Coaching Women Through Perimenopause and Menopause: A Comprehensive Guide
Are you a fitness coach looking to better support your female clients through the changes of midlife? It's time to understand the unique challenges women face during perimenopause and menopause.
This guide provides practical strategies and insights, drawing from a recent CoachRx & OPEX Fitness Community Call featuring women's health coach and gym owner, Haley Milard. Learn about exercise modifications, nutrition advice, and why community matters during this significant life stage. Get ready to empower your clients to move, live, and feel their best!
Understanding the Phases of a Woman's Life
It's easy to get confused by the terms "perimenopause" and "menopause," so let's clarify the distinct phases in a woman's life cycle:
Premenopause: The reproductive years, from puberty until the start of perimenopausal symptoms.
Perimenopause: The transitional period when women begin to experience hormonal changes and symptoms like irregular periods, hot flashes, and sleep disturbances. This phase can start as early as age 35.
Menopause: A single day, marking 12 consecutive months without a menstrual period.
Postmenopause: The years following menopause.
It's a common misconception to use "menopause" as a blanket term. Menopause is literally just one day! For example, a woman who hasn't had a period for 11 months is still in perimenopause, not menopause or postmenopause.
The Three Types of Estrogen
Did you know women have three types of estrogen, each playing a unique role?
Estrone: This weaker form of estrogen dominates during menopause and is produced primarily by fat tissue.
Estradiol: The primary hormone in premenopausal women, estradiol maintains ovulation.
Estriol: Produced only during pregnancy, estriol supports the placenta.
It's important to understand these differences. Many women believe they have no estrogen left after menopause. However, they have estrone, which provides some protective effects, though not as strong as estradiol.
Coaching Consideration #1: Pelvic Floor Function and Strengthening
Pelvic floor health is often overlooked. However, it is a critical consideration for women, especially during perimenopause and menopause. Let's explore the anatomy and function of this important area.
The pelvic floor has three layers:
Eurogenital Triangle: The most superficial layer, likely involved in sexual function and support of the pelvic floor muscles.
Eurogenital Diaphragm: The middle layer, controlling continence through the internal urethral and anal sphincters.
Deep Pelvic Floor: The most well-known layer, supporting the pelvic organs, preventing prolapse, and maintaining urinary and anal continence.
The pelvic floor performs four essential functions:
Constricting the urethra, vagina, and anal canal.
Supporting the pelvic organs.
Helping stabilize the trunk.
Regulating intra-abdominal pressure.
The pelvic floor works closely with the transverse abdominal muscles. This collaboration is key for core stability and managing intra-abdominal pressure, especially during exercise.
Prolapse occurs when internal organs protrude into or out of the vaginal canal due to weakened pelvic floor support. This can be uncomfortable and affect a woman's quality of life.
Understanding Genitourinary Syndrome of Menopause (GSM)
Genitourinary Syndrome of Menopause (GSM) affects a significant number of women. A chronic and progressive condition, GSM impacts the female genital and urinary tracts.
Consider these facts:
84% of postmenopausal women experience GSM.
19% of pre- and perimenopausal women have GSM.
Symptoms include:
Vaginal dryness
Genital burning
Sexual dysfunction
Pelvic organ prolapse
Urinary dysfunction
Many women are embarrassed to discuss these symptoms, so creating a comfortable environment is essential.
Risk factors for GSM include:
Ovary removal
Alcohol consumption
Smoking
Lack of exercise
Cancer treatment
Absence of vaginal childbirth
Fortunately, treatments are available, such as:
Non-hormonal vaginal lubricants
Vaginal estrogens
Systemic hormone therapy/HRT
Pelvic floor physiotherapy
Laser therapy
Pelvic Floor Issues: What Can Coaches Do?
As a coach, you can play a vital role in supporting clients with pelvic floor issues.
Start by conducting a pelvic health screen during client intake. This doesn't require in-depth assessment, but it opens the door for discussion. Be professional and comfortable talking about these topics. Clients will appreciate your openness.
Encourage healthy nutrition, exercise, and lifestyle practices. These habits support overall health, including pelvic floor function.
Consider referring clients to a pelvic floor physiotherapist for specialized care. When possible, collaborate directly with the physiotherapist (with the client's permission) to create a well-rounded support system.
To get started, here are some questions you can include in a pelvic health screen intake form:
Have you had children? If so, what type of birth experience did you have?
Have you experienced any urinary leakage or bowel leakage?
Do you experience any pelvic pain or pressure?
Use these phrases to ease into conversations about pelvic health:
"Many women experience changes in their pelvic floor health as they age. Is this something you've noticed?"
"I like to ask all my clients about their pelvic health, as it can impact exercise and overall well-being."
Coaching Consideration #2: Common Training Concerns and pelvic floor
Pelvic floor dysfunction should be a primary consideration in your training approach. Urinary incontinence and pelvic organ prolapse are common issues. Keep the following in mind:
Stress incontinence results from increased intra-abdominal pressure, such as jumping or lifting heavy weights.
Urge incontinence is the involuntary loss of urine due to a sudden urge to urinate.
Pelvic organ prolapse becomes more common after menopause due to decreased estrogen and weakened pelvic floor tissues.
Hallmark symptoms of pelvic floor prolapse include:
Feeling a bulge in the vagina
Tissues protruding from the vagina
Difficulty emptying the bladder
Remember to coach the client in front of you, noticing their individual needs and adjusting your approach accordingly.
Practical Programming Adjustments for Pelvic Floor Issues
Here are some practical programming adjustments to support clients with pelvic floor issues:
Reduce the load on exercises.
Decrease the range of motion.
Modify the exercise form, such as using a wider stance.
Reduce impact by choosing step-ups instead of box jumps.
Reduce sets or reps.
Increase rest periods.
Change equipment as needed.
Breathing and bracing techniques can also help:
Avoid excessive upper abdominal gripping.
Cue clients to gently draw their pelvic floor upward during exertion, contracting the muscles about 30%.
Experiment with breathing patterns, such as inhaling during exertion or exhaling slightly to release pressure.
Experiment with different positions to find what feels best for your client, such as lying on the floor, half-kneeling, standing, or sitting.
Coaching Consideration #3: Musculoskeletal Pain
Hormonal fluctuations can impact a woman's experience of pain and recovery. As estrogen declines, systematic inflammation increases. Clients might report:
Increased soreness
Popping, cracking, or creaking joints
Before attributing pain solely to perimenopause, rule out other factors like nutrition, sleep, and hydration. If musculoskeletal pain persists, consider these strategies:
Reduce the load.
Reduce the range of motion.
Use more joint-friendly positions like seated or lying down.
Incorporate different equipment, such as resistance bands.
For example, you might suggest a seated row instead of a standing row, or a bodyweight squat to a box instead of a full-depth squat.
Coaching Consideration #4: Osteopenia and Osteoporosis
Osteopenia and osteoporosis are significant concerns for women as they age.
Osteopenia is reduced bone density, with a T-score between -1 and -2.5.
Osteoporosis is a more severe loss of bone density, with a T-score of -2.5 or lower.
Starting in their mid-40s, women lose an average of .4% of bone mineral density each year. This rate accelerates around menopause, with women losing up to 4.4% annually between ages 50 and 54.
Risk factors include:
Menopause
Low body weight
Inadequate nutrition
Low physical activity
Genetics
Smoking
Certain medications (corticosteroids)
Medical conditions (rheumatoid arthritis, diabetes, cardiovascular disease)
These conditions often have no symptoms until a fracture occurs. Prevention is key. The best actions a coach can take:
Educate clients about bone health.
Program progressive overload workouts.
Incorporate high-impact exercises (if appropriate).
Encourage a healthy lifestyle, including quitting smoking, limiting alcohol, and eating nutrient-dense foods.
It's also important to dispel the myth that "less is better" when it comes to nutrition. As women age, adequate nutrition becomes even more critical.
For clients who don't consume dairy, recommend calcium-rich foods such as:
Leafy green vegetables (kale, spinach)
Calcium-fortified plant-based milks
Tofu
Sardines
The National Osteoporosis Foundation is another resource you can share with your clients to understand more about Osteoporosis.
Coaching Consideration #5: Exercise Selection
OPEX coaching methods already align well with the needs of women in peri- and postmenopause. The key is to consider the client's symptoms daily.
Symptoms can cause frustration, fatigue, and difficulty completing exercises as written. Give clients "this or that" options, and use the Rate of Perceived Exertion (RPE) scale to adjust workouts.
For example:
RPE 1-4: Opt for a walk and stretch, or rest.
RPE 5-7: Modify sets, reps, and weight.
RPE 8-10: Proceed as written, but be prepared to make changes.
Movement Pattern Considerations for women
When designing exercise programs, keep these movement patterns in mind:
Balance exercises: Essential for maintaining independence as women age.
Rotation exercises: Important for core stability and functional movement.
Trunk movements: Include flexion, extension, lateral flexion, and rotation.
Crawling exercises: Help maintain fundamental movement patterns.
Crawling exercises like lying to standing, Turkish get-ups, three-point get-ups, and crab walks can help clients maintain strength and coordination. The goal is to help them be able to get up off the floor to help themselves.
Pelvic Floor Exercises: The Connection Breath
Mastering the connection breath is crucial for pelvic floor health. Here's how to perform it:
Place one hand on your ribs and the other on your lower abdomen.
Sit on your sit bones on a firm surface.
Inhale deeply, breathing into your hands and expanding your pelvic floor.
Exhale, deflating your rib cage and abdomen, and relaxing your pelvic floor.
Aim for a 30% maximal contraction.
Perform 8-10 repetitions in your warm-up.
If sitting is difficult, try lying down, lying on your side, or getting on all fours.
Pelvic Floor Exercises: Endurance and Strength Contractions
The pelvic floor contains both slow-twitch and fast-twitch muscle fibers. Therefore, it is important to train both.
Endurance (Slow-Twitch) Contractions:
2-3 sets of 8-12 repetitions, holding each contraction for 6-8 seconds.
Perform 2-3 times per week during your warm-up.
Focus on a 30% contraction.
Strength (Fast-Twitch) Contractions:
Include these during the concentric part of an exercise.
Switch up the exercise each workout to promote functionality.
2-4 sets of 8-12 repetitions, holding the contraction for 1-2 seconds.
For example, you might contract your pelvic floor during a bicep curl, goblet squat, or bench press.
Bone Health: The Interconnectedness of Systems
Bone health is linked to other bodily systems and lifestyle choices. Key factors include nutrition, exercise, sleep, mineral regulation, sex hormones, and immune function.
The OPEX CCP method already addresses many of these factors.
Nutrition for Bone Health
Bone health responds to energy availability, so consuming enough calories is vital. Aim for 1 gram of protein per pound of ideal body weight to support bone volume and density.
Encourage clients to eat calcium-rich foods, especially if they avoid dairy. Leafy greens, fortified plant-based milks, tofu, and sardines are good choices. Combining calcium and vitamin D maximizes absorption.
Fiber also plays a role in bone health. It improves bone mineral density through the production of short-chain fatty acids by gut bacteria. Aim for a daily fiber intake of 25-40 grams.
Metabolic Health: Beyond Metabolism
Metabolic health refers to how well your body uses energy and nutrients to maintain stable blood sugar and blood pressure. Hormones contribute to metabolic health, but they aren't the only factor.
Sex hormones like estradiol, progesterone, testosterone, and FSH influence:
Energy balance
Body heat production
Insulin sensitivity
Glucose metabolism
Adipose tissue health
During menopause, lower estrogen levels can affect appetite. There can also be increased anabolic resistance, making it harder to build muscle.
Metabolic Health and the Impact of Lower Estrogen
As estrogen levels decline, the body produces less leptin which is related to appetite. Lower estrogen can impact appetite, create anabolic resistance, and increase inflammation and pain perception.
Metabolic Syndrome: A Key Concern
Metabolic syndrome becomes a greater concern as women age due to the loss of estrogen. It can lead to:
Impaired glucose metabolism
Insulin resistance
Increased visceral fat
Hypertension
Inflammation
Oxidative stress
Cardiovascular disease
Practical Strategies for Metabolic Health
Emphasize the importance of:
Eating nutrient-dense foods
Consuming plenty of fruits and vegetables
Prioritizing healthy fats
Reducing processed foods
Minerals also play a key role. Low magnesium is linked to metabolic syndrome, while selenium helps regulate glucose metabolism and fat accumulation in the liver.
Encourage clients to eat colorful fruits and vegetables for antioxidants. Healthy fats like omega-3s, nuts, seeds, olives, and olive oil have anti-inflammatory properties. Managing body weight and maintaining a healthy body composition are also important.
Building a Supportive Community for Your Clients
Build a network of trusted health professionals to support your clients. Referrals from someone you trust are invaluable. A good network might include a pelvic floor physio, nurse practitioner, psychologist, naturopath, massage therapist, and nutritionist specializing in perimenopause and hormone health.
Join CoachRx Community Calls monthly to connect and learn from coaches.
Resources
Download free coaching resources from CoachRx to help enhance your coaching skills.
Explore the LearnRx full library of coaching education including Pelvic Floor Considerations for Strength Training, As fitness professionals, understanding the complexities of the pelvic floor and its impact on overall strength and performance with Aimee Shelton & Katie Fincher.
Final Words of Wisdom
Remember to coach the individual in front of you. Open communication and community support are vital. By continuing to learn and expand your knowledge of women's health, you can empower your clients to thrive through perimenopause and beyond.
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