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Menopause: A Time of Power

by June Kaminski, MSN

"You can gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You must do the thing which you think you can not do." - Eleanor Roosevelt.

By this time in your life, you have accumulated an amazing amount of knowledge and experience about yourself. You have come to recognize what makes you feel good, what stresses you, and how to find some relief from pressure and strain. Mid-life brings the gift of wisdom and an awareness of who you are as a person.

The experience of menopause often helps women to deepen their awareness of their bodies, their emotions, and their needs. The physical changes that come with menopause create extra nutritional requirements. Nutrition and diet pointers are presented to help you choose the best diet for you. A diet that will help you move through menopause with energy and pep. A personal fitness regime will give you the stamina and flexibility you need to make this transition with assurance and comfort.

Menopause often triggers concerns about sexuality and desirability. Your sexual health is important, at any age. Set the stage for the kind of sexual contact that you desire, to provide you with confidence and a relaxed approach to intimacy. These three topics put together - nutrition, fitness, and sexuality provide a framework to help you to create your own recipe for personal rejuvenation.

The Food Connection

Menopause is one of the most nutritionally challenging times in a woman’s life. Your informed food choices can have a positive effect on your well-being as you move through this natural change. To stay active, your body needs proper nourishment for a smooth hormonal transition and sufficient energy reserves. A well-rounded diet, with optimal levels of vitamins, minerals, enzymes, and phytoestrogens will lay the groundwork for a healthy adaptation to menopause. A balanced diet includes six basic nutrients. These are water, carbohydrates, protein, fats, vitamins, and minerals.

In mid-life, the need for all essential nutrients is important. A healthy, balanced diet is the cornerstone of good health. Nutrition and exercise are key factors in preventing heart disease and osteoporosis. A plant-based diet, especially one that includes soy products is abundant in phytoestrogens which help to ease the symptoms of menopause and prevent cancer.

The general guidelines for nutrition during menopause is to choose a balanced diet using the U.S. Department of Agriculture’s 1992 recommendations of:

  • Minimum 1,500 calories per day
  • Fats, oils, sweets - use sparingly
  • Milk, yogurt, cheese - 2 to 3 servings per day
  • Meat, Fish, poultry, Dry beans, Eggs - 2 to 3 servings per day
  • Vegetables - 3 to 5 servings per day
  • Fruits - 2 to 4 servings per day
  • Bread, cereal, rice, pasta - 6 to 11 servings per day
  • Eat a low fat, high fiber diet with plenty of whole grains, legumes, raw seeds and nuts, fruits, and vegetables.
  • Eat foods rich in phytoestrogens which are plant-derived estrogen-like compounds: Soybeans and soy products, apples, carrots, yams, green beans, peas, pomegranates, potatoes, red beans, brown rice, whole wheat, rye, and sesame seeds, legumes, flaxseed, and pumpkin seeds Phytoestrogens are weaker versions of human estrogen. There are over 300 plants with estrogen-like activity, but soy bean products(such as tofu) are the highest. In countries like Japan and China where soy beans are used daily, there are much lower breast cancer rates and symptoms of menopause are scant. Phytoestrogens can provide an estrogen lift without increasing the risk of cancer as hormone replacement therapy frequently does. Phytoestrogens also help reduce the thinning of the vaginal tissues which is often associated with menopause.
  • Eat foods high in Calcium: milk, yogurt, cheese, oysters, sardines, canned salmon with bones intact, dark green vegetables, spinach, broccoli, and supplements as needed
  • Eat Folate rich foods for protection against heart disease: legumes, orange juice, green vegetables

Vitamin and Mineral Supplements

Most vitamins and minerals are readily available by eating a varied, well-rounded diet. There is usually no reason to take vitamin and mineral supplements. If you show signs of vitamin or mineral deficiency, your physician or nutritionist may suggest some form of vitamin and mineral preparation.

Tips for Enjoyable Dining and Digestion

For better digestion and a healthier lifestyle, try these tips:

  • take some time to plan your meals
  • take time to savor your meals. Light some candles, play soft music, and enjoy. Don’t rush.
  • eat when you are hungry. Let your body tell you when it is time to eat, not the clock.
  • eat four to six small meals throughout the day, instead of two to three large meals.
  • eat some calcium-rich food just before bedtime
  • Ten to twenty minutes of direct, moderate sunlight on your arms or back per day makes 400 I.U. of Vitamin D - for free!

Fitness in Menopause: Strength, Flexibility, and Endurance

Experts classify physical fitness indicators into three categories - flexibility, strength, and endurance. A well-rounded approach to fitness is needed to cultivate all three aspects. Flexibility is achieved by regular stretching, yoga, tai chi, ballet and other dance warm-ups, gymnastics, and some swim strokes. Strength is developed through weight-bearing exercises such as weight-training, brisk walking, isometric exercises, and stair climbing. Endurance is built through aerobic activities like walking, hiking, jogging, running, bicycling, swimming. The benefits gained from a well-rounded fitness regime are many. What is important is to find the best work-out program for you. One that is tailored to your current physical condition, your fitness goals, your activity preferences, and your lifestyle. It is wise to visit your doctor before starting any rigorous exercise program. A thorough medical examination and consultation is recommended before you begin.

It is never too late to begin a fitness program. The middle-years are just as good a time as any to develop physical well-being. You can improve your body’s flexibility, strength and endurance at any age. Still, it is best to start out slowly and build up to more strenuous activities. For most people, day-to-day physical activity is not a good enough workout to maintain fitness. Besides working out, you can enhance your physical exertion as you go about your day. Take the stairs, stroll around town, do your errands on foot. A higher level of physical activity promotes longevity. As with all things, exercise should be done in moderation. Many fitness clubs, spas, and organizations offer classes and groups geared specifically to middle-aged adults. Many women have never participated in sports, or attended fitness classes before. It’s important to find activities that you enjoy, whether in a class, with your partner or a friend, or on your own.

The health benefits of fitness are many. Weight control, feelings of self-esteem, improved sleep patterns, better digestion, strong muscle tone, and added pep and vigor are gained. Exercise also offers protection against many diseases common to the middle years, including osteoporosis, heart disease, depression, and symptoms common to menopause. Regular exercise can reduce hot flashes for many women. Aerobic exercise three to four times per week for at least 20 minutes helps to alleviate hot flash symptoms. You can also fight depression by exercising. Regular exercise can reduce psychological stress and other symptoms related to menopause. Women who engage in regular activities report better moods and less depression compared to sedentary women. Exercise can also help to reduce night sweats, anxiety, and sleep disorders. It is wise to be involved in a wide range of exercises to sharpen your sense of balance.

An exercise program for menopausal women that includes both aerobic and resistance training may prevent or relieve problems such as cardiovascular disease, obesity, muscle weakness, osteoporosis and depression. A specific and individualized exercise prescription is recommended for menopause problems such as vasomotor symptoms or hot flashes, bone loss, cardiovascular disease, depression and sleep disturbances, weight gain, and muscle weakness. Combine aerobic, resistance, and stretching exercises to improve your quality of life. Women who exercise on a regular basis report fewer symptoms and problems related to menopause and aging.

As you reach menopausal age, your body requires less energy because of a decline in physical activity and loss of lean body mass. Raising your activity level will increase your need for energy and help you to avoid gaining weight. Sedentary women suffer more from chronic back pain, stiffness, insomnia, and bowel irregularity. They often have poor circulation, weak muscles, shortness of breath, and loss of bone mass. Women who regularly walk, jog, swim, bike, dance, or perform some other aerobic activity can more easily circumvent these problems.

Weight-bearing exercise, such as walking, or other types of aerobic exercise can help reduce the risk of osteoporosis and heart disease, especially if the activity is started before menopause actually begins. A diet rich in calcium coupled with regular, weight-bearing exercise can help slow down bone loss and improve your overall health. After menopause, decreased estrogen levels reduce your bones’ ability to absorb calcium. This can lead to thin, porous, fragile bones. The most important treatment for osteoporosis is prevention. This is best achieved by practicing a lifetime of aerobic, weight-bearing exercise. Exercise is an important determinant of bone mass.

Bone loss is best prevented by exercise performed on your feet, such as jogging or walking, and by resistance exercises like weight-lifting. Weight-bearing exercise, like walking, strengthens bones. The weight of the body has to be carried by the bones in order to stimulate bone strength. Brisk walking or jogging adds the needed stress to the hip joint to build bone density in a natural way. An increase in bone mineral content have been found in lumbar vertebrae and distal radial sites of women who participate in exercise programs. Just like muscles, bones adhere to the "use it or lose it rule"; they diminish in size and strength with disuse. Exercise stimulates the cells responsible for generating new bone to work overtime. Bone tissue lost from lack of use can be rebuilt with weight-bearing activity. Resistance training can also improve muscle strength and joint mobility. Just avoid exercise that jolts or puts weight on your back.

Exercising regularly can also reduce the risk of respiratory and cardiovascular disease. Engaging twice a week in weight-lifting and other strength-training activities can prevent weight gain which leads to a higher risk for diabetes and high blood pressure. Regular aerobic exercise improves cardiovascular endurance. Natural remedies, including regular exercise and diet, can reduce the risk of heart attack by 75 percent, and are the keys to preventing heart disease.

Regular, energetic exercise can improve your mood by raising your endorphin levels. Mood changes related to levels of brain chemicals respond favorably to exercise. During exercise, hormones called endorphins are released in the brain. They are "feel good" hormones involved in the body’s positive response to stress. The mood-heightening effect can last for hours. Exercise also has a positive effect on self-esteem and body image. Aerobic exercise also prevents some age-related increases in body fat and elevates the resting metabolic rate, which correlates with lean body mass. Inactivity, not hormonal change is the most common cause of obesity.

The Magic of Walking

It's not surprising that walking has emerged as the most popular form of physical recreation in the United States, with 77 million Americans walking for health every day. It's easy, it's painless, and it can be enjoyable. Seriously overweight people can begin to shed pounds and tone muscles almost immediately by walking for just half an hour every other day. Whether it's a stroll or a five-mile-an-hour racewalk, any amount of walking at any intensity will build muscle, strengthen bones, relieve stress, improve cardiovascular function, and boost your outlook on life.

Anyone can start a walking program to improve health and fitness, no matter what their current fitness level is. Rather than worry about the distance you walk, at first concentrate on increasing your fitness level. To do this, you should keep three things in mind: duration, intensity, and frequency.


If you are just starting out, take it easy in order to protect yourself from injury and unreasonable muscle soreness. Try to make your walk last from 20 to 60 minutes.


Increase the intensity of your walk by moving more quickly or by walking up hills. Monitor the intensity of your workout by making sure you feel comfortable throughout the walk. You should be able to easily talk at all times and should never gasp for air. Don't walk at a pace that leaves you breathing heavily, especially if you're just starting to exercise. You should be able to carry on a conversation or sing a song without becoming breathless as you walk.


As you become stronger, increase the number of days that you work out to about five or six times a week.

Fitness walking is not just an afternoon stroll. Remember to:

Stand up straight. Look directly ahead. Imagining that a string is attached to the top of your head and is lifting you from the ground helps you to naturally stand tall. Keep your shoulders back and relaxed, chest out, and tailbone slightly tucked under.

Relieve your stress points. Relax your shoulders and shake out any tension from your arms and wrists. Bend your arms at the elbow about 83 degrees. Swing your arms naturally as you walk, but try not to let your hands extend above your chest.

Keep your steps short and fast. The faster you move, the better your cardiovascular workout. Try to keep an even stride and maintain a steady pace.

Use a heel-to-toe motion. As you walk your heels should be the first part of your foot to hit the ground. Roll along the length of your foot and push off with your toes. This reduces the risk of shin splints and tendon pulls.

Your Target Heart Rate

Whenever you work out, try to keep your heart beating at a rate that provides the most beneficial conditioning for your heart and lungs (see chart below). To determine your heart rate at any point during your workout, stop and press your fingers to the large artery at the right side of your throat. Count for six seconds, then add a zero to the number to get your beats per minute. Too fast? Slow down for a while. Too slow? Pick up the pace.

Age (years) Target BPM
35 117-176
40 114-171
45 111-167
50 108-162
60 102-153
65 99- 149
70 96- 145
Table1: Target Heart Rates during Exercise

Most people find it hard to believe something as simple as walking can burn calories at a level that prevents or gets rid of weight gain. Just by walking at a moderate pace, people can burn fat at a faster clip than those who jog the same distance. The difference is that walking a certain distance takes longer, so more time is spent boosting your metabolism and shedding fat. The longer the walk, the greater the benefit.

Regardless of fitness level, everyone needs to perform some gentle stretching before working out, as well as slower warm-up and cool-down periods at the beginning and end of each workout session. All three components will guard against overexertion, shin splints, muscles aches, and the fatigue that can sabotage even the best of intentions. A good schedule for beginners is 30 minutes a day, every other day. After a week or two, you will be ready to extend your workouts to 45 minutes. In subsequent weeks, try to increase the distance you can walk in 45 minutes, which will provide a better aerobic workout and increase muscle tone. Working up to an one hour walk, covering about four miles every other day, is ideal for anyone interested in a lifelong, total-body fitness program that really works. In study after study, researchers are finding that the healthy benefits of walking depend not on the distance covered or the speed achieved, but on the consistency with which a fitness routine is followed. It's not enough to start a walking program; the rewards come with sticking to it.

Calories burned per hourFat burned per hour
At rest: 60 Calories are burned; 40 of those from fat.
Walking 3 mph : 260 Calories are burned; 130 of those from fat.
Walking 4 mph : 350 Calories are burned; 140 of those from fat.
Walking up a 10% graded hill: Doubles your Caloric burn.
Table 2: Calories and Fat burned per Hour of Walking

For greater benefits, do multiple workouts. While the Caloric burn for two 30 minute workouts is the same as for one 60 minute workout, the two workouts give you two post-exercise metabolic spikes instead of one. The President's Council on Physical Fitness & Sports recommends 20-30 minutes, 3-5 times per week to improve the functional efficiency of your heart, lungs and blood vessels as well as improve your muscle strength and endurance.

Stretching for Flexibility

It is desirable to stretch both before and after you go on your walk. Try the stretches below and remember you should always be warm before stretching. It is important to ease into, hold and ease out of each stretch. Hold each stretch for a minimum of 20 seconds. Stretching should never be painful, although you may feel a mild discomfort. Never bounce while stretching. Perform stretches with equal intensity on both sides of your body.

Ham-string Stretch
Prop your leg against a tree or chair at a comfortable height with knee slightly bent. Lean slowly forward to feel the stretch at the back of the thigh. Hold for 20 seconds. Do this three times. Switch to other leg and repeat on other side.

Back Stretch
Sit on a chair with both feet on the floor. Turn your arms, head and shoulder and grasp the back of the chair. Make sure that you keep your buttocks firmly planted on the chair. Hold for 20 seconds. Perform three times. Repeat on other side.

Calf Stretch
Stand with your hands placed on a wall for support. Put one leg behind you, keeping your heel flat on ground. Keep your other leg slightly bent with your body weight on your back leg. Hold for 20 seconds. Perform three times. Repeat with other leg.

Quadriceps Stretch
Bring your heel up to your bottom and gently push your hip forward to increase the stretch. Hold for 20 seconds. Perform three times. Repeat on other leg.

To increase your level of flexibility, try to stretch three times a week for 20-30 minutes. This may sound like a lot of time to spend stretching; however, if you incorporate it into your walking or other workout routine. If you stretch 10-15 minutes before weight training/cardiovascular work and 10-15 minutes after, it is a reasonable time frame to work with.) Stretching should always be preceded by a 5-10 minute warm-up period where you are moving in a rhythmic fashion using all your major muscle groups. This sends blood to the muscles and readies them for activity. Remember to try to hold each stretch for at least 10-30 seconds.

Strength Training for Physical Power

Strength training can improve flexibility by improving muscular tone and endurance. Try to participate in some type of strength training activity two times a week for 20 minutes. Strength training can be done with or without weights. You can do abdominal work, push ups, pull ups, tricep dips, lifting your child or grandchild, and so on, without picking up a weight or using a weight machine. If you'd like to use some type of equipment, try hand weights, rubber bands, tubing, dynabands or health club equipment. Whatever you decide to use, make sure you use the proper technique and form. If you belong to a health club, ask a trainer for help. If you don't belong to a health club, purchase a video which gives instruction on how to use the piece of equipment you have purchased.

When doing strength training, form is everything - make sure the last repetition you do is as precise as the first. If you are interested in using free weights, make sure that you get proper instruction. It is important to work the muscle groups evenly. Muscles need to contract or flex as much and as evenly as they extend or stretch out. Each movement must flow evenly with your breath. As your muscles extend, you breathe in deeply, as they contract, you breathe out fully. Free weights, when used correctly, work amazingly well in strengthening your upper body. They can help you avoid flabby arms, to strengthen your posture and expand your rib cage, and build up your chest muscles. Use light weights to avoid bulky looking muscles. Two to five pound hand weights are heavy enough to give you sinewy, dancer-like arm muscles. As with cardiovascular exercise, stretching should also be incorporated into a strength training workout. Begin by warming up for 5-10 minutes (on a treadmill, exercise bike, or loosely running on the spot). Then stretch your major muscle groups, perform your weight training segment, and end by again stretching the major muscle groups.

Sexual Health and Enjoyment

During menopause it is important for you to understand the changes taking place in your body. Many women fear a loss of sexuality and sexual attractiveness as they reach their middle years. As menopause begins, you may notice a decrease in libido - that your desire for sex is different than it used to be. Physicians attribute this to a decrease in the male hormone, testosterone which affects the sex drive in both women and men.

Getting educated about the changes you may experience, and being able to be open and honest with your sexual partner are keys to a fulfilling sex life at any age. Often women find, that their zest for sexual intimacy actually improves in post-menopause. The need for birth control is gone, pregnancy is not an issue, and they have come to feel secure in their new stage of life.

There are physical changes common to menopause that can challenge your enjoyment of sex. When menopause occurs, decreased estrogen and progesterone levels lead to changes in your reproductive system. The condition is labeled as vaginal atrophy and manifests as changes in the shape of the vagina, reduced pubic hair, and vaginal dryness. The lining of the vagina becomes thinner and less supple, which can cause itching, tenderness, and possible inflammation. Vaginal infections such as yeast, may become more common. These changes may seem undesirable and indicative of old age. In essence, they are natural adaptations in response to the body no longer needing to be ready for a potential pregnancy.

Ironically, the best way to prevent the discomfort associated with vaginal changes is to continue to enjoy an active sex life. Regular intercourse helps the vagina keep its natural elasticity and lubrication. Often, women report that sexual relations actually become more enjoyable at this stage of life, especially with a sensitive partner.

Estrogen creams applied directly to the vaginal tissue offer relatively quick relief to the delicate vaginal lining. They increase the flow of blood to the vagina and can help restore moisture and prevent frequent infections. Some women take hormone replacement therapy, either in pill or patch form, as a long-term way to keep the vagina healthy.

Other women may take testosterone to treat their decreased sex drive. However, this is a controversial method to deal with these natural changes, and may lead to depression, plus masculine side effects such as facial hair, muscle weight gain, and a lowered voice. With the diminished estrogen levels common to menopause, women naturally have a higher level of testosterone than they did in their younger years. This can help to maintain and even increase sexual feelings as you get older.

Non-prescription lubricants are effective in combating vaginal dryness. However, none of them offer the benefits to the vaginal tissue available with prescription estrogen treatments. The type you use depends on your needs - some are best used only during intercourse, others can be used at all times and can even help to prevent infections because of their low pH (acidic) makeup, and others double as spermicides. Some common brands available include K-Y Jelly, Astroglide, Lubrin, Moist Again, and Replens.

Oil-based lubricants, like petroleum jelly or baby oil should be avoided as they can cause vaginal irritation. However, Vitamin E oil or sesame seed oil can be used to relieve itching and irritation, fight dryness, and preserve vaginal elasticity.

Personal Hygiene Tips

To keep the vagina as moist as possible and free of infection, avoid hot baths and bath oils. Antihistamines should be used sparingly. They not only dry the nose and sinuses, but the vagina as well. Also, avoid douches, soaps containing alcohol, and wiping yourself using colored or scented toilet paper which can irritate the labia and vagina, and reduce the vagina’s protective acid mantle. Use mild soap and avoid personal hygiene sprays, dry thoroughly after a shower or bath, and wear cotton-lined underwear.

Psychological Factors and Sexuality

Often, reduced sex drive is not due to a lack of interest but because of fear, fatigue, pain, or discomfort caused by other conditions, such as illness, incontinence, sleep problems, and medications (for instance, high blood pressure pills or anti-depressants).

Feeling unattractive because of physical changes associated with aging, such as gray hair, wrinkles, changes in breasts can also lead to sexual avoidance. Some women have accepted the notion that sexual desirability is the domain of the young and linked to marriageability and fertility. If your doctor is approachable, ask for advice on dealing with these physical and psychological changes. A sexual therapist or counselor can also offer a listening ear and sound advice to help you deal with these feelings and sensations.

Sexually transmitted diseases (STDs) need to be considered, especially if you are not in a monogomous relationship. The risk of contracting one can increase after menopause because of the natural changes that occur in the vaginal tissues. It’s a good idea to continue to have regular checkups for STD’s as well as a annual Pap smears.

Later in menopause, your vaginal and urethra tissues lose collagen and become thinner and paler. Because of the thinning of the urethra and the relaxation of the muscles around the bladder, you may experience urinary incontinence, which is a leakage of urine when you laugh, cough, or sneeze. Again, remaining sexually active can help to relieve this. The increased blood flow to the genitals during sexual arousal will thicken the vaginal walls and muscles considerably. Varying sexual positions and the creative use of pillows can ease any discomfort during intercourse. It is also helpful to make your relationship a priority, by creating intimate, private, undisturbed moments with your partner. Stress urinary incontinence can also be alleviated by exercising the pelvic floor using Kegel exercises, a tightening of the perineal muscles surrounding the vagina and urethra. Tighten this area for a few seconds during the day, as you go about your routine activities. Black cohosh and ginseng tinctures and teas are said to increase vaginal and urethral wall thickness if ingested regularly.

Each of us relates sexually to menopause in an individual and personal way. Our sexual ideas, preferences, desires, and expectations affect our lives after menopause as they did before. The way we feel about ourselves as vital sexual beings has an impact on our libido, and our self-image is influenced by societal attitudes. Common attitudes reflected in modern society include ageism, sexism, and puritanical views. We have been led to believe that our aging bodies are undesirable. Middle age is a good time to examine our relationships, to look at who we have become, and who we are with our partner, or if single, with the world.

One concern that is often mentioned by women is the lack of available partners. In the menopausal years, more women are single due to divorce, separation or widowhood. Women live an average of eight years longer than men. Celibacy is often a reality after divorce, separation, or death of a partner. Some women find April-December romances with a younger man to be both appealing and a reality as they grow older. The point is, your sensuality and appeal does not disappear as you age or reach menopause. We are loving beings, meant to touch, cuddle, love, and share intimacy until the day we make the Great Transition, and depart from this Earth plane.

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