disease. This is believed to be due to a combination of factors such as decreased metabolic rate due to ageing, a lack of activity and poor diet in addition to menopause (1,2,3).

Cardiovascular conditions Postmenopausal women carry a higher risk factor for a range of cardiovascular conditions than pre- or peri-menopausal women (2,3,4). These include severe cardiovascular disease/ coronary heart disease, hypertension, atherosclerotic disease and reduced glucose tolerance and diabetes. The causal factor for this appears to be the reduction in oestrogen that has a detrimental effect on both cardiovascular function and on metabolism.

Osteoporosis Bone density is significantly affected by the drop in oestrogen production that occurs around menopause and the risk of osteoporosis and associated fractures increases (3,5).

Menopausal arthralgia Joint pain is reported by more than half of women over the menopausal period (6) although neither the pathology of menopausal arthralgia nor a direct link between menopause and joint pain are determined, it is likely to be related to reduced levels of oestrogen. There may also be a link with musculoskeletal symptoms arising from osteoarthritis, rates of which increase around this age group regardless of menopausal factors.

KEY PSYCHOLOGICAL EFFECTS OF THE TRANSITION INTO MENOPAUSE Depression and anxiety One of the most commonly reported effects of menopause is depression. While the precise cause of this is undetermined, there are two likely reasons for transient depression; the biological processes and hormone fluctuations are both factors and there may also be a sense of loss for the end of the childbearing period. These psychological effects are more common in the peri-menopause and usually ease once menopause occurs.

Mood disturbance Changing hormone levels during the reproductive life of women are well documented and menopause is no exception (3). Women who have undergone hysterectomy appear to have reduced levels of physical functioning in midlife which has implications for physical state and quality of life in later years (7).

Medication: benefit and side effects As with all pharmacological interventions and treatments, medicines prescribed for menopausal women give both benefits and side effects. Key side effects are listed in Table 1 and so have implications for exercise. Side effects such as hypertension need careful screening while gastrointestinal (GI) and abdominal effects may make exercise feel uncomfortable. As with all clients, a thorough health and medical status screen should be carried out and any symptoms of the condition and medicine side effects taken into account when planning exercise.

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BENEFITS OF PHYSICAL ACTIVITY As many of the documented effects of menopause take place in the peri-menopause – that is the years leading up to cessation of periods – it makes sense for women aged 35 and over to start, or maintain, some form or regular exercise and activity as early as possible in order to reduce some of these effects. Of particular importance is the benefit for bone health and cardiovascular function to reduce the risk factors for osteoporosis and CVD in later life.

Bone health While falling oestrogen levels are the most significant risk factor for osteoporosis, inactivity is a close second. Regular weight bearing activity and resistance exercise has been shown to have a protective effect on bone density (5,8).

Cardiovascular health Research suggests that menopause is associated with a greater progression of subclinical atherosclerosis, in itself a significant risk factor for CVD (9). Diet and exercise interventions slow this progression and as CVD is the leading cause of premature death in women, exercise should be a priority for all women approaching menopause.

Body composition Menopause is associated with an average weight gain of 2-3 kilogrammes, particularly around the waist, that carries a greater CVD risk and which can be upsetting for many women. The role of exercise, particularly aerobic exercise, in weight loss and management is fairly self-evident and an increased duration of exercise is associated with lower weight regain. An appropriate programme of regular, light exercise, including resistance exercise, will help to maintain a healthy body composition, improve physical capacity and reduce the risk of CVD and diabetes (10). For overweight or obese women these gains may be particularly unwelcome for both aesthetic and health reasons. Furthermore, it would appear that while for many women menopausal weight gain is a trigger for improving diet and adopting activity, there may be a threshold above which overweight or obese women lose confidence in their ability to

As menopause nears, fat deposits on women’s bodies appear to change. Fat tends to accumulate more around the waist instead of more evenly throughout the body. This can change a woman’s metabolic profile and contribute to an increased risk of metabolic syndrome and cardiovascular disease

The REPS Journal 2009;00(Month):00-00 The REPs Journal 2011;21(June):15-22