A healthy lifestyle, including maintaining a healthy weight range, exercise, stopping smoking, limiting alcohol intake, and adequate intake of calcium (preferably dietary) and Vitamin D, can help with some of the symptoms of early menopause (EM) and protect against bone density loss and heart disease, potential long-term risks of premature ovarian insufficiency/EM. Alcohol, caffeine and spicy foods can be triggers for hot flushes in some women. Maintaining a cool environment may help manage hot flushes, for example by adjusting clothing, using a fan and drinking cool liquids. Weight gain may make hot flushes worse and weight loss in women who are overweight has been shown to reduce hot flushes. Exercise is beneficial for heart health, and weight-bearing exercise (e.g. weights or resistance training, running, dancing, tennis) for bone health. Exercise may also improve mood and sleep.
Lifestyle changes: What women knew
Most of the women we interviewed were aware of the potential role of lifestyle changes to help manage symptoms of EM and protect against long-term health risks. This was following advice from their health practitioners, their own research and reading, or through personal experience.
Melinda’s endocrinologist told her that in addition to taking HRT, exercise and getting enough calcium were important.
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She really said in my case, the benefits would far outweigh those risks, said that I would probably be best to take HRT for at least 10 years and then maybe rethink it, review. But she said at least until I’m really up over that 50, 50 years of age. Again, just to support my skeleton really to also take Vitamin D and also to exercise.
She said you just need to be looking after yourself and it’s not just about taking the HRT you need to do all those other things as well. I actually do take calcium and Vitamin D supplements and that was recommended for me to do that, but also try and exercise a couple of times a week. So I’m doing weight-bearing exercise and she said that is really just as important. And then I see, for me, the role HRT has played, has allowed me to have the energy to actually undertake exercise because I think I would have really struggled. Well, I certainly would have back at that time, yeah, having the energy to do that. She certainly talked to me about, you know, eating well and she did talk holistically about looking after myself.
Lifestyle changes to protect bone and heart health
Concerns about loss of bone density as a result of EM were mentioned by many women (see Long-term health effects of early menopause). Most said they were taking a calcium supplement and/or Vitamin D to help with calcium absorption, as well as trying to increase dietary calcium and do weight-bearing exercise. To protect against heart disease, a few women described dietary changes such as avoiding ‘fried’ foods, cooking low fat meals, and generally ‘eating well.’ Women were less likely to discuss exercise in relation to promoting heart health than in terms of helping with bone health, mood and relaxation.
Alex, who experienced surgical menopause following an oophorectomy for ovarian cancer, recounted the advice she had received about protecting her bones and heart.
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So I am under the guidance of my oncologist and GP. She is guiding me through calcium supplements and Vitamin D supplements to prevent osteoporosis – oh, not prevent – they said it’s guaranteed I will get osteoporosis so I’m prolonging [sic] that by taking those supplements and also I’m on a pretty full-on exercise regime because – what’s it called? Impact exercise actually helps your bones, to again prolong [sic] that whatever, the weakness of your bones coming through. So I see an exercise physiologist who’s in oncology and I do walking every day and yoga all the time. I’m going to start netball when I’m a little bit better and boxing is going to be the plan then for some high-impact stuff to help my bones. … Apparently there’s really good research for the more exercise you do, the stronger your bones will be. …
And what about cardiovascular health? Did anyone talk about that?
Yeah, my naturopath and GP discussed with me that I have to be really careful with calcium supplements because on a long-term basis, apparently there’s a bit of research that says it can also affect your arteries and stuff. So it’s a bit of a balancing game and I’m just going to be quite monitored with my bone density. So I’ve done a bone density test now to see where I started. Obviously that’s fine because I’m 32. So we’ll be checking that and my overall fitness. They just kept saying fitness, like I have to keep exercising which I’m happy to do because it also helps emotionally as well, so that’s good.
Lydia’s bone density declined after having a bilateral oophorectomy to reduce her risk of breast and ovarian cancer. She described her efforts to look after her bones and heart health.
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I was part of a study and that looked at women. So your first interview was before you went into menopause and then it was every time you went in afterwards, was after menopause, or after my ovaries were taken out were all the other interviews. So, part of that was doing bone density scans. So, I think my first bone density scan was before I had my ovaries out and then at the two year mark was the next one and there was a rapid decline in my bone density.
I actually just went and had another one which has been two years since, just last week so I’m due to go and get the results for that. I’m interested to know, but yeah I just try and keep up my Vitamin D and just try and be active, just walking and do what I can there.
Do you take supplements then for Vitamin D?
Yes, so I take a Vitamin D supplement. We ended up getting two dogs, two puppies which was one of the best things we did and so I walk the dogs yeah and you know go for between a 20 and 40 minute walk. I could go longer but the dogs don’t really cope with that. [laughs] And I also do a big fundraising walk every year, so I’ve got training for that. So I walk you know, like 10 – 14 kilometres training for that. So, yeah, walking is the main thing that I do.
I also asked about cardiovascular health?
I probably just changed my diet. Just really eating better, cutting out like saturated fats, they’re just like a big treat, if I have something, just trying to eat better. I decided to become vegetarian for a little bit of time, just to not have meat. I actually felt heaps better doing that. I’ve gone back to eating a bit of meat but yeah, I think just changing my diet and the exercise as well and that’s probably mostly what I’ve done.
EM symptoms
Lifestyle changes were also helpful for easing or reducing EM symptoms such hot flushes or anxiety. Women described limiting some drinks or foods (e.g. alcohol, caffeine, sugar, and spicy food) that made hot flushes ‘worse’, or adding others that they found ‘cooling’ (e.g. sage tea, watermelon, cold water). Maddy found sugar and caffeine increased her hot flushes: ‘a little bit of chocolate or something (…) can make me feel really horrible. The next day or a bit later that day I can feel just irritable, or I can even have a coffee and I have a bit of a sweat an hour later.’
After experiencing spontaneous EM,
Maddy cut back on caffeine as found it triggered hot flushes.
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Food. I’ve had to get, I ate pretty well but I can’t even eat those small things, those little treats, anymore.
Little treats?
Like a little bit of chocolate or something. Because it can make me feel really horrible. I can eat it and then the next day or a bit later that day I can feel just irritable or I can even have a coffee and I’m like have a bit of a sweat an hour later and it’s the coffee. I don’t drink alcohol. So that wasn’t a problem. But I liked one coffee a day so now I’m probably one every other day if that. But it doesn’t happen all the time. Like I had one today and I did have a bit of a sweat but it was very small. But then I could have one in a few days and it doesn’t happen.
Exercise was seen as beneficial for anxiety and sleep problems women associated with EM, as well as overall wellbeing.
Kirsty, who experienced spontaneous EM, found exercise beneficial for her mood and sleep.
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Exercise has been really important. Diet and exercise are really important in terms of helping to manage that mental health and those emotions. So if you’re having one of those days where you feel like your emotions are swinging, you can go and pump it out in the pool or you know, walk it out, or box it out or whatever you need to do to get through it, yeah. I can feel when I haven’t done exercise that day. You know, I feel a little bit more panicky or a little bit more stressed and I notice that I don’t sleep as well.
Challenges of making lifestyle changes
Some women found changing their lifestyle challenging. Exercising, eating healthily, or remembering to take calcium or Vitamin D supplements (for those who had been recommended to take them) could be difficult while recovering from cancer, coping with EM symptoms such as hot flushes or fatigue, or while dealing with other health conditions at the same time. Jenni, who experienced spontaneous EM, struggled to find ‘motivation’ to exercise: ‘I don’t want to go to a gym because I find that intimidating. I do a lot of walking. It kind of gets boring on your own. So yeah the social isolation [means] I’m not getting the exercise that I know I need.’
Kate was having ovarian suppression therapy (goserelin and an AI) as part of her breast cancer treatment and had not found a medication to alleviate her hot flushes. She wanted to be able to exercise more but found it difficult.
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Is diet and exercise still part of your everyday management of the symptoms?
Yeah, I try. Diet – diet definitely and exercise. I wish that I could probably do more than what I’m doing but at the moment I kind of feel so debilitated by these hot flushes, night sweats, not sleeping. How my body feels, that’s my motivation for exercise, when I know that I need to get sweaty and hot and probably out of breath and I just think about that and I go err, I can’t do this. But I really do believe it’s extremely important in how you physically feel but then how you mentally can be able to cope with these physical menopause symptoms.
Ella found having several chronic conditions as well as EM made it difficult for her to look after her bone health.
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Are there any other things that you do apart from like – do you take any calcium, or do you try to do weight-bearing exercise, or anything like that?
With the calcium, I just forget. I have had Vitamin D very low. I had a doctor in [regional town] ask me if I lived in a cave, because [laughing] my Vitamin D was so low. And then I might take it for a while, and then I forget. So I know I should, but one thing I do is try to get out in the sun for the Vitamin D. But with the weight-bearing exercises, I was doing – in this town – like this female gym, which is strength training. But now I’m just doing walking and yeah, so yes, “No,” is the answer to the question.
So with the menopause dropping off the radar a bit, I think it’s because I’ve got the fibromyalgia, and even the gastro things have now – obviously, my GP, because I mentioned about the sleepless, or the vivid dreams I have, and he wondered whether it was the depression medication. So we’re sort of looking at that.
So I think that’s why the menopause has dropped off, because we have so many other things to discuss. Maybe he thinks, ‘Well, that’s an issue, that it’s in the past,’ sort of. I will remind him though about the bone scan, and say, “Is there anything else that we need to look at?” Certainly, if there’s a bleed or something he would act on it very promptly.
Weight gain after EM could also make it challenging for women to stay motivated to maintain a healthy lifestyle.
Mary sometimes wondered what ‘the point’ of exercising was as had found losing weight very difficult following early menopause.
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My weight was so stable for years and I never really – I was no gym junkie. I liked to go for walks and stuff like that. But I never really had a weight problem before, until going through menopause. And it just seemed my metabolism just completely slowed down and it’s just, you know. It used to be like this and now it’s just like that. I don’t seem to burn the calories like I used to and everything I eat just goes straight onto my belly and my bum and my thighs and it’s so annoying.
I go for walks occasionally. I joined a gym a couple of years ago because I thought, “I’ve just got to keep on top of it. Because if I don’t do something it’s just going to get worse and worse so I’m going to be enormous by the time I’m 50.” Yeah. I went – oh, I had a personal trainer for the first time in ages, last year and she was fantastic. But she moved so I haven’t actually gone back to see another one.
She gave me the names of a couple of other ones, but she moved and I haven’t gone back to see another one, because I think, “What’s the point?” [laughing] Because I just can’t shift the weight, well, the fat is what I really want to shift. That’s probably the only thing I’ve, you know, the first time I’ve ever had a personal trainer.
Adapting to lifestyle changes
Other women described gradually adapting to changes to their diet and lifestyle. As Yen-Yi, who experienced menopausal symptoms as a result of ovarian suppression therapy following breast cancer, commented: ‘I’m happy that now I’ve at least got a routine with the exercise. It’s no longer dragging myself to the gym and things like that.’
Anna described the lifestyle changes she had made to accommodate living with symptoms of EM after she stopped taking HRT.
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How do you manage those symptoms to the extent that you are able to? So everything from the…
I really tried to eat healthily and I’m probably only really getting the hang of that now, six years later [laughs]. You know, like I know that if I’m going to have a few wines on the weekend, just expect to have hot flushes for the next week [laughs]. So I really try to counteract that with a whole lot of water [laughs]. And I know that I feel so much better if I exercise regularly, so that has become a real priority for me. Obviously that’s a lot easier now because my children are older and pretty independent, so that’s probably, you know, has helped as well.
I try to get enough rest. That makes a massive difference to my symptoms of hot flushes or fogginess in my mind. But you know, like I said, sometimes I’m lying awake at two o’clock in the morning and I can’t go back to sleep. I have been doing yoga. That really helps and that whole learning that relaxation methods through yoga really has been beneficial for me. Yeah, and I guess because I’m older now, there’s not as much pressure to have that glass of wine. I mean, not that you ever have to, but you know, friends accept the fact, you know, that okay, you’re not feeling like a drink or, you know, it’s a catch up rather than having a few drinks [laughs].
Further information:
Talking Points (Women)
Talking Points (Health practitioners)
Other resources