
Women who are sedentary are 28% more likely to have severe menopausal symptoms than active women
Exercising for 30 minutes three times a week was linked with less severe hot flashes
Women who lead sedentary lives have more severe menopause symptoms compared with more physically active women, a new study finds.
Researchers in Central and South America asked more than 3,500 women living in several Latin American cities about their menopause symptoms, including hot flashes, irritability, insomnia and depression. They also asked the women how many times a week they have recently engaged in at least 30 minutes of physical activity, such as walking or jogging, bicycling or swimming.
The researchers found that women who were sedentary, meaning they exercised fewer than three times a week, were 28% more likely to report having severe menopause symptoms than those who exercised more. Not surprisingly, sedentary women were also 52% more likely to be obese.
"This is great support, and another study, showing that being sedentary is not only not good for your health, it is not good for your menopause symptoms," said Dr. JoAnn Pinkerton, executive director of the North American Menopause Society and a professor of obstetrics and gynecology at the University of Virginia. Although Pinkerton was not involved in the current study, she selected it for publication in the society's journal, Menopause, where she is an editor. The study came out on Wednesday.
Numerous studies have reported a link between physical activity and menopause symptoms, including one that found losing weight through diet and exercise, could ease hot flashes. Hot flashes and night sweats are among the most disturbing menopause symptoms, and the most common reason that women seek medical help for menopause.
In the current study, sedentary women were 21% more likely to experience hot flashes. They were also 17% more likely to feel sad or depressed.
Pinkerton suspects that exercise could also help other common menopause symptoms, such as irritability, fatigue and difficulty sleeping.
The authors of the study speculate the reason that physical activity is so good could be that it spurs the brain to produce chemicals that help control mood, sleep and alertness, such as serotonin and dopamine. These are the same chemicals that might be lacking before and during menopause when levels of estrogen drop.
"That's the current theory," Pinkerton said. Although she thinks that exercise is probably having a direct effect on reducing menopause symptoms, it is hard to rule out that other differences in the lifestyle of sedentary women, such as having more children than active women, are not also making their menopause worse.
Questions remain around the effect physical activity has on menopausal symptoms, said Rebecca C. Thurston, associate professor of psychiatry and director of the Women's Biobehavioral Health Laboratory at the University of Pittsburgh. This kind of study can't answer that question because of the other possible lifestyle differences between sedentary and active women, added Thurston, who is also an editor at the journal, Menopause, but was not involved in assessing the current study.
Exercise would probably help mood and sleep among women in menopause, Thurston said, just because it has been shown in clinical studies to have that effect for people with depression.
Even with the uncertainty, "exercise is really important for women in the menopausal transition…It will probably make them feel better, help them maintain lean muscle and bone mass and prevent heart disease that could manifest once they become postmenopausal," Thurston said.
How much should women exercise?
Exercise can help in some many ways, including reducing the risk of heart disease. But based on the fact that about 60% of people in the world are sedentary – or 63% of the women in the current study – many people have room to improve.
Although exercise can be beneficial for women of all ages, if you "start when you're in your 40s, you can avoid gaining that 12 to 15 pounds [that women often gain during the menopausal transition] and you can be in better shape and better able to handle the stresses that are thrown at you when you have hormonal changes and menopausal symptoms," Pinkerton said.
The average age that women go through menopause is 51, but before that, they go through a period called perimenopause, usually starting in their 40s. During this time, levels of estrogen fluctuate, metabolism changes and muscle can be lost, all of which can conspire to make it easy for women to gain weight and hard for them to lose weight.
Women should aim to get at least 30 minutes of exercise three days a week, Pinkerton said. That half-hour could be split up into three 10-minute sessions a day. "Instead of thinking about how I have to go to the gym for an hour, think about walking more, getting up and moving around," Pinkerton said.
It is also important to remember that exercise may not necessarily take the place of other treatments for menopausal symptoms. "Exercise may help you navigate the perimenopausal transition and may decrease the severity of hot flashes and symptoms, but if you have persistent symptoms, talk with a specialist about other options out there," Pinkerton said.
What else can help women during menopause?
Hormone therapy is the gold standard for treating just about all symptoms of menopause, Pinkerton said. Women who have severe hot flashes could be candidates, but so could those with milder symptoms, such as mood changes or difficulty sleeping, and those who want to prevent bone loss.
"But not every woman wants to or can take hormone therapy," Pinkerton said. Many women and doctors are still worried, she added, about the Women's Health Initiative study in 2002, which reported that estrogen plus progestin increased the risk of heart disease and breast cancer. However, updates to this study in the last several years suggest that hormone therapy is safe for treating women in early menopause.
Women who want to avoid hormone therapy could be candidates instead for an antidepressant, such as paroxetine, known as Paxil, Pinkerton said. They would generally take a lower dose than for treating depression, and that would be associated with fewer side effects.
The choice in treatment also depends on the types of symptoms women are having. For those who are struggling with sleep problems, a pain medication such as gabapentin, known as Neurontin, could be a good choice because one of its effects is to induce drowsiness, Pinkerton said.
For women who want to avoid medication altogether, there is some evidence that cognitive behavioral therapy and hypnosis therapy can be effective. A 2015 analysis suggested that cognitive behavioral therapy, which focuses on helping people change their thoughts and feelings to be more positive, may help improve mild depression in menopausal women.
These therapies can reduce hot flashes in general because they help women relax, which in turn can help their brains do a better job of controlling temperature perception, Pinkerton said.
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