Lifestyle medicine for menopause. What matters to you? Do you need to make some changes? Could you focus on improving your level of physical activity, eating real foods, finding time for good quality sleep, exploring effective stress management, avoiding toxic overload, developing healthy relationships and feeling a sense of purpose? Lifestyle and how it affects hormonal health is the heart of a holistic menopause consultation at Rowena Health with Dr Carys Sonnenberg.
Genetics play a 20-30% role in our lifespan and our health span (the time where we enjoy good health without chronic illness) but 70-80% of our health span is due to factors in our environmental, like those above. Making even small changes, and starting slow can have a hugely positive effect. Here are some of our tips at Rowena Health. Do share yours with us if you find something useful.
Activity
How can you add physical activity into your daily life and spend less time sitting? Regular exercise can help us live longer, reduce periods of ill health in our lives and increase the all-important health span. Can you write down some ways to improve your aerobic exercise? Can you add 2-3 sessions to improve muscular strength each week? When do you practice balance? Do you remember your pelvic floor exercises?
Do you love being with nature? Might ecotherapy, connecting with nature, be something you would enjoy? Clear and abundant evidence demonstrates that interaction with nature affects not only our well-being but our health throughout life. A simple walk in nature can reduce anxiety, lift your spirits, and even improve memory. Do read more about the benefits of ecotherapy in this article if it interests you.
These are some examples you might enjoy, if you are exploring different ideas:
- Aerobic: 150-300 minutes a week of moderate intensity exercise, getting a bit hot and sweaty, building up and doing what you love, including running, skipping, jumping, dancing in the kitchen, something you love and that brings you joy. Do it in bite size chunks, make it easy for yourself. Outside is great if you can. Aim for 300 minutes or more if you want to lose weight and maintain weight loss.
- Strength: strength based exercises should be done at least twice a week. These are just some options for you to explore if you like online classes:
- Kate Oakley Your Future Fit
- Jane Wake
- Balance practice – help to protect yourself from falls: 10 minute balance exercise class
- Pelvic floor exercises: the muscles in the pelvic floor help prevent prolapse, bladder and bowel problems: pelvic floor exercises
- If you need help with this, a pelvic floor physiotherapist is the perfect place to get advice.
Sleep
Ensuring we get enough, good quality sleep is vital for our overall health and wellbeing, and so it is for good reason that sleep is one of the six pillars of Lifestyle Medicine. Sleep is essential for restoring our energy levels and giving our bodies a much-needed rest. We are becoming increasingly aware of its wider health benefits – as well as the harmful effects of poor sleep and sleep deprivation. There are benefits of getting between seven – nine hours of sleep every night. Do you need to explore this further?
For adults, getting between seven – nine hours of good quality sleep can help to build up our long-term disease immunity. The maintenance of healthy immune cells relies on us getting enough sleep if we are to effectively fight infections and even some cancer cells. The body’s microbiome, the trillions of microorganisms which perform a variety of important tasks for us, also needs sleep to perform its functions effectively.
Our body’s metabolism, which balances our insulin as well as our glucose intake, is in part dependent on sleep. Increased appetite and calorie intake is also associated with sleep deprivation, and may contribute to weight gain.
Cognitive function, memory and mental health are all dependent on good quality sleep. Studies show that when we sleep our brains are busy cementing new learning and processing new information. Lack of sleep reduces concentration, impairs memory, and evidence shows it can contribute to cognitive decline.
To help manage stress and support mental health, good quality sleep is essential. We know that high cortisol levels are associated with anxiety and stress, getting the right amount of sleep can help to manage these. Sleep can also reduce the risk of anxiety, depression, PTSD and the long-term effects of grief. Sleep helps us to process difficult emotions and experiences, giving us a better chance of staying resilient, positive and happy.
Tips for good sleep:
- Maintain the same wake and sleep time each day
- Ensure your bedroom is dark, cool and quiet
- Avoid caffeine after 2pm and limit alcohol consumption
- Try to spend some time each day outside in natural light to ensure your body gets a good dose of the melatonin it needs to sleep well. This also helps your hypothalamus to understand the difference between light and dark, triggering your natural body clock and helping you sleep better.
- Keep active: ensuring you are physically active can help you to enjoy better sleep
Mental wellbeing
None of the six pillars of lifestyle medicine exists in isolation, and mental health is no exception. There is a clear link between all of the other five pillars and mental health – what we eat, how active we are, harmful substance reduction, sleep and healthy relationships.
Tips to improve mental health:
- Disconnect to Connect- reduce screen time and limit social media use, increase meaningful social connection
- Practice Mindfulness, meditation, yoga or Tai Chi and spend time in nature to relax and reduce stress and anxiety
- Avoid unhealthy habits – we often mistakenly think smoking and drinking alcohol will reduce stress but in the long-term these toxic substances harm our mental and physical health
- Sleep well – getting good quality sleep for seven to nine hours each night can help to improve mental health
- Physical activity has been shown to reduce stress hormones such as cortisol and adrenaline while releasing positive “feel good” hormones such as endorphins, serotonin and dopamine. Regular physical activity also increases brain-derived neurotrophic factor (BDNF) which has generative effects in the brain, improving cognition and memory and reducing the risk of neurodegenerative disorders like Alzheimer’s Dementia and Parkinson’s Disease.
- Keep a gratitude journal to nurture positive psychology and focus on the good things in life, and maintain meaningful social connections and be kind to others to improve health, happiness and well-being
This FAQ is about how lifestyle can improve our pillars of health, but if you need support with your mental health please speak with your Dr.
Healthy eating
There is no one diet or way of eating which suits every one for good health. These are some tips and include advice from the BSLM:
- Explore how you can enjoy protein in every meal and snack
- Eat the rainbow, aiming for 30+ different plants each week and vary them: fruit, vegetables, nuts, seeds, beans and legumes
- If choosing meat or fish, choose unprocessed – and if you can choose food with high welfare credentials with less hormones and antibiotics in the processing the better.
- Advice is to eat ultra-processed food and drinks sparingly. These are foods which have been processed with the addition of additives and preservatives and are high in salt, fat and sugar.
- Choose wholegrain or wholemeal varieties of starchy foods such as rice, pasta and bread
- Ensuring you have adequate dietary calcium, about 1000mg a day
- Ensuring you have adequate Vitamin D levels from sunshine on your skin or consider taking a supplement
- Gut health is important: learn more about fermented foods, fibre, probiotics, prebiotics and polyphenols from the Zoe podcasts and this might be helpful: The Zoe gut guide
The Mediterranean diet pyramid
How to balance your plate to eat well
- Hydrate well with water
- Consider reducing caffeine, if necessary and think about when you are drinking caffeine and might it be having an effect upon your sleep?
Minimising harmful substances
The risks associated with harmful and toxic substances – such as alcohol, tobacco or recreational drugs – are well known. Smoking and heavy drinking in particular are key behavioural risk factors associated with many chronic physical and mental health conditions.
Achieving positive behaviour change is the difficult part – and this is perhaps most challenging when it comes to reducing or stopping harmful substances like smoking or drinking too much alcohol.
Lifestyle medicine can help to support with replacing harmful – and largely ineffective – ways to “feel good” and reduce stress with healthy alternatives such as physical activity, connecting with nature, sleeping well, eating healthy food, meditation, listening to music and improved social connections.
Listen to the BSLM podcast on creating healthy habits
Healthy relationships
Enjoying healthy and meaningful relationships and better social connection is essential for good mental and physical health.
As human beings we are hard wired to connect with each other; we are social beings and our family and community relationships give our lives purpose and meaning. Connecting with others not only helps us to survive but to thrive.
There is a growing evidence demonstrating a link between the quality of our social connections and the associated risk of conditions including obesity, heart disease and even some cancers. Our mental health too is closely linked to our relationships with others, and loneliness is a key risk factor for depression. High levels of loneliness can increase the risk of heart attack and strokes by 30 per cent.
How often do you see others?
Social connection and healthy relationships are critical to a lifestyle approach to healthy longevity alongside being active, a healthy diet, getting good quality sleep, avoiding harmful substances, and reducing stress.
Other recommendations
- Book: ‘Get well stay well’ by Dr. Gemma Newman
- Women’s health concern wellness hub
Lifestyle medicine calls for a move away from the traditional doctor-patient relationship where the clinician is the expert information provider. This is needed because we now know that giving simple lifestyle advice such as “eat less and move more” is often ineffective. At Rowena Health we want to work with you to improve your hormonal health and your general health, we feel lifestyle plays a vital part.
Being proactive about your future health can make a huge difference. It is never too late to make some simple changes which can help you enjoy good health in the future. We all want to be able to look after ourselves when we are older and to make it upstairs to go to the loo without help.
Simple lifestyle changes now can support your health in the future.
How might we want to keep healthy in the future?
Heart and blood vessel health
When hormones change at menopause, metabolic health can also change, affecting where you store body fat, your blood pressure, blood fats (lipids) and blood sugar.
Blood pressure rises as we age so it is sensible to check it at least once a year.
Blood lipids rise so we recommend you check yours. It might be that you need treatment to lower your lipids to reduce risk of cardiovascular disease.
There is natural gain weight through aging, which is accelerated around the time of menopause. The way body fat is stored changes, encouraging more around the middle.
The amount of muscle reduces (sarcopenia).
Insulin resistance can increase. Insulin is a fat storage hormone that helps to regulate blood sugar. Insulin resistance can increase risk of developing Type 2 diabetes.
Healthy lifestyle choices can improve your metabolic health. Advice is to have a healthy balanced diet similar to a mediterranean diet, keep a healthy weight, do moderate intensity exercise 150-300 minutes a week and strength based exercise at least twice a week, prioritise sleep to 7-9 hours a night, stop smoking and reduce alcohol to less than 14 units a week. Certain HRT regimes and other medications (like lipid lowering medications or blood pressure lowering medications) can also play a role at improving your metabolic health.
Bone health
The risk of osteoporosis increases after menopause. Osteoporosis is a disease which occurs because there is an imbalance in the normal process of bone remodelling by osteoclasts (break down old or damaged bone tissue, also called bone resorption) and osteoblasts (create new bone tissue). As we get older, bone breakdown by osteoclasts increases and isn’t balanced by new bone formation by osteoblasts. This results in a fall in bone mineral density (BMD) and a change in the composition, architecture and size of the bone. Osteoporosis is characterised by low bone mass and a structural deterioration of the bone tissue. Because of this, bones become fragile and are at risk of fracture. The prevalence of osteoporosis increases with age from 2% at 50 years to nearly 50% at 80 years of age.
Women are at greater risk of osteoporosis, due to the loss of oestrogen at menopause, which accelerates bone loss. Oestrogens are important for maintaining bone mineral density. Direct oestrogen effects on osteocytes, osteoclasts and osteoblasts lead to inhibition of bone remodelling, decreased bone resorption and maintenance of bone formation. A major consequence of loss of oestrogen at menopause is an increase in bone resorption and a fall in bone density.
Bone loss leading to osteoporosis starts before the menopause happens. There is a time of ‘fast bone loss’ which starts a year or so before the final menstrual period and continues for about 3 years and then the rate of loss slows, but continues post menopause.
Osteoporotic fractures usually occur in older postmenopausal women. Characteristically, occurring in the wrist, spine, and hip, but they can occur in other bones such as the arm, pelvis and ribs. One in three women will suffer from at least one osteoporotic fracture during her lifetime.
HRT has a protective effect against osteoporosis, and related fragility fractures, while is is being taken.
To protect your future health a recommended website to find out more about bone health, look at the Royal osteoporosis Society for advice about nutrition and exercise for bone health, check you are taking enough calcium in your diet using this link. You will need between 700-1200mg of dietary calcium daily.
Supplementing with Vitamin D 1000iu daily long term may be beneficial.
This article and attached videos from the Royal Osteoporosis Society are brilliant and definitely worth listening to.
Cancer
We cannot change our genetics but we can use healthy lifestyle choices to help protect us from cancer.
Attending regular screening when invited: breast, cervix and bowel can pick up cancers early.
Pelvic floor, vaginal/vulval and bladder health
Keep the pelvic floor muscles strong to avoid weakness causing bladder and bowel problems or prolapse.
If you are struggling a pelvic floor physiotherapist may be able to help. Please try using the Squeezy app to remind you or look at this link: how to do your pelvic floor exercises
Genitourinary Syndrome of the menopause is a term used to describe how low oestrogen levels affect the genitals and the bladder causing symptoms which affect almost 80% of women, but often they do not speak about them, due to embarrassment or thinking it is a normal part of aging. Vaginal dryness and bladder symptoms are common.
Treatment using intimate care regimes, pH balanced non hormonal moisturisers and lubricants, and with addition of low dose vaginal oestrogen products are really effective, take time to work and need to be used regularly, long term to help manage the symptoms. This treatment can be used safely by most women, please seek advice from your Dr.
Recommended websites to get more information about bladder health:
Brain health
It is common for women to struggle with brain fog and memory problems during the menopause transition.
Prioritising sleep, reducing stress, eating a mediterranean diet, drinking alcohol less than 14 units a week, socialising and learning a new skin can help.
This video is helpful:
International Menopause Society: Professor Maki: short video
International Menopause Society: Professor Maki: short video menopause and cognition
Body checks
Breasts: please do monthly body checks of your vulva, skin and breasts and attend regular mammograms.
Coppafeel have great information to help you examine your chest.
If you have questions about individual risk and benefit and require more information about this please make an appointment to talk about us about it.
Mental health
There are lots of ways we can positively support our mental health. Using nature and having a daily walk is the most simple and easy way to do this, evidence shows even just looking at greenery for less than a minute can improve mental health.
Reducing stress and finding things which bring you pleasure are simple starting points to support mental health.
You may need more help with mental health so please talk with us if this is the case.
This advice is for guidance only and please discuss with your doctor if you have any medical concerns
Book an appointment at Rowena Health to please speak with us – Dr Carys Sonnenberg Rowena Health – October 2025
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