Exercise as medicine for Menopause if you are unable to take certain medications such as Menopause Hormone Treatment (MHT) used to be known as HRT - Specifically post Breast Cancer diagnosis.

Menopause and all the joyful symptoms it brings can be tricky at the best of times! But how do you go about it when you’ve got a history of breast cancer?

For some people, a breast cancer diagnosis and the associated treatment means that they go into early Menopause, or they get a re awakening of their Menopause symptoms. For others, taking hormone replacement therapy (HRT) may be complicated or not an option.

So, what options do you have to manage Menopause symptoms when hormone replacement therapy is not an option?

While there are a range of prescription medications that can help to manage various symptoms, the focus of today’s blog is on exercise.

We all know that exercise is good for us, but how can exercise specifically help you when it comes to managing Menopause symptoms?

Hot Flushes & Night Sweats

Hot flushes and night sweats (collectively known as vasomotor symptoms) occur due to hormone changes creating a dysregulation in temperature. These can cause significant discomfort, annoyance and interruption and can impact our overall quality of life.

Observational studies have shown that women who are more physically active experience fewer hot flushes compared to those who are sedentary. When we directly compare women who are completing a strength training intervention with those who are doing no strength exercise, those doing regular strength training reported an almost 50% reduction in frequency of hot flushes. Research has also shown that a combination of both aerobic and strength exercise can have a positive impact on hot flushes and night sweats.

In addition to the positive effects of reducing frequency of the hot flushes themselves, research also suggests that those who participate in regular exercise have improved quality of life during Menopause. This is in part due to an improvement in mood and ability to cope with the symptoms of Menopause.

Sleep

Sleep is another thing that can get tricky when it comes to Menopause. Sleep disturbances can come in the form of night sweats (see above) as well as reduced sleep quantity and sleep quality, including restlessness.

Increased vasomotor symptoms (night sweats) as well as higher incidence of depression appear to be associated with poor sleep outcomes, as does higher body weight and increasing age. Hormone therapies such as aromatase inhibitors (e.g. Anastrozole) for breast cancer treatment also increase the likelihood of sleep disturbances.

While we may not be able to do much about the number of birthdays we have had, we do know that exercise can have a positive effect on body weight and symptoms of depression. Regular participation in exercise has been shown to be beneficial in the management of depressive symptoms, across a wide range of populations. And as we have already covered, exercise can also help to manage night sweats.

Another advantage of exercise is that it can also help to manage cortisol levels. Cortisol is our major stress hormone and can play a role in preventing you getting to sleep as well as nighttime waking.

The research is mixed on how helpful exercise can be in managing the side-effects associated with aromatase inhibitors, however we do know there are a vast number of benefits associated with regular exercise participation for women undergoing treatment for breast cancer, in particular bone and muscle health, as we discuss below!

Pelvic Health

We experience a reduction in estrogen and progesterone as we enter Menopause, which can lead to vaginal dryness, atrophy, impaired sexual function and urinary incontinence. This can also increase the risk of urinary tract infections.

Specific pelvic floor exercises have been shown to aid in the management of urinary incontinence which can lead to a decrease in the frequency of urinary tract infections and improve sexual function.

It is a good idea to consult a women’s health physiotherapist or exercise physiologist for specific guidance on appropriate pelvic floor exercises.

Bone and Muscle Health

Another important symptom that you need to be aware of when dealing with Menopause, is the increased risk of bone and muscle loss. While we don’t always directly feel these as a symptom the way we do with hot flushes or poor sleep, it is no less important.

In fact, about 1 in 3 women over the age of 50 will experience an osteoporotic fracture in their lifetime. The risk of sarcopenia (low muscle mass) also increases with age, with up to 12.5% of women over the age of 80 being classified as sarcopenic. Both osteoporosis and sarcopenia can be further exacerbated by cancer treatment.

The reason that this is so important, is due to the impact it has on our overall health, as well as our independence. Stronger bones and stronger muscles mean we can be lift, carry, get in and out of chairs and keep doing the things we love!

And there is no surprise that exercise plays a vital role in managing our bone and muscle health. This is where strength exercise is your best friend. Not only can it help to manage the vasomotor symptoms associated with Menopause, but it will also keep your muscles and bones strong!

Strength exercise is quite simply, a non-negotiable when it comes to bone and muscle health. Ideally, you should have an assessment with an exercise professional such as an exercise physiologist as they can assess and prescribe to suit you, your lifestyle and any chronic health conditions you may have. They understand the complexities of cancer treatment and know how to safely prescribe exercise that is appropriate and specific for you. Speak to your GP about a Team Care Arrangement that can help subsidise the cost of accessing an exercise physiologist. You can find your nearest Accredited Exercise Physiologist here https://www.essa.org.au/maps.

There are also some simple things that you can do at home to help maintain your strength. These include things like sit to stands, push up at your bench or calf raises. These are some general exercises that can help, but specific, individually tailored exercises will have a greater impact, particularly when it comes to bone health.

So, while exercise won’t magically make all your Menopause symptoms disappear, they can certainly help to make the day-to-day symptoms such as hot flushes more manageable. While night sweats may still cause you to wake, those who are more physically active tend to be more able to get back to sleep and have better sleep quality (more deep sleep and more restorative sleep). And last but most definitely not least, strength training is vital for maintaining or improving muscle and bone health. While this may not be a symptom that wakes you up at night, it cannot be overlooked, particularly if you have a history of cancer treatment.

So, make sure you include exercise as part of your Menopause Management Toolkit!