Did you know regular exercise can provide relief from menopause symptoms? But where to begin? UK-based Chartered Physiotherapist Phillipa Butler offers help with her Pilates and Yoga Online classes designed to support women up to, through and beyond menopause.

shillpi a singh

Phillipa Butler is a UK-based Chartered Physiotherapist with a wealth of experience treating musculoskeletal conditions, disorders affecting bones, joints and muscles. She has spent her career developing and refining knowledge and skills and is passionate about movement as medicine. She’s a certified Pilates Mat and Reformer teacher, 200 hours certified Hatha Yoga instructor and certified meditation teacher.

She’s the founder of Precizion Ltd where she offers online physiotherapy advice, private movement coaching, group Pilates and Yoga classes. She runs workshops and provides ongoing support to guide one to optimal health. A firm believer of Movement as Medicine, she has been at it for three decades, working with patients, housewives, career women and athletes to improve their lives through movement and exercise. 

“My philosophy in my own life is that prevention is better than cure and I believe that a regular programme of appropriate exercise is the key to a fitter, healthier future. I work to help people to achieve their goals; manage pain, improve mental and physical performance and participate in activities they enjoy,” says Phillipa.

Her programmes improve posture, dynamic balance, and muscle and bone strength. “My movement approaches provide the perfect antidote to the challenges of midlife, ageing and the detrimental impact of our modern lives,” adds Phillipa.

Her ‘Moving through Menopause’ Podcast is now in its fourth season. “It is my contribution to the conversation. Health experts and ordinary people share insights, information and a few giggles,” she states. Listen Here. 

In an exclusive conversation with me, she shares health information and advice to help a woman while dealing with menopause up to, through and beyond menopause.  

Q: What are the general symptoms of menopause?

A: I was one of the 25% of women who suffered severe symptoms in the peri-menopausal period. Beginning from the age of 45 with a gradual onset, I experienced many symptoms that undermined my ability to perform at work and at home and severely impacted my quality of life. I had always been a healthy specimen and embraced a healthy lifestyle, and like many, I rarely sought the help of my doctor. 

Unfortunately, on this occasion, and despite exhibiting a majority of the symptoms of approaching menopause, I found myself misled and mostly unsupported by the healthcare system. Hence my quest was to learn all I could to support my shifting physiology and psychology. I now incorporate all my learning and expertise into the movement programmes that I teach online. 

The common symptoms of Menopause include:

Night sweats, hot flushes, irregular heartbeat;

Disrupted sleep, fatigue;

Anxiety, depression, panic disorder;

Digestive problems, bloating, weight gain;

Muscle tension, joint pains, electric shocks, tingling;

Osteoporosis;

Itchy skin, hair loss, brittle nails, allergies, body odour;

Memory lapses, poor concentration, irritability;

Headaches, dizzy spells;

Stress incontinence, frequency, urgency, frequent UTI’s, vaginal dryness, dyspareunia, decreased libido, irregular periods, breast soreness;

Burning mouth and gum problems.

Q: What is the age for the onset of menopause?

A: Menopause marks the end of the reproductive years and is a natural part of ageing that usually occurs between 45 and 55 years of age. Menopause is reached when a year passes without having had a menstrual period. In the UK, the average age for a woman to reach menopause is 51. 

Q: How long on average do menopause symptoms last?

A: Menopause arrives after Perimenopause or “pre-menopause” when levels of female sex hormones are gradually declining. You can expect this “pre” menopausal stage to last from a few months up to 10 years. This period of fluctuating hormonal levels is when symptoms are most likely to be experienced.

Q: How important is it to be aware of your body and the changes? 

A: Most women will experience some symptoms around menopause, but the age of onset, duration and severity varies greatly from woman to woman. This results in confusion and uncertainty. Some women will proudly announce that they ‘got away with it’, suffering only mild symptoms yet others suffer from heroic levels of determination. For some women, a medley of menopause symptoms makes them wonder whether there is something seriously wrong with them! Unfortunately, a trip to the doctor can result in a varied approach to advice and management and women are not always supported to receive what should be offered.  

Women must be aware of the symptoms of menopause and their options for treatment. The National Institute for Clinical Excellence guideline for menopause diagnosis and management states women should be offered HRT for vasomotor symptoms after discussing with them the short-term and longer-term benefits and risks.

I have always embraced a holistic approach to health since my young son was diagnosed with cancer 20 years ago. We have always relied on home-cooked nutritious food and regular exercise as a family. I have used complementary approaches to support our health, including acupuncture, homoeopathy and aromatherapy and rarely resorted to visiting the doctor apart from routine health checks or vaccinations. It is important to understand that I am not opposed to hormonal replacement therapy and, in fact, I take it myself but even this doesn’t necessarily address all of the short and long term health challenges and complementary approaches will sit happily alongside. 

Because the challenges of menopause are as many and varied as the women who experience them, I have reached out to experts and professionals through my podcast to bring information and advice to women. Out of that, a group of women we call the Menopause Collective has grown; we aim to offer advice and support to women journeying through menopause.

Q: Why are women gaining fat in menopause?

Fluctuating and falling hormone levels around menopause can affect how we store fat and develop “insulin resistance” making our bodies store, rather than burn calories. Actually, our body needs less energy as we age, studies suggest we may need around 200 calories a day less than we did in the past. Finally, we are losing muscle mass, known as sarcopenia, at around 8% per decade after age 40. Muscle is more metabolically active meaning it burns more energy so less muscle corresponds to more weight gain.

Q: Why do they have hip problems and bone problems too?

A: Oestrogen has a key role in the normal bone cell turnover cycle. Declining bone density is associated with oestrogen decline. Bone density is one factor that affects your bone strength overall, and low bone density or osteoporosis increases your risk of a fracture. Common fracture sites include the wrist, hip and vertebrae. www.nhs.uk/conditions/osteoporosis

Osteoporosis affects men and women of all races. But white and Asian women, especially older women past menopause, are at the highest risk. (Royal Osteoporosis Society) Worldwide, 1 in 3 women over age 50 will experience osteoporosis fractures, but only 1 in 5 men aged over 50 will. (International Osteoporosis Foundation).

A wrist fracture may be the first sign of osteoporosis and is quite common in middle-aged women who put out their arms to break a fall. Just a word to the wise, if I had a pound for everyone I saw who fractured a wrist falling over their dog, I would be a wealthy woman right now! A healthy bone should cope with this kind of force, so these breaks are called fragility fractures. It gets more serious when we discover that around 50% of people with one fracture due to osteoporosis will have another. This is when our overall health and ability to live our lives as we would like become affected. Worse still, a hip fracture is associated with increased mortality risk.

Q: Does a woman feel normal again when it’s all over?

A: What is normal? What is true is that human beings have an amazing capacity to adjust to a new set of circumstances with a degree of amnesia about the past. There is also an unwritten rule that a woman has to bear the burden of hormonal fluctuations, whether at puberty, pregnancy, or menopause. Acceptance is our default, this is not the case for me, and I want all women to know it doesn’t have to be the case for them either.!

So although these physical symptoms can reduce after menopause, this is not always the case, and women in their 70’s can still experience hot flushes and sleeplessness, for instance. 

Q: What are the long-term health consequences of oestrogen loss?

A: All women will live the rest of their lives without oestrogen. Life expectancy in the UK from 2017 to 2019 83.1 years for females; this is now a whopping 32 years of living with oestrogen deficiency! So what are the long term health consequences of menopause?

The effects of oestrogen are far-reaching as the 34 symptoms of menopause suggest. The many structures and systems that can be affected include our bones, muscles, brain, cardiovascular system, and pelvic organs. As you probably realise, by now, this is a lifelong deficiency with far-reaching health ramifications.

Q: How can women stay healthy through and beyond menopause?

A: Now we know all about the possible far-reaching effects of declining oestrogen levels, let’s consider the appropriate action to prevent and mitigate these far-reaching effects. There is evidence and a clear consensus that lifestyle management strategies considerably contribute to our ability to improve our symptoms, both in the long and short term. 

Exercise can positively influence bone, muscle, the brain, cardiovascular system and even the bits below the waist. Where to begin? With Pilates, of course!

I have incorporated the current guidance and research and the lessons I have learned into the Pilates programmes I now teach for the benefit of all women. 

Q: What kinds of exercise should women be doing? 

A: Pilates has the potential to positively influence menopause symptoms, bone, muscle, tendon, cartilage, nerves, the brain, heart, and even the bits below the waist! I have incorporated all the lessons I have gleaned from my research and self-experimentation into the Pilates programmes that I now teach. My Pilates for Menopause programmes helps women have better balance, strengthen muscle and bone, improve posture and flexibility, protect the pelvic floor and feel relaxed and invigorated all simultaneously!

The Pilates principles of concentration, control, core, body alignment, and precision nurture the mind-body connection, making Pilates a perfect way to introduce physical training safely in midlife and beyond.

Q: How does training help a person’s posture and ageing?

A: Ageing causes alterations in various body functions, such as motor, sensory, cognitive and psychosocial. One of the factors associated with ageing is the decline in proprioceptive function, this is essential for the body’s normal functioning during movement and maintaining balance.

Pilates is all about proprioception; we increase body awareness and incorporate a deep mind-body connection whilst undertaking our Pilates exercises. Developing an understanding of ‘where your body is in space’ helps us adopt new movement habits such as standing up straighter. My physiotherapy training allows me to choose the exercises that provide the necessary joint mobility and back muscle strength to hold us up. 

Q: How does Pilates work? What is Pilates?

A: Pilates is a system of exercises designed to improve physical strength, flexibility, and posture and enhance mental awareness. 

The key components are breathing, body alignment, core muscle activation, and always moving with precision and control.

The power of the breath is often underestimated, but breath is the power and movement with breath is Pilates!

Pilates is all about paying attention to how we move and helps us move better, feel better, and look better. I love that Pilates is a whole-body exercise and is suitable for everyone of any age.

When we do Pilates, it creates long, lean muscles, increases flexibility and improves posture. The focus on the core muscles improves the abdominal muscle tone and can promote weight loss.

Pilates Integrates the body and mind, and you will leave a class feeling energised, not drained! 

Q: How long should a menopausal woman workout in a week?

A: When it comes to improving athletic performance, the American College of Sports and Exercise Medicine (ACSEM) has a model for fitness that incorporates six key parameters: muscular strength, muscular endurance, cardiorespiratory endurance, neuromuscular control, body composition and flexibility. 

Training effects will only be realised if we apply the principle of overload. What that means is that for any exercise the last couple of repetitions should ‘feel difficult’.

Valuable guidance exists in the Royal Osteoporosis Society Consensus statement on physical activity and exercise for osteoporosis published in 2019. The recommendations from the Royal Osteoporosis Society provide a good starting point when considering the ‘dose’ of resistance training that is advisable.

• On 2-3 days a week undertake activities or exercise to feel a push or pull on the muscles (explain mild discomfort afterwards is normal).
• For maximum benefit, depending on fitness levels, recommend increasing the intensity of exercise to work muscles harder using weights or resistance bands. 
• Build up to 3 sets of exercises with 8-12 repetitions of the maximum weight that can be lifted safely.

But we must remember that strength training is only one part of a programme to achieve physical fitness. Luckily this is my bread and butter, and flexibility, muscular strength and endurance, flexibility and neuromuscular control are all taken care of. So all you need to do is fit in your daily walking and appropriate nutrition.

Q: How much should a woman walk in a day?

A: I aim for 10,00 steps a day. But we must remember why we are doing it; for heart health, how we do it matters. I maintain that it must be purposeful walking and that you cannot count pottering around your usual day as your steps. Yes, it is better to be pottering around than sitting down all day, but as with all these things, there is a bit of science involved, so the intensity of the activity matters. 

The general recommended exercise intensity from the American Heart Association to prevent cardiovascular diseases is 30 minutes, five times a week to reach at least 150 minutes per week of moderate exercise, or 25 minutes, three times a week to reach at least 75 minutes per week of vigorous activity. It could be a mix of both, of course.

To understand exercise intensity, we can measure the heart rate. The American Heart Association recommends exercising with a target heart rate of 50 to 75 per cent of your maximum heart rate for beginners and moderately intense exercise. You can work at 70 to 85 per cent of your maximum heart rate during vigorous activity.

You can calculate your maximum heart rate threshold using the equation 220 minus your age. Then the threshold is a percentage of that figure. At 54, my maximum HR is 166, 50% is 83bpm, 75% is 124bpm. I use a wearable device to monitor my activities and my heart rate while doing it. Now you know what it takes to feel fitter. It is important to know that anything is better than nothing, and Rome wasn’t built in a day!

Q: What are the benefits of strength training?

A: Resistance training will combat the effects of sarcopenia. Studies have found that both resistance training and aerobic exercise increase muscle protein synthesis and improve muscle function irrespective of age and may help counteract some of the effects of ageing. Reference 

Most women love the discovery that an increase of 2kg of muscle will provide a 10% increase in the Basal Metabolic Rate. Developing strong and toned muscles will make clothes fit better and increase self-confidence.

Resistance training makes us feel better, and Brain-derived neurotrophic factor (BDNF) is released. This is like a fertiliser for the brain and guards against neurodegeneration. Studies show that regular exercise can reduce the risk of developing dementia by about 30 per cent, and by 45 per cent for Alzheimer’s disease specifically. 

My message is that regular exercise can transform how we feel physically and emotionally and protect us from illness and disease. It can be a lot of fun too, so what are you waiting for? Your time is now.

(Phillipa Butler can be contacted via email if you have any questions: hi@precizion.co.uk)