What you can influence yourself in the menopause

Part 10 of 12 · All topics on the menopause

Looking after your health without the pressure to optimise yourself

Many guides promise that the menopause can be “brought under control” with a particular eating plan, intensive training or a perfectly organised evening routine. Such promises sound tempting, but they can add pressure. If the hot flushes stay despite a healthy diet, or the joints keep hurting, it is easy to feel that you have done something wrong. That would be an unfair conclusion.

Lifestyle measures are valuable because they can support health, strength and wellbeing. But not all of them have been shown to work against every menopausal symptom. The large 2024 overview of exercise and menopausal symptoms found signs of improvement depending on the intervention, but a very mixed body of evidence. Training that strengthens bones and muscles does not have to reduce hot flushes reliably as well. This difference is a strength of good health advice and not an argument against exercise. [1]

A realistic question is therefore: Which two or three changes would do my health good and fit my daily life? Someone with little time, chronic pain or shift work needs different approaches from someone with plenty of free time. The most effective routine is rarely the most complicated one. It is the one you can keep up over the long term and without constant feelings of guilt.

Exercise: strength, endurance and balance

Regular exercise supports heart and circulatory health, muscle strength, metabolism and mental wellbeing. In midlife it makes sense to distinguish three areas. Endurance is trained, for example, by brisk walking, cycling or swimming. Strength is trained by moving and holding loads, for instance with dumbbells, machines, your own body weight or elastic bands. Balance and flexibility make movements steadier and can affect the risk of falls in older age.

You do not have to walk into a gym straight away. For a woman who has done little training so far, two short strength sessions a week, done regularly, can be an achievable start. More important than a particular piece of equipment is that the muscles are increasingly challenged in a suitable way. This can be done through exercises led by a professional, rising numbers of repetitions or a careful increase in load. With osteoporosis, heart and circulatory disease or significant joint problems, the training should be tailored to the individual.

Many women underestimate everyday movement. Stairs, walking to places or a short stroll in the lunch break do not replace every form of targeted strength training, but they can make an important contribution to an active life. It is possible to start even after a long period of inactivity. Nobody has to compare themselves with a 25-year-old to benefit from more movement.

Food: looking after your body rather than punishing it

There is no single diet that halts the menopausal transition. The body still needs energy, protein, fats, carbohydrates, fibre, vitamins and minerals. A varied diet with vegetables, fruit, wholegrain products, pulses, suitable sources of protein and mostly unsaturated fats fits many general dietary recommendations. Specific needs, however, differ depending on health, lifestyle and personal preferences.

Protein is discussed particularly often in midlife, because keeping muscle and strength training go together. This does not mean that every woman has to buy protein powder. Many can meet their needs through food. An individual assessment makes sense, for example, with a very restricted diet, kidney disease or particular training goals. An adequate supply of calcium and vitamin D is also relevant for bone health; however, blanket high-dose supplementation without working out the need is no substitute for a balanced diet and an assessment of osteoporosis risk.

If you want to change your weight, you are entitled to have that as a personal goal. At the same time, rapid diets are often hard to keep up in the long term and can narrow the focus on muscle strength and wellbeing. A health-oriented diet is not a moral judgement on body shapes. It should support your daily life, not turn every pleasure into a table.

Alcohol, nicotine and caffeine: individual rather than magic rules

Alcohol can affect sleep and general health; smoking raises numerous health risks. Stopping smoking and handling alcohol responsibly therefore make sense regardless of the menopause. Some women also notice that alcohol or very hot drinks trigger or worsen individual hot flushes. It is fine to observe this. However, one person’s experience of a trigger does not prove that giving up all “warm foods” across the board would be an effective therapy for every woman.

The same goes for caffeine. If you feel wide awake at night after coffee in the late afternoon, you can change the timing. Others tolerate a cup in the morning well. Your own observations help more than strict general lists of bans. It is worth distinguishing between habits that are generally recommended for health and individual adjustments that feel pleasant.

Sleep as a protected part of the day

Regular times for getting up, daylight, physical activity, a quiet bedroom and less disturbing screen activity shortly before going to bed can create favourable conditions. Even so: chronic insomnia is not simply a sign of poor sleep hygiene. Anyone who lies awake persistently despite good conditions may need specific treatment. That is why cognitive behavioural therapy for insomnia was explained on the page Treatment without hormones.

A common problem is trying to make up for poor sleep by lying in bed for ever longer. For some people this strengthens the link between bed and being awake. Individual sleep advice can be more effective here than yet another soothing tea. If there is noticeable snoring, pauses in breathing or severe daytime tiredness, sleep apnoea should also be considered.

Reducing stress does not mean wishing the cause away

Stress is not a simple explanation for all menopausal symptoms. Even so, high pressure can make it harder to cope with physical changes. Small breaks, conversations with people you trust, reasonable working hours, relaxation techniques or therapeutic support can improve general wellbeing. There is no need to “optimise” every thought. Sometimes the most important measure is for demands from outside to be reduced.

Someone who constantly feels exhausted should therefore not only ask how she can become more resilient. She may also ask whether the workload, caring duties or the way family tasks are shared are realistic. A biological transition meets social conditions. Both levels can be looked at when searching for solutions.

A four-week plan you can put into practice

A change often succeeds more readily when it is small and specific. In the first week you could look for two fixed time slots for exercise. In the second week, see whether they were realistic and, if appropriate, add a simple strength exercise. In the third week, work on one sleep habit that you can really influence. In the fourth week, review what has helped and what feels needlessly burdensome. This sequence is an organisational example, not a clinically tested special therapy.

The plan only works sensibly if it is adapted to your life. With more severe symptoms it does not replace medical treatment. It is meant to widen your options for action, not to push responsibility for every symptom back onto you.

Habits do not work equally against every symptom

Diet, exercise and sleep habits appear in almost every guide to the menopause. That is understandable on the one hand: midlife is a sensible time to support your health for the long term. On the other hand, some guides blur the difference between general health promotion and a specific treatment for hot flushes. It is well established that physical activity can promote general health. It is less clear whether a particular form of training reliably reduces vasomotor symptoms in every woman. The 2024 systematic overview of reviews on exercise and the menopause accordingly shows mixed, in part limited, results. [1]

This distinction protects you from disappointment. If you go for a regular walk for four weeks and the episodes of night sweats remain, that is not a personal failure. Your activity can still be worthwhile for fitness, mood or long-term health. Conversely, an improvement after starting to train does not automatically prove that the effect of training was mediated solely through menopausal hormones.

Dividing exercise into three parts that suit daily life

First, endurance activity can support cardiovascular fitness: brisk walking, cycling, swimming or dancing are examples. Second, strength training is important for keeping muscle and physical function. Third, balance and flexibility sessions help to make movements safer and more comfortable. Which mix makes sense depends on starting fitness, pain, health conditions and personal preferences. Not every woman wants to jog; not every woman needs a gym.

If exercise has had little room in your life for a long time, small, plannable sessions can be a better start than an ambitious six-week plan. What matters is a build-up that you can keep going. Two things should also come together: load and recovery. Someone who sleeps badly and is also under heavy pressure in daily life may be overwhelmed by training that is too hard. Training may be tiring, but should not constantly use up the last of your available energy.

It can help to judge activities by their effect rather than by the calories they burn. Do you feel steadier in daily life? Is the staircase easier to manage? Are you less afraid of moving? Can you carry your shopping better? Such goals are often more concrete and lasting than the wish to get back to a particular clothes size.

Eating without a list of bans

There is no single scientifically well-confirmed “menopause diet” that switches off all the typical symptoms. What makes sense is a diet that supplies enough energy, protein, fibre and other nutrients and that fits your culture, preferences, income and health. Vegetables, fruit, wholegrain products, pulses, suitable sources of protein and unsaturated fats can be parts of such a pattern. Anyone with particular conditions, for example diabetes or kidney disease, may need more individual recommendations.

On social media, food is often presented as a moral question: whoever avoids the right foods will have no symptoms. That is neither fair nor compatible with the complex biology. Some women observe that certain drinks or meals trigger their hot flushes. Such personal links can be taken seriously and tested pragmatically. It does not follow, however, that every woman has to give up coffee, spices or sugar. The Menopause Society does not regard a general change of diet as a sufficiently proven specific therapy for vasomotor symptoms. [2]

For bone and muscle health, an adequate supply of the relevant nutrients makes sense. That does not mean taking as many supplements as possible. Someone who eats a one-sided diet, loses weight unintentionally or has a medically confirmed deficiency may need particular support. With dietary supplements, you should check whether the recommended amount, the quality of the product and possible interactions are suitable. The page Supplements and myths looks more closely at the scientific assessment of individual products.

Why the sleep environment can help but does not replace therapy

A pleasantly cool bedroom, suitable bedding and the chance to change clothes easily during night sweats can make daily life easier. They are practical aids, not a scientifically proven cure for the underlying mechanism. With persistent insomnia, specialised sleep treatment can be more effective than ever new tips on the “perfect evening routine”. [3]

Some women turn sleep hygiene into an extra task. They avoid too many things, check sleep clocks and come under pressure to get everything right every evening. With a chronic sleep disorder in particular, such self-monitoring can backfire. The question is not whether you keep all the rules, but whether your sleep, and how you cope with it, are getting better.

If hot flushes are the main reason for waking at night, targeted treatment of the vasomotor symptoms should also be discussed. But if you mainly lie awake and brood, sleep therapy may come to the fore. Different causes call for different approaches, even if the experience of “I am tired” the next morning sounds similar.

Coping with stress without the pressure to optimise yourself

The advice “reduce your stress” can easily sound like a reproach, especially when pressures cannot simply be changed. Someone who cares for relatives, works shifts or worries about financial security cannot simply dissolve these circumstances with meditation. Even so, small amounts of room to manoeuvre can help: a realistic bedtime, clear agreements within the family, help with caring or deliberate breaks after intense working days.

Mindfulness, relaxation and breathing exercises can feel good. However, depending on the method, the evidence for a specific reduction of hot flushes is weaker than for certain medical therapies. A guide should therefore not promise that enough relaxation will “regulate” a biological transition. It is perfectly legitimate to like yoga without its having to be turned into a medical treatment. [2]

A weekly plan that also works in a bad week

Instead of changing every area of life at once, you can pick one small measure that you can check. Perhaps you go for a brisk walk on two fixed days. Perhaps you put short strength exercises in the calendar for three weeks. Or you arrange an appointment to look into your sleep because you can hardly sleep despite calmer evenings. A good change does not have to be spectacular; it has to fit your life.

After four weeks, ask: Was the measure workable? How did I get on with it? Is an adjustment needed? With symptoms that fluctuate a lot, longer periods of observation and looking at several aspects make more sense than a daily mark for success. If you notice that the self-optimisation itself is becoming a burden, that is a reason to make the plan smaller. Health promotion should create resources and not permanently generate extra tasks.

A plan for the first week

At the start of a change, it helps to ask what is really doable. A woman who works shifts will need different routines from someone with fixed office hours. Another with chronic pain has to plan her start with exercise more carefully. There is no reason to measure yourself against an idealised daily routine that only works under perfect conditions.

You could begin with three small observations: How much do I move on an ordinary working day? When do I eat meals that fill me up well? And what disturbs my sleep most? A sensible next step often follows from this. Some decide on short daily walks, others on two strength training sessions a week, others again on looking into persistent sleep problems.

It is important not to measure a measure against all of your symptoms. Strength training can improve physical function even if the hot flushes stay the same. A better sleep routine can help with falling asleep, but cannot treat sleep apnoea. Healthy behaviour is no substitute for a medical diagnosis and should not be sold as one.

Why social support can be more than motivation

When daily life is already full, what is needed is often not another hint about a lack of discipline. Sometimes it is more helpful to get practical support: a task that is reliably shared, an exercise group, a shared meal plan or someone who takes the strain seriously. Health does not depend solely on individual decisions. Working hours, financial means, surroundings and responsibility for relatives influence the options.

A guide should therefore offer different routes. A gym may suit one woman, a short exercise session at home another. Someone who looks after relatives may not be able to create long periods of rest, but can arrange relief in a targeted way. Not every solution is medically spectacular. Its effect in daily life can still be great.

Starting strength training without making sport a second job

When you read about muscle health, it quickly sounds as if you had to start a new fitness life overnight. In fact a start that suits daily life can look much simpler. What matters is finding a form of load in which the muscles are challenged regularly and can then recover. For some, exercises with their own body weight are suitable, for others machines or free weights. Anyone with pain, a risk of falls or certain conditions can plan the start with professional support.

The term progressive loading means that the training is adjusted over time to your increased capacity. It does not have to get harder every week, but in the long run the body needs a suitable stimulus. At the same time, recovery is part of training. Someone who hardly sleeps because of night sweats, or who is recovering from an illness, cannot expect the same performance every day. Flexible planning is more a sign of experience than of a lack of discipline.

Do not think of strength only in kilograms. Perhaps after a few weeks you carry the shopping bags more easily, climb a flight of stairs without a pause or feel safer when lifting. Such progress can be more motivating than a body weight set in advance. For long-term health, being able to manage everyday tasks independently is an important goal.

Endurance exercise does not have to be perfect

Brisk walking, cycling, swimming or dancing can support heart and circulatory health. What matters is not to take on a sporty identity but to fit movement in so that it stays possible in the long term. A woman with irregular working hours could cover short distances actively, another could use fixed times for a class. The surroundings play a big part: safe routes, time, cost and family responsibilities all affect the possibilities.

If you have been inactive for a long time, a gradual start makes sense. This applies especially with heart and circulatory disease, breathing problems or other medical limitations. A health guide should not sell blanket high-intensity programmes as a duty. The right load is based on your state of health and on what can realistically be kept up.

Sport can have a positive effect on mood and on long-term health risks, but it is not a guaranteed treatment for every menopausal symptom. The overview of reviews published in 2024 found mixed results on the direct effect of exercise on menopausal symptoms. If you suffer from hot flushes despite regular exercise, you have not done anything wrong. [1]

Eating as nourishment rather than control

In a phase of life when much seems unpredictable, food can become an area that you want to control especially strictly. Some programmes promise to repair the hormonal balance through particular times, bans or foods. Often, general findings from nutrition science are turned into a specific menopause therapy without any corresponding controlled studies.

Good eating may be simple and varied. Regular meals, suitable sources of protein, vegetables, fruit, wholegrain products and other nutrient-rich foods can help to make sure that your general supply is covered. Anyone who is vegetarian or vegan, has allergies or has to manage particular conditions may need special planning. There is, however, no scientific reason to recommend the same extreme diet to all women over 40.

An adequate energy intake matters too. If women eat very restrictively out of fear of putting on weight, this can contribute to tiredness, a tense relationship with food or a poor supply of nutrients. The aim of a health strategy should not be to ignore hunger or to make a problem of every social meal. A way of eating that is sustainable in the long term fits daily life and is medically appropriate.

Protein, calcium and vitamin D in context

Protein supports the maintenance and building of body tissue, including muscle. In a balanced diet, suitable sources can be, for example, pulses, dairy products, fish, eggs, meat or plant-based alternatives. The individual need is not the same for everyone; age, activity and illnesses can affect it. Instead of taking over high gram figures from an advertising plan, qualified nutrition advice can make sense if you are unsure.

Calcium and vitamin D are relevant for the bones. But this does not mean that every woman should buy dietary supplements in the highest possible doses. Whether a supplement makes sense depends on diet, risk factors and, where relevant, medical findings. Especially with existing conditions, high doses may be undesirable. Looking after your health cannot be reduced to the number of capsules taken each day.

Sleep, relaxation and personal limits

Relaxation can be good for you. An evening walk, a calm routine or a mindfulness exercise can help you find your way out of a hectic day. They are not, however, an equivalent substitute treatment for every severe insomnia. Anyone who has suffered from considerable sleep problems for months should consider treatment from sleep medicine or psychotherapy. Likewise, severe hot flushes cannot be reliably ended simply by “letting go” enough. [3] [2]

The wish to do everything right can itself become a source of stress. Some women keep a calorie log, a sleep tracker, a hormone app and a daily mood rating all at once. These aids can be useful for a specific question, but they are not compulsory. If they cause unease, less monitoring can be healthier. A short overview before a doctor’s appointment is enough in many cases.

The difference between a plan and an ideal picture

An ideal picture demands that every day you eat healthily, sleep enough, train and stay calm. A plan allows for the fact that sometimes you fall ill, care for relatives, work longer or sleep badly. A plan may therefore include small steps, pauses and adjustments. It has less to do with perfection than with a decision you can repeat.

You could ask yourself three questions for a month. What is my biggest health project at the moment? What can I realistically influence? Who or what would help me with it? Perhaps this becomes a sporting routine. Perhaps the first step is to make an appointment because of heavy bleeding. Perhaps above all you need support in caring for a relative. Good health promotion is individual – just like the treatment of menopausal symptoms.

If you do not want to change anything

Not every woman has to reorganise her whole life in the perimenopause. If you feel well, are active enough and questions about preventive care are settled, there is no reason to start extra programmes just because of your age. The menopause is not a project that necessarily demands a fresh start. These pages can show possibilities without making them a duty.

If, on the other hand, you are under a lot of strain, you may decide on medical help even if your lifestyle is not “perfect”. Effective treatment should not be tied to moral conditions. It is possible to look after your health sensibly and, at the same time, to need support with symptoms.

A suggested four-week outline

A practical plan can help without becoming a new duty. In the first week you simply observe which health question matters most to you. Perhaps it is hot flushes, perhaps exhaustion or a change in your physical fitness. If there are medical warning signs, looking into them naturally comes before any attempt on your own.

In the second week, think about which small change is realistic. If more exercise seems sensible, it could be one extra walk each day. If you are already active, you may want to add two short strength sessions. If sleep problems are the main issue, arranging an advice appointment could be more helpful than buying yet another tracker.

In the third week, check whether the change fits into your daily life. What also works on stressful days? What regularly fails because of time, pain or tiredness? A plan that is adjusted has not failed. In the fourth week, look at the specific aim: do you feel more resilient, have you gained more clarity about the symptoms, or started an important medical step?

The point of these four weeks is not to control the menopause. It is about finding a step you can reach. If the symptoms are still considerable afterwards, that is a good reason to discuss the medical treatment options. Living healthily should not be a condition for getting help.

Expect setbacks

A routine that works in a calm week can be interrupted by a cold, a family conflict or a trip. What matters is not to avoid every interruption, but to pick it up again without blaming yourself. Menopausal symptoms can fluctuate too. One bad month does not mean that all your progress so far is worthless.

Anyone who suffers from marked symptoms should also not make herself dependent on daily success scores. A noticeable improvement can sometimes become visible only over time, and not every measure works against every outcome. A realistic, medically informed plan takes this into account.