“It’s a miracle that you haven’t been to see me until now,” said my GP as she looked over the results of my hormone tests. “It seems like you have been self-medicating with exercise!”
I was just 39 and in the grip of the premature menopause symptoms I’d long been expecting – my mum, sister and maternal grandmother all went through it in their mid to late 30s too – so when my doctor confirmed that my oestrogen levels had rapidly plummeted, I wasn’t surprised. But just because I had been expecting it doesn’t mean I was coping.
When you search Google for images of menopausal women, you’re met with pages of elegant, white-haired ladies of a certain age, usually holding their heads in their hands and very much alone. They are not in their 30s, slumped on their kitchen floor in pyjamas with two small children clambering on them while they sweat and despair.
I couldn’t help but feel bitter that I’d been propelled straight from the rollercoaster of early motherhood to the challenges of midlife without time to catch my breath. Throw in the pandemic and, after a lifetime of thinking “mental health” was just something other people struggled with, I was in a bad place – and desperate to find a solution without immediately turning to medication. My mum had breezed through her menopause without hormone replacement therapy (HRT) and was worried about some of the risks of me taking it. Even though many of those have been debunked since she went through it, I didn’t want to worry her.
How exercise is twice as effective as antidepressants
While I did experience some of the textbook physical perimenopause symptoms like hot flushes and insanely irregular periods (nothing for five months, and then four in six weeks), the part that felt it most impacted my life – and my family’s – was mood-related. I was snappy, stressed and emotional, and began experiencing panic attacks out of nowhere.
At the same time, despite a lifetime of inactivity, something inside me was telling me I needed, urgently, to move. I had always hated exercise, having felt self-conscious about my curvy body and lack of coordination ever since the trauma of comprehensive school PE, but suddenly it was the only thing that could help; I was overcome by what felt like an almost primal urge to get fit and strong. So I was unsurprised by the striking new research showing that regular exercise can be twice as effective as antidepressants.
The science shows that running a few times a week is the most effective for symptoms of depression, improving symptoms by 63 per cent (versus 26 per cent for antidepressants). My approach was a classic one: I downloaded the Couch to 5K app, which took me from short run/walk intervals to a regular running routine in a matter of weeks (and four years on, I’m about to run the London Marathon).
It was tough at first, but once I had got into it, thanks to Jo Whiley’s audio spurring me on, the physical and mental benefits outweighed the blood, sweat and tears. However, if the mere thought of huffing and puffing through the park brings you out in a cold sweat, it’s by no means the only option: more gentle activities like walking, dance, strength training, cycling and yoga were all found to have more positive impact than medication and all of these can also be particularly beneficial in menopause, helping with physical symptoms too.
What I find interesting is why exercise feels so good when your hormones are going haywire: how much of it is physical, and how much is in the mind? Dr Rachel Hines, a clinical director at the online menopause clinic Stella, says it’s a combination of both. “Exercise helps with serotonin release, which then helps to manage mental health symptoms, so has a chemical effect,” she explains. “There are also psychological benefits as it brings a sense of achievement, can reduce stress and improve sleep, all of which can improve mental health symptoms. Exercising outside can be especially beneficial.”
This certainly chimes with me – nobody is more surprised than I am that I will now happily pound the pavements in hammering rain, or even get up before 6am to beat the heat on a summer’s day, because any physical discomfort is rapidly offset by how good it makes me feel. I am more creative, productive and content after exercise, the only problem being that, like with any addiction, if I go a day or two without it, everyone knows it.
Is it time for HRT?
Since my trip to the GP, I’ve also been on a low dose of HRT to reduce the hot flushes and give my body the hormones it should still have a plentiful supply of in my early 40s and I’ve just about persuaded my mum that this is the right decision for me too. HRT has definitely helped me, but the problem is, many women feel disappointed when it doesn’t offer the “cure-all” they had been hoping for, as generally it’s when it’s combined with lifestyle changes that you really feel the benefits, particularly when it comes to mood.
“Regular exercise can help with vasomotor symptoms such as hot flushes and night sweats,” says Dr Hines. “But HRT is an excellent option for treating vasomotor symptoms, and if lifestyle changes aren’t making a significant difference, it can really help. Other non-hormonal options are antidepressants, gabapentin, clonidine and fezolinetant – a new medication which treats hot flushes only.”
As with most things, it’s all down to finding the right combination for the individual. Right now, I feel fitter and more energetic than at any other point in my life, with no need for antidepressants or any other treatments beyond HRT. But I am still “only” 43, so I know that this could change over the next few years as my body approaches the normal age for menopause.
For now, I’m confident that my routine of running, strength training, a bit of Pilates and a lot of jumping around with my kids, now eight and six, is why I haven’t experienced a panic attack in three years. And as for rage? Well, when I find myself shrieking “get your shoes on” for the 37th time on a Monday morning, I’m pretty sure it’s down to the normal ups and downs of motherhood and not my hormones.
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