When I became a mother ten years ago, I was hopelessly ill-prepared for how pregnancy and childbirth might affect me, both mentally and physically. After having two babies in under two years, I found myself feeling physically weak, with ongoing diastasis recti and a pelvic floor that no longer functioned quite so well, and mentally depleted, with low mood and anxiety. Becoming a mother is a huge transition in itself. Turns out that feeling broken and clueless doesn’t help. I also found that trying to build new habits to support my health - for example, daily pelvic floor squeezes - while in the throes of sleep deprivation and overwhelm was extra challenging.
Why didn’t anyone tell me? I could have put all these things into practice beforehand.
I’ve vowed not to walk blindly into peri-menopause in the same way. Aged 39 and now a mum of three children aged 9, 7 and 3 years, I consider myself something of an in-betweener. I don’t really see myself as postpartum any more - my babies are growing up - but I’ve not yet arrived at my next key life stage - peri-menopause. Peri-menopause (meaning “about menopause”) can happen in our 30s but most often starts between the ages of 40-44. It’s peri-menopause which gives rise to all those stereotypical cliches about menopause - for example hot flushes and mood swings - because as the drop in oestrogen speeds up and the body works harder to produce eggs, many women will experience symptoms. I’m not there…yet. I track my periods each month, and these are still very regular.
The decline in circulating oestrogen brings with it various health risks, so I am consciously using this in-betweener phase to put myself in the best possible place when the time comes for me to navigate peri-menopause and - hopefully - to live a fulfilled and healthy life beyond menopause, which happens on average at the age of 51 (menopause is the day when it’s been a year since your last period). I’m doing this both by learning as much as I can about what happens during peri-menopause and by establishing habits now that - based on what I’ve learned - I believe will serve me well through those next chapters. These habits can be divided broadly into the following themes: movement, mental health and pelvic health.
As an adjunct, I’ve also taken the opportunity to learn about different forms of Hormone Replacement Treatment (HRT) so that I know my options when the time comes. Because who can be learning that stuff while in a hormonal fog? I won’t go into that here, but you’ll find a wealth of information in our Menopause by Umi course, including a whole module by our General Practitioner contributor.
1. Movement
Insufficient physical activity (less than 30 minutes of moderate activity daily per week) is currently one of the leading risk factors for mortality worldwide. My goal during this in-betweener phase is to establish a consistent movement habit - with a focus, too, on rest and recovery - which will support my body as my oestrogen levels decline; moving for my bone health, my muscle health, my heart health and my mental health. I’ll cover the first three here. Movement for mental health follows in the next section.
Bone health - I am using this decade as a time to really focus on keeping my bones as strong and dense as possible. It might seem odd that I am thinking about bone health in my thirties, but our bone mass peaks at around the age of 35, after which time we break down more bone than we build. As oestrogen levels fall, we can see a swift decline in our bone mass. The good news is that bone is living tissue which responds to exercise by getting stronger. So by training intelligently, we can both stop the decline of our bone mass and even increase it.
I want to go into peri-menopause with the best bone density possible. Think of it like a bank account: the greater the bone density we begin with, the lower our chance of developing osteoporosis, a bone condition that occurs when the body loses more bone than it creates, makes too little bone, or both, resulting in a low bone density.
My personal preference is for resistance training. Resistance training - where we exercise against the resistance of weights, bands or our body weight - results in the tendons pulling on the bones, which boosts our bone strength. I do resistance training four days a week, training my upper body and lower body in a balanced way. I also include a range of weight bearing exercise - activity done on my feet that works my bones and muscles against gravity. When our feet and legs carry our body weight, more stress is placed on our bones, making our bones work harder. Higher impact activities serve to jolt the bones rapidly and firmly, providing more benefits. My personal preferences are brisk walking, jogging, and skipping.
Muscle health - Another priority for me this decade is building some more muscle (i.e hypertrophy), or at very least preserving what I already have. Muscle mass declines naturally with age, starting in our thirties, and muscle strength declines, too. Menopause doesn’t help matters, with declining levels of testosterone making us more vulnerable to muscle loss. I ensure that my resistance training has an emphasis on progressive overload, which simply means doing more over time. As things start to feel too easy, I make them a bit harder, to keep challenging my body and drive adaptation. Nutrition is an important part of muscle growth, so in addition to my training, I ensure I’m consuming sufficient protein each day, which I prefer to get from my diet rather than by supplementing wherever possible. I’ve hoovered up all the advice of Kristy Coleman, Nutritionist, in our Menopause by Umi course, to make sure I am supporting my body as best I can.
Heart health - Oestrogen offers some protection for our hearts, so we need to be mindful of our heart health as our oestrogen levels decline with menopause. As oestrogen levels drop, the level of fat in our blood can increase, putting us at risk for developing heart and circulatory system disorders such as high blood pressure, high cholesterol, stroke and heart disease. Physical activity is super important here. The World Health Organization recommends at least 150 to 300 minutes of moderate exercise or 75 to 150 minutes of vigorous aerobic exercise a week for adults up to age 64. That works out to about 30 minutes a day, five to seven days a week and, frankly, I can’t see myself establishing that sort of habit when I am navigating the effects of fluctuating hormones, so I am working to build it now! The activities I enjoy most are: brisk walking, jogging (though I freely admit to being a fair weather runner) and interval training on my assault bike or ski erg.
It’s important to mention here that, although my kids are getting older, they are still of the age where life can be very unpredictable. We get our fair share of lurgies, and sleep can of course be interrupted. This unpredictability can make consistency hard. For me, consistency is not about no excuses / keeping going whatever the circumstances / never missing a Monday etc. It’s about recognising that interruptions do and will happen, and being able to start back again as soon as circumstances allow me to. So, if I miss a session or two, I don’t just throw the towel in. I pick back up as soon as I can and carry on. I trust that practising this skill again and again during this chapter will serve me well as I move to the next.
2. Mental health
This one is significant for me. Having babies had a massive (and unforeseen) impact on my mental health; the combination of hormones, adjusting to life as a mum and, of course, the bone-aching tiredness that comes with raising small humans. Looking back, I know now that my brain back then was full of a lifetime of unhelpful thinking habits (e.g. compare and despair, critical self, catastrophising, black and white thinking) which went into overdrive with all the uncertainty of becoming a mum, and I did not have the tools to self-soothe or to challenge those thoughts. I had never acquired them.
Hormone changes during peri-menopause can affect our mental health, with many women reporting mood swings, low mood and anxiety. If you have a history of depression, like me, you’re more likely to experience depression during peri-menopause, too. Rather than feeling like I am doomed (old me would definitely have felt this!) I am looking to control what is within my control, now, establishing healthy habits and making sure I am as well as I can be when my hormone levels start to change more significantly. I see this as no different from the approach I am taking with my physical health. There shouldn’t be any stigma around it. Here are the areas I’m focusing on now, in my thirties:
Talking therapy - Between 2021 and 2022 I had a course of 20 sessions of Cognitive Behavioural Therapy (CBT) to work through some long-standing issues which were becoming pretty disruptive in my day-to-day life and causing a huge amount of anxiety. I appreciate this isn’t something that everyone can access, but if you can access it and you’re worried to do so because you feel vulnerable or embarrassed or unhelpable (I felt all three of those) I would encourage you to explore it. It’s not a quick fix; it takes hard work, but it can be life-changing. I am no longer having regular therapy, but I’m using the skills I learned every single day. I also know therapy is something I can seek out again if ever I need to, and it hopefully won’t feel like such a daunting thing if I do need to, because I’ve done it before.
Movement - There are heaps of studies which have shown that physical activity can improve our mental health. I’ve already outlined my broad movement habits above, but my absolute favourite thing for my mental health is a walk outdoors, preferably with my phone left at home. When I’m short of time, even a five minute outside walk gives me a boost. The nice thing about walking is that we can take it as briskly or as gently as we need, and I know this will be a go-to movement choice for me as I navigate peri-menopause, just as it was in those long, sleep-deprived days after I had my babies.
Sleep - With age, I’ve come to realise how fundamental sleep is to my mental health. When I am more tired, I notice myself default to my long-established unhelpful thinking habits, and I find it harder to calm my anxiety. Declining oestrogen can impact our sleep quality and many women experience sleep disturbances during peri-menopause and beyond. I am using this in-betweener phase to get into good habits with my sleep, again with the hope that a settled routine will help me as I navigate peri-menopause. My ‘bedtime routine’ involves keeping a pretty regular time for going to bed at night and waking up each morning, avoiding caffeine and alcohol (more on this below), putting my phone away at least 30 minutes before I head to bed and reading a few pages of my book before lights out.
Cutting out booze - In May 2021 I decided to stop drinking alcohol. I wasn’t a heavy drinker; I would have a small glass of wine 3-4 times a week. At that point in time, my anxiety was wildly out of control, and I was embarking on CBT. I didn’t want to add anything into the mix that might hinder my ability fully to benefit from my talking therapy or increase my anxiety. I hadn’t intended to give up alcohol for good, but the longer I went without drinking alcohol, the more I realised that I didn’t miss it. Moreover, I felt better, calmer, happier, more clear-headed without it! And with peri-menopause looming somewhere on the horizon, I’ve decided to stay off booze all together for now. Anecdotally, many peri-menopausal women say that drinking makes symptoms like mood swings, hot flushes, and insomnia worse, so for me this feels like a really sensible variable to control.
Connection - Though it’s the last thing I feel like when my mood is low, I know that speaking to, being with and seeing other humans makes me feel better! Feeling connected with my friends and family is good for my mental health. This is an area where early motherhood certainly took its toll. I had less time to see my friends, and less energy for it too. Now my kids are a little older, I’m making more of an effort to nurture my relationships, so that I have a good support network in place as I move into peri-menopause, and connection comes more easily. Checking in with friends, picking up the phone, making plans to see people, even going for a walk and talk all fill my cup.
3. Pelvic health
I am well aware from my work and studies that pelvic floor issues, left unchecked, are likely to worsen with age. I had three big babies between the ages of 29 and 35, and birthed all vaginally. It was a priority for me to spend time rehabbing my body postnatally, and part of this involved seeing a pelvic health physiotherapist for a full assessment, including a check of my pelvic floor muscles, and doing kegels (pelvic floor exercises) several times a day.
I am at a point now where my pelvic floor feels good the majority of the time; I don’t think about it as I did when I was in the early weeks and months postpartum. But I don’t want to stop thinking about my pelvic floor completely! I make sure I do a handful of pelvic floor squeezes every single day, in standing. I usually do these in the shower as this helps me to “habit stack”. Sometimes I change up my foot stance to make the challenge different (e.g. wide legs, split stance), and I always do a mix of short squeezes (squeeze and let go immediately) and long (10 second) holds, to work both the fast and slow twitch muscles. I make sure my daily habits are supportive of my pelvic health; using a stool to prop my feet up when I poo, staying well hydrated and avoiding constipation. I make sure that my exercise supports rather than hinders my pelvic health too, so no bearing down into my pelvic floor when I’m lifting weights, and making sure I include some high impact exercise like jumping and running, to challenge those muscles in a way which cannot be replicated with kegels. There’s loads more expert pelvic health guidance from my co-founder Helen Keeble in our Menopause by Umi course, and I’ll be leaning further into her tips and suggestions when the time comes.
So there we have it! All the things I am doing in my thirties to set me up, I hope, for a smoother peri-menopause and a healthy, fulfilled post-menopause. I hope I’ve given you some ideas to put into practice so that, rather than being a passive bystander through peri-menopause, you can be proactive now in ensuring you have an informed, empowered and as-comfortable-as-possible peri-menopause.
For a progressive, online strength and conditioning programme you can follow at home or in the gym to boost your bones, muscles, heart and mental health check out my LIFT programme.
You can find loads more evidence-based information to inspire and equip you for menopause from your thirties onwards in our Menopause by Umi course.