EXERCISE FOR PREVENTION AND SELF-HELP DURING THE MENOPAUSAL YEARS
– by Honora Lee Wolfe
Menopausal women need not believe that they are doomed to years of hormonal nightmare. Premenopausal women need not anticipate with dread the menopausal years. All women, however, need to act with intelligence to bring their being into a state of health whereby menopausal discomforts may be reduced or eliminated. On the one hand, it is important for all of us to recognize and accept the facts of aging and decline. These are part of the human condition and used to be accepted as such. On the other hand, we need not believe that either menopause or the postmenopausal years doom us to several decades of excessive and continual suffering. It is up to us to determine how these years will be experienced, and it is up to us to act upon that determination. This article gives suggestions for perimenopausal women (the years on either side of menopause) to improve their bodies’ overall health, increase their production of qi and blood, and reduce stress, thereby improving their chances for a healthy and symptom free menopause and slower decline in the postmenopausal years.
Since aging according to Chinese medicine has largely to do with the state of the kidneys and since so many signs and symptoms of menopausal syndrome are directly related to decline of the kidneys, most of the suggestions classically given to perimenopausal women have to do with maintaining the health of the kidneys. In this article, however, equal attention will be given to the health of the liver, which, in my opinion, is equally important in our culture and at this time in history.
The order in which these suggestions are given does not imply an order of importance. All of them are important, but few of us have the time to do everything that is described here as useful. As you read, note which suggestions you personally resonate with and can accept or incorporate into your life and which you cannot, and why. Consider that perhaps the ones you have the most resistance to may be the most important for you.
Remember that these suggestions are given with the understanding that not all of them will be or even should be taken. Few of us are capable of doing everything that we know is good for us, and moderation even in the things that are good for us is probably a sign of a relaxed and basically healthy attitude to life. Try to develop habits or choose regimes that fit into your life without creating more stress. If you find that you feel you cannot make any of these options a part of your life, you may want to think about whether your lifestyle is a fundamentally healthy one and if some basic changes need to be made.
Everyone needs exercise to maintain health. Exercise is important for stress reduction, weight control, and cardiovascular health. To be effective for cardiovascular health, exercise need not be overly strenuous. Studies done recently have shown that moderate exercise may be just as beneficial to the heart and lungs as vigorous exercise. Also, research just publicized this month has indicated that women who exercise regularly have lower rates of breast and possibly other cancers. It is also true that for weight reduction, more calories are burned with more vigorous exercise or a combination of moderate and vigorous exercise during the same session. But whether you are a vigorous or moderate exerciser, it is, as the advertisement goes, very important to “just do it” and on a regular basis.
If you are not interested in sports, or in joining an aerobics class, many normal daily activities can be exercise. Housework, yard work, walking to work or to the bus stop, washing the car, all these are exercise. If you are really motivated, walking or biking to work has the added benefit of helping the environment and saving money on gasoline, parking, and auto maintenance. If none of these activities are possible on a regular basis, try finding a walking, jogging, or bicycling buddy. This will give you the incentive to keep up your schedule since there is another person depending on you for your support. This also helps prevent boredom since it gives you someone to talk to while you’re exercising. However a woman goes about getting sufficient regular exercise, a number of benefits will accrue to her, all of which are valuable.
For menopausal women, regular exercise is even more important because lowered levels of blood estrogen are related to an increased risk for cardiovascular disease in women over 50 years of age. Exercise has been shown to be of benefit in reducing cardiovascular disease.
Another continuing issue for many women after menopause which is related to exercise is weight control. Some Western doctors believe that this struggle with weight is related to the fact that the estrogen which our body continues to produce after menopause requires fat cells for its metabolism and use by the body. This increase in fat cells is the body’s way of trying to create more estrogen as blood levels of estrogen begin to drop. Exercise has always been an important part of weight control programs, and can help the menopausal woman control this tendency to store excessive fat.
By this I do not mean that women can or even should try to regain or maintain the figure of a sixteen year old. This is neither a possible nor a healthy endeavor. It may even be true that a body with a little extra fat on it is healthier than a very thin one. Remember that from a Chinese medical point of view substance is yin, and yin is what most menopausal women are lacking. Excessive or neurotic thinness can exacerbate yin emptiness. Too much substance becomes pathogenic dampness and is also not healthy, but as a culture we often err to the side of trying to be too thin for our own health.
The third reason why exercise is important is that it helps control stress and minimizes stagnation. Stagnation is the opposite of movement, so the external movement provided by exercise circulates the qi and blood and any other substance in the body tissues which may be stuck. If the qi is flowing freely, the emotions are more likely to be balanced and flowing freely as well. If the emotions are flowing freely, there is less tendency for the qi to stagnate in the first place. Women with a tendency to irritability, anger, or moodiness will benefit greatly from regular exercise and so will those around them!
Also, from the point of view of Chinese medicine, regular exercise stimulates the spleen and strengthens the lungs. Since we know that the spleen is less active as we grow older, anything which helps the spleen function will improve digestion, help transform dampness and phlegm, and boost the general energy level. Strengthening the lungs is also important because, according to five phase energetics, it is the lungs which must keep the liver in check. This prevents liver qi from becoming full, rising up out of control, or venting itself on other organs, most commonly the spleen and stomach.
As mentioned above, recent studies reported in the media show that women who exercise regularly lower their chance of developing breast cancer. The more years of exercise, the more this protection increases. This makes perfect sense from the information in the above paragraph and in the previous chapter on Chinese medical theory. If the spleen is strengthened by regular exercise, there is less likelihood of the production of phlegm and dampness which can congeal into neoplasms. Also, exercise helps prevent blood stasis which is, according to Chinese medical theory, a contributing factor in many types of cancer. Considering this, exercise contributes to longevity by helping prevent cancer as well as a healthier menopause.
Finally, many studies have been done which show that weight bearing exercise, even of a relatively moderate type, such as walking, swimming, or dancing, will increase bone calcium levels of postmenopausal women, and help prevent bone demineralization or osteoporosis. Since 90% of all cases of osteoporosis in the U.S. occur in postmenopausal women, it is easy to see why exercise is so important. Risk factors for osteoporosis include:
-Caucasian or Asian heritage
-a family history of osteoporosis
-lifelong low calcium intake
-surgical removal of ovaries at a young age
-a sedentary lifestyle
-excessive alcohol, salt, or caffeine intake
-excessive protein intake
-treatment with steroid drugs
Obviously, the more of these risk factors anyone has in their lifestyle or medical history, the higher is their risk for osteoporosis and, concurrently, the more is their need for regular weight bearing exercise. Other preventive therapy to lower the risk of osteoporosis will be discussed in the section on orthomolecular or micronutrient therapy and in Appendix II.
For some of us, exercise comes naturally and is not a difficult part of our lives. Unfortunately, it is often the people who resist exercise that need it the most. For example, people with an overabundance of pathological dampness and phlegm in the form of overweight find it difficult to exercise energetically. Yet, because exercise mobilizes and melts dampness and phlegm, it is a very important part of therapy for anyone with this type of problem. Since the sedentary lifestyle that many women have by this time in life may lead to overweight, regular exercise becomes all the more important. If you are a person for whom the commitment to exercise is difficult to make, try taking it in smaller, simpler steps. Don’t create an exercise program that is unrealistic. You will not stick to it and this will just convince you all the more that you cannot do it. Try parking your car closer to home and farther from work or try taking the bus and walking to and from the bus stop. Find a local class in something you’ve always wanted to learn like tennis, ice skating, or belly dancing. There are also many types of exercise tapes available if you prefer to exercise alone and in the privacy of your home. These can usually be rented from libraries and video rental stores so that you can get an idea of what sort of tapes you like before making any financial commitment. The possibilities for exercise are really limitless. The important thing is that you find something that you like and can stick to on a regular basis.
Although stretching is really a type of exercise, I have given it its own section because it is important for different reasons than those listed above and because I wish to emphasize its importance. The practice of stretching can be included either as part of an overall exercise program or as a separate regimen, but it should not be overlooked in any case. In fact, it is my belief that if you cannot discipline yourself to any other type of exercise, stretching may be the most important type of exercise to get.
The reason that I say this is that as we age our bodies become less flexible. This is due to the natural decline of yin associated with aging. Yin is the fluid and blood that keep the tendons, ligaments, bones, and joints supple and flexible. As yin is lost, there is the natural tendency for these tissues to become dry and stiff. If these tissues are stretched and kept as supple as possible on a daily basis, they will be more likely to remain that way for a longer time.
Additionally, because of this decline of yin and consequent stiffness, joint and muscle aches and pains are common complaints of older people. Gentle, regular stretching can be a great help in preventing the debilitating effects and financial drain of chronic pain syndromes related to aging.
There are many ways to go about stretching. Most city recreation departments have yoga classes. There are a number of good yoga books and video tapes as well, although if you wish to take up yoga regularly, I suggest taking at least a few classes initially so that you do not injure yourself by wrong postures or overstretching. There are also books available on just plain stretching which are quite good. I have listed several books in the Suggested Reading section which may be of help.
If you are going to aerobics or dance classes, or using exercise videos as your main form of exercise, be sure that there is at least a minimal stretching component to them. One of the healthiest postmenopausal women I know, despite a double mastectomy eight years ago, is a dance teacher who stretches and exercises daily. She is a reminder to me not to underrate the importance of exercise for overall health.
Finally, whatever type of exercise you choose to do, there are a few things to remember:
- Regularity or consistence is more important than vigorousness.
- It is important to pick something that you enjoy doing.
- Regular stretching should be a part of every exercise regime.
- The quality and comfort of your golden years will be directly related to the health of your body, which will be greatly improved by regular exercise.
Self-massage may sound strange to some women, but its efficacy for improving health has been known in Japan for centuries. Although there are self-massage regimes for the entire body, the abdomen or hara is considered especially important. In Japanese, the hara is the entire soft portion of the belly. It stretches from just below the diaphragm to the top of the pubic bone. In Asia this area is considered a person’s vital center. Anatomically, it contains all the vital organs of Oriental medicine except the heart and lungs. In traditional Japanese medicine, it is believed that a healthy hara is the sign of and key to health in general.
Traditionally, the hara’s health is ascertained through palpation (touch). Pain, lumps and bumps, abnormal muscular tension, abnormal pulsation, and hyper- or hypotonicity may all be signs that the internal organs are imbalanced or dis-eased. A corollary of this is that, if pain or other abnormal findings in the abdomen are relieved, imbalance or disease of the internal organs these signify will simultaneously be relieved.
Happily, one can not only diagnose the balance and imbalance of the organs by palpating the abdomen but one can directly treat these organs and bowels with nothing more than pressure applied with one’s own hands. Many famous Japanese therapists, such as Kiyoshi Kato and Naoichi Kuzome, treat the full range of human disease primarily through hara shiatsu or abdominal massage.
The stomach, spleen, and intestines are of primary importance to health according to Traditional Chinese Medicine. If the stomach and intestines are functioning normally, abundant qi and blood will be produced. Likewise, the clear yang (consciousness, intelligence) will arise and the turbid yin (waste products) will descend for excretion and evacuation. This rise and descent is called the qi mechanism. A healthy qi mechanism insures that the qi and blood will travel unobstructedly in their proper directions and to their proper destinations, thus nourishing and empowering all the functions and tissues of the organism. When the qi mechanism and the stomach and intestines are functioning in a healthy way, neither qi, blood, dampness, phlegm, food, or fire will have an opportunity to become stagnant and thus give rise to disease.
The intestines or bowels like to be “empty” according to traditional Chinese medical theory. This means that the bowels function correctly when they constantly send down the turbid, the residue, for excretion. When this residue or turbidity is retained within the organism, it gives rise to numerous disease mechanisms. It is the qi which empowers peristalsis and moves the turbid down through the intestines.
Abdominal self-massage is one easy but nonetheless effective way to keep the qi and blood in the internal organs flowing unobstructedly and the bowels from becoming stagnant with retained turbidity. Although hara shiatsu is often performed professionally in Japan by trained therapists, it is easy to do a simpler version oneself and is all the more effective when done on a daily basis.
One begins by lying on their back with their knees drawn up. If the feet are spread slightly apart, the knees can fall together in the center and hold themselves up without any further effort. Next one presses with the flats of the fingers of both hands under the right ribs. One begins pressing as one exhales. Continue to press and exhale to a count of six. When inhaling, move the fingers down and over to the sides of the rib cage and exhale and press again. Do this three times until one winds up pressing under the floating ribs at their sides. See the previous page for a visual image.
Next go back to the midline beneath the ribs and repeat this sequence moving to the left in three exhalations. During this first pass over the hypochondrium, the pressure should not be too strong. Now repeat this entire sequence two more times, each time pressing a little harder.
At first, it is not uncommon to experience pain, resistance, or tension pressing on this area under the ribs, which is called the hypochondrium. This is a sign of congestion, mostly in the liver and gallbladder, which rule this area. As one continues over a period of weeks, this pain and tension will disappear and one’s fingers will sink deeper under the ribs. This is quite important because it means that the liver’s main function of governing the smooth dispersal of qi and blood is improving.
When the liver’s smooth dispersal function is healthy, peristalsis is normal and digestion is good. Also, one’s mood will be even and light and one will have regular elimination and freedom from depression. Therefore, one can see that just this first hara shiatsu move promoting the free flow of the liver gallbladder qi can have a deeply healing effect.
Next, one positions their hands on their lower right abdomen next to their pelvic bone. With each exhalation, one presses down for a count of six. As one inhales, one moves up the abdomen until finally their hands are beneath the ribs again. One makes three passes up the abdomen on the right side. Anatomically this follows the course of the ascending colon.
Then, beginning at the solar plexus, one presses down the midline to just above the pubic bone. Likewise, one makes three other lines down the left abdomen moving from the center out to the sides. These passes down the left abdomen follow the course of the descending colon. One should repeat this entire sequence up the right and down the left sides of the abdomen three times, each time exerting a little more pressure.
Next, go back to any places where one felt special pain or resistance. As one exhales, exert pressure on these spots to the limits of one’s tolerance but without torturing oneself. Often the same spots or areas will be sore day after day. But as one does this abdominal self-massage day by day, these areas will tend to become less sore and sensitive. Typically, in a relatively healthy person, after from two to four weeks of doing this regime daily, one’s abdomen will be free from any such specially reactive areas. This signals that incipient stagnations within the organs and bowels have been relieved even before they may have given rise to any other signs and symptoms.
According to some doctors, if one finds an actual lump or mass in the abdomen, besides having this checked by a primary health care professional, one should not press directly on the center of such a lump. Rather, one should search for a sore or sensitive spot on the edge or periphery of the mass. It is here that pressure should be exerted.
Finally, one returns to the right hypochondrium and again presses once three times out to the right and then from the solar plexus once three times out to the left. This concludes one’s daily session of abdominal self-massage.
After from two to four weeks of daily practice the average person will find their abdomen has become painless and supple. This should be accompanied by better bowel movements, better appetite, and therefore better, more abundant energy. This entire procedure takes approximately 15-20 minutes. It can be performed directly upon arising or just before bed. After the abdomen becomes pain free and normalized, one can do the massage every other or every few days. However, if one does not take care of oneself, after some time, the pain, lumps, and tension may return and these are signs that one’s imbalance has also reestablished itself.
In traditional Japanese medicine, it is felt that sensitive spots, lumps, and tension in the abdomen are precursors to more serious disease. A person may otherwise be symptom free but to many Japanese physicians, if there is some abnormality in the hara as diagnosed by palpation, there is some incipient disease process taking shape. Therefore, if one eliminates these abnormalities, one can abort such disease processes even before other signs and symptoms arise.
Also as stated above, ten of the twelve organs of traditional Oriental medicine are located in and can be accessed through massage of the hara. Also, meridians connected to four of the most important organs, the kidneys, spleen, stomach, and liver traverse the soft abdomen and are directly affected by this abdominal massage.
One cannot easily massage their entire body, but one can easily massage their abdomen. Since the abdomen or hara is the root of the entire body, massaging it massages the root of all the rest. If the roots of a plant are healthy, the leaves and branches will likewise tend to flourish. Although abdominal self-massage appears simple, it is based on voluminous and profound theory. For those interested in reading more about the hara and its importance in Oriental medicine and also more about hara shiatsu, the reader is referred to Hara Diagnosis: Reflections on the Sea by Matsumoto and Birch.
Stress and Relaxation Therapy
In our culture stress is endemic — job stress, political stress, environmental pollution stress, relationship stress, sexual stress, travel stress, the stress of the constant decisions required by living in a “free” society. We have created a society which produces more stress than the human body can process and still remain healthy. Past a certain age, most of us will develop symptoms due to this fact. These symptoms may come and go and we can learn to keep them largely under control, but it is arrogant and unreasonable to think that we can forever keep up the often frenetic pace (physically or mentally) which many of us must (or believe we must) in order to survive and still be free of the ravages of stress.
Women especially find themselves at a time and place in history with “unlimited” options, where our roles are multiple and our sense of self often ill-defined. Our family structure is weaker and less supportive than at any time in American history; community support for parenting, women’s health care, and menopausal issues is inadequate; divorce is endemic; and the stay-at-home mother-and-housewife is no longer an option for most of us. The arrival of menopause is another stressor in and of itself. It brings us face to face with aging, loss of fertility, and possibly the empty nest syndrome. We know that our culture is not supportive of postmenopausal women, and somewhere deep inside this may affect our sense of self worth. The constant demands on the time of the average 35-55 year old woman in our society often leave us with no “down” time and the feeling of being always behind, always pushed, always squeezed. This is what stagnation of qi, specifically liver qi, feels like.
The single most important part of any treatment program for symptoms related to qi stagnation is daily relaxation. We have already discussed the fact that the presence or absence of qi stagnation may spell the difference between the presence or absence of menopausal symptoms and/or their severity. This therapy, if done consistently and with perseverance, can make a difference on a long term basis, not only in terms of menopausal or other symptoms, but on the fundamental level of who a person is. The reason this therapy is so effective is that it addresses the long term effects of stress and emotional upset, which are at the root of all problems related to liver depression qi stagnation. In most cases having an emotional component, I believe this therapy can be as beneficial as good psychotherapy. This is because I believe that whatever happened that makes one frustrated or angry or bitter or afraid is better released and forgotten as quickly as possible. This does not mean that psychotherapy or other counselling may not also be useful in helping us sort out difficult situations in our lives, or that changes may not need to be made. However, regular daily relaxation will help us to let go of the things we cannot change and keep even the ones we can change in perspective so that external situations do not put our health in jeopardy.
The emotional responses that we have to situations are healthy in that they may help us to see that changes need to be made in our lives. Making changes to improve our life and limit our stress may be difficult. If our problems are complex, we may need the help of professional psychotherapists, our family, job counselors, our church, or friends. Perhaps for some women major changes are not possible. But no matter how we go about changing our lives or not changing them, holding onto anger and frustration is not useful and it has been demonstrated in both Western and Chinese medicine that it is deleterious to the health. Regular relaxation therapy will help us to do the letting go.
Daily relaxation therapy is one way to turn off the heat of stress, loosen the vise grip of that squeezed feeling, and lessen the toll that any pressures in our lifestyle can take on our health. In moments of anger and frustration, I find it useful to think of two things. First, consider whether what is making you angry will matter in a year. If not, then you may be wasting your precious energy being angry. Second, I try to remember that the best revenge is a good life. Stewing in my anger does not feel like a good life to me.
In order for this therapy to have measurable clinical effectiveness there are a few criteria which must be met.
- It must result in somatic, physical relaxation as well as mental relaxation.
- It must result in the center of consciousness coming out of one’s head and into some part of the lower body, preferably the area of the lower abdomen.
- It must be done a minimum of 20 minutes per day, although no longer than 30 minutes are required.
- It must be done every day without missing a single day for at least 100 days.
There are many possible techniques which may accomplish this type of relaxation, including hatha-yoga, certain types of meditation, biofeedback training, etc. The easiest way that I have found, however, is to purchase one or two relaxation or stress reduction tapes available at health food stores, or “new age” bookstores. These take about 25-30 minutes each, are relatively inexpensive, and require minimal discipline.
Some people say that they cannot relax, or that it is very difficult for them to keep their mind concentrated during meditation, or that they do not have time to relax. It is precisely these people who need to relax the most. The tapes are helpful for these people in that, to some extent, they supply the needed concentration. Each time the mind wanders, the tape brings one back to the task at hand, so that one does not need to concentrate on anything, just to listen to the tape.
Additionally, it is best to try to do the tape at the same time each day, so that after a while it becomes like eating, getting dressed, or brushing your teeth, in other words a nondiscretionary part of your day.
At the end of three months a person may expect to be calmer, less flappable, and have a generally increased state of health with fewer of their prior symptoms manifesting. At the end of three years of regular practice, one will be a different person altogether.
Smoking and Recreational Drugs
We all know that smoking is deleterious to the health. From a Chinese medical point of view tobacco is dry and bitter and damages the lung qi. The lungs control the liver, as has been stated several times, and are responsible for astringing the surface to control perspiration which is very important for menopausal women. Furthermore, the lungs are the mother of the kidneys. If lung yin is damaged by the heat and dryness of tobacco, kidney yin will suffer. It is interesting to note here that smoking is a major risk factor for osteoporosis, and according to Chinese medicine, the kidney yin and jing rule the bone and the marrow. Menopausal women can ill-afford to damage the kidney or lung yin.
Recreational drugs come in all types, and therefore have varying effects on the body. None of them, however, is useful for the menopausal woman. By and large they damage the liver and kidneys, leading to weakness of both these organs, the possible deleterious effects of which we have already discussed in detail from many points of view.
Finding Purpose and Meaning
In Western culture, as well as in China, up until fairly recently women did not often live into great age. Many women died in childbirth, from excessive childbearing or overwork, overexposure to the elements, and all manner of diseases. When we read the classics of Chinese medicine, we can see that a woman of 49 was considered an old woman.
In our century, at least in Western countries, this has changed. Most women have 15-30 good years after menopause in which to work, to contribute, to create. In fact, there may be fewer stressors on women during those years than there were in the previous two decades, as the duties of rearing children or producing income are lessened, leaving them freer to participate in other activities. At the same time, most women have, by popular media standards, lost much of their physical beauty and sexual attractiveness by this time in life. Women must find another source of self-esteem and life satisfaction than a good figure or a pretty face.
What I am leading up to here may be the most difficult self- help suggestion that I have, but it is perhaps the most important since it relates to our mind and heart. What I have observed is that the women for whom menopause is the easiest are those women with a purpose larger than themselves in their life. This purpose may be societal, political, ecological, artistic, or spiritual, but it must be strong enough to short circuit any media or other input from the popular cultural bias which damages basic self-esteem. By this I am not talking about some sort of false ego boosting. I am talking about usefulness which allows the development of inner strength and inner beauty. For, if we have not the impermanent beauty of youth nor the inner beauty which grows naturally from purpose and enthusiasm, it is then that our lives feel empty and mean, and there is room for anger, frustration, and depression. From a purely medical point of view, it is then that we feel stuck and feeling stuck is the experience of liver depression qi stagnation.
Of course this may not be easy and it may even sound trite, but among the people that I know, it is the ones with purpose who seem to be the healthiest. This is not to say that one has to be Mother Theresa, Indira Ghandi, or Jane Goodall to have a meaningful life. Neither is it to say that women with useful, purposeful lives have no health problems. Perhaps, however, if one feels useful, the magnitude of ones problems seem less, and are easier to cope with or rise above.
For some women this suggestion may imply volunteer work; for others it may imply a career change. There are no rules which say what gives meaning to a life. But it is certain that what gives meaning to life can change life for the better, bringing happiness and self-esteem in a real sense, which in turn cannot help but be reflected in the health of our bodymind.
Besides the suggestions in this chapter, there are other possible things that a woman can do for herself to help prevent the arisal of disease. An important one that is not included in this chapter is proper diet and vitamin/nutrient therapy. In fact, these are so important that the following two chapters are entirely devoted to them.
This article’s author, Honora Lee Wolfe, has been a practitioner of acupuncture and Chinese medical massage for 15 years and is the author of several books on women’s health and dietary therapy.