No, it’s not all in your head. No, you are not the only one experiencing weird symptoms. It’s time we all talk about the lead up to menopause. And not just the symptoms that everyone knows about. We mean ALL of them.

The years leading up to the end of your period—known as the menopause transition—often start in your mid to late 40s. During this time, your hormones fluctuate, which can lead to all sorts of symptoms, like sleepless nights, hot flashes, tiredness, mood swings, joint aches, bladder leaks, brain fog, vaginal dryness, and even a dip in your desire for intimacy. These are the classic menopause symptoms we all hear about, and the good news is, many of them can be managed with the help of a pelvic floor physiotherapist!

But there’s more to menopause than just these obvious changes. There are a few “silent” issues that don’t always get the attention they deserve: menopause’s effect on your bones, heart, and brain. These can show up as osteoporosis, heart disease, and even dementia. And with women’s life expectancy growing longer, many of us can expect to spend 30 or more years post-menopause— that’s about 40% of your life1! The more we learn about how menopause affects our bodies and how to manage it, the better equipped we are to live a healthy, vibrant life.

Let’s take a look at these three “silent” changes and how to take action:

Bone Health

After menopause, a drop in estrogen causes bones to lose density faster than they can rebuild, making them more fragile. In the first 5 to 6 years after menopause, you might lose about 10% of your bone mass, and for many women, the loss can be even greater— up to 20%2. This condition is called osteoporosis, and it increases your risk of fractures. In fact, 80% of fractures in women over 50 are due to osteoporosis3! These fractures can seriously affect your mobility and quality of life.

The good news? There are things you can do! Hormone replacement therapy (HRT) can help improve bone density for many women4, but pelvic floor physiotherapists can also help with other strategies like regular exercise (both strength training and cardio), fall prevention tips, stress management, and lifestyle changes like quitting smoking5. If you want more info on bone health and osteoporosis, check out the “Strong, Steady, Straight” guide—it’s a great place to start6!

Heart Health

Heart disease is the leading cause of death in women, and menopause can make it even riskier7. If menopause starts before the age of 45, the risk increases even more8. This is because, as estrogen drops, women can see an increase in risk factors like high LDL (bad cholesterol), low HDL (good cholesterol), high blood pressure, and weight gain—all of which contribute to heart disease.

The great news is that 90% of these risk factors can be controlled9. With the right changes—like regular exercise, a heart-healthy diet, cutting back on alcohol, and quitting smoking—you can lower your risk. A team approach (including a physiotherapist) can help guide you through these changes. And while HRT isn’t recommended specifically for heart protection, taking care of yourself with exercise and healthy habits goes a long way.

Brain Health

Did you know that 70% of women experience changes in their brain during menopause? This can show up as things like forgetfulness, mood swings, and insomnia, which are signs that your brain is going through a lot of changes too10. As your body adjusts to lower estrogen levels, it can affect the areas of your brain that control memory, mood, and focus. This can sometimes lead to what’s often called “brain fog.”

Additionally, for women with a family history of Alzheimer’s, the loss of estrogen may make them more vulnerable to developing this disease10. While we don’t have all the answers yet, it’s clear that menopause is a time when our brains need extra care. The good news is that many of the same lifestyle changes we mentioned—like regular exercise and a healthy diet—can help reduce your risk. And while we’re still figuring out if HRT can prevent dementia, staying active and reducing alcohol and smoking are great steps to take now11.

Key Takeaways

The menopause transition brings more changes than just hot flashes and mood swings. It can affect your bones, heart, and brain in ways that are often silent but just as important. The good news is that there are lots of things you can do to reduce your risk and feel great in your post-menopausal years! Working with a pelvic floor physiotherapist can help you take a holistic approach to your health, creating a plan to stay strong, active, and thriving long after menopause.

References

1 – US Preventive Services Task Force. Mangione CM, Barry MJ, Nicholson WK, Cabana M, Caughey AB, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Stevermer J, Wong JB. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: US Preventive Services Task Force Recommendation Statement. JAMA. 2022 Nov 01;328(17):1740-1746. [PubMed] [Reference list]

2 – Ji MX, Yu Q. Primary osteoporosis in postmenopausal women. Chronic Dis Transl Med. 2015 Mar 21;1(1):9-13. doi: 10.1016/j.cdtm.2015.02.006. PMID: 29062981; PMCID: PMC5643776.

3 – https://osteoporosis.ca/what-is-osteoporosis/

4 – Wells G, Tugwell P, Shea B, Guyatt G, Peterson J, Zytaruk N, Robinson V, Henry D, O’Connell D, Cranney A; Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocr Rev. 2002 Aug;23(4):529-39. doi: 10.1210/er.2001-5002. PMID: 12202468.

5 – Cole Z, Dennison E, Cooper C. Update on the treatment of post-menopausal osteoporosis. Br Med Bull. 2008;86:129-43. doi: 10.1093/bmb/ldn017. Epub 2008 May 12. PMID: 18477578.

6 – Brooke-Wavell K, Skelton DA, Barker KL, Clark EM, De Biase S, Arnold S, Paskins Z, Robinson KR, Lewis RM, Tobias JH, Ward KA, Whitney J, Leyland S. Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. Br J Sports Med. 2022 May 16;56(15):837–46. doi: 10.1136/bjsports-2021-104634. Epub ahead of print. PMID: 35577538; PMCID: PMC9304091.

7 – Benjamin, EJ, Muntner, P, Alonso, A, Bittencourt, MS, Callaway, CW, Carson, AP, Chamberlain, AM, Chang, AR, Cheng, S, Das, SR, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2019 update: a report from the American Heart Association [published correction appears in Circulation. 2020;141:e33]. Circulation. 2019;139:e56–e528. doi: 10.1161/CIR.0000000000000659

8 – Ryczkowska K, Adach W, Janikowski K, Banach M, Bielecka-Dabrowa A. Menopause and women’s cardiovascular health: is it really an obvious relationship? Arch Med Sci. 2022 Dec 10;19(2):458-466. doi: 10.5114/aoms/157308. PMID: 37034510; PMCID: PMC10074318.

9 – https://www.menopauseandu.ca/health-concerns/heart-vascular-health/

10 – Mosconi, L., Berti, V., Dyke, J. et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep 11, 10867 (2021). https://doi.org/10.1038/s41598-021-90084-y

11 – https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia/additional-treatments-for-dementia-risk/hormones#:~:text=Alzheimer’s%20disease%20is%20more%20common,damage%20caused%20by%20Alzheimer’s%20disease.