Caroline Freedman is a personal trainer and a TRX Sports Medicine Suspension Training exercise professional. While many of the symptoms of menopause are repeated by health and fitness outlets every October for Menopause Awareness month, one of the lesser covered issues that affects many women is the loss of bone mass, leading potentially to osteoporosis and even scoliosis.

M&F Hers talked to the fitness coach, based in London, to find out how all women can hope for better health outcomes during this challenging phase in their life, by embracing exercise. Freedman has a wealth personal of experience in this area too: She suffered with scoliosis from a young age, and her daughter also wore a brace to straighten her spine. It’s no wonder then, that her life and work has been the driving force behind writing The Scoliosis Handbook. Now aged 56, the popular PT is passionate about maintaining bone-mass, muscle-tone, and fitness levels in order to lessen the negative effects of perimenopause. Look out for the suggested exercises at the end of this article, too.

Would you agree that when it comes to menopause, bone-loss is perhaps not as well-known as other symptoms such as hormonal changes, hot flashes, and low mood? How important is it for women to understand that it is common to develop osteoporosis as a result of menopause?

I do agree that loss of bone quality is not quite as well-known. Osteoporosis is often associated with something you only get when you are elderly and women are not so aware that this aging of the bones can start through menopause.

When women age to around 50, estrogen levels deteriorate thus leading to the risk of osteoporosis and osteoarthritis, which can be due to the menopause. Osteoporosis causes thin and brittle bones, this can lead to osteoarthritis, which causes swollen and painful joints. Additionally, lack of estrogen results in joint dehydration as the body shows an inability to hold onto fluid, causing uric acid to accumulate and trigger inflammation. The drop in such an essential hormone can also increase weight, this is not only annoying but can also put a strain on joints depending on the amount.

Research indicates that up to 20% of bone loss can happen around menopause and approximately 1 in 10 women over the age of 60 are affected by osteoporosis worldwide. So, it is vital for women to understand the importance of protecting their bones as they reach menopause. Using weights and performing load bearing exercises is proven to increase bone density.

How does loss of bone quality begin to show itself to us?

I have seen several new personal training clients who are over 50, as well as friends, complaining of joint aches and pains, and backache, where they have not had any previous issues before. This is due in many cases to reduced bone density causing osteoporosis. As women reach perimenopause, many start to complain that their bones and joints begin to ache. This is generally worse when they wake up or have been sitting still for a long time and it carries on right through to menopause.

With age, the joints and discs start to collapse in the lumbar area (lower part of the spine). Discs may protrude and eventually slip which can cause scoliosis. There are two ways women in menopause can suffer from degenerative scoliosis. The first is those who are diagnosed with scoliosis at an earlier age and find their curve progressing during menopause. The second instance is where it develops later in life, which can be triggered by menopause. Scoliosis is a side-to-side curvature of the spine in an ‘S’ shaped form of over 10 degrees. It can affect any age from before birth (congenital), in young children (early onset), teenagers (adolescent idiopathic) where the scoliosis has developed through puberty/growth and into adulthood. But it is also seen in women going through menopause.

Physically, the first thing women may notice is pain on one side of their bodies. This is due to the spine twisting and pulling the lateral muscles across the rib cage. Over time, as the curve progresses, this can lead to neckache, headaches, and then central and lower back pain. Pain, as we know, causes tiredness and coupled with all our hormonal changes, this just adds to the feeling of exhaustion. Women may also notice that they do not look as symmetrical and one shoulder may protrude forward, lifting the shoulder blade. This causes clothes to hang differently and often people cannot work out why.

As someone who suffered with scoliosis from a young age and had multiple surgeries to help correct this, how does exercise help with bone conditions?

I began exercising at 14 and weight training at 18 years old. I do not lift heavy weights, as lighter weights with higher repetitions are more beneficial to build muscle while avoiding strain – with a spinal condition like mine. If I don’t exercise at least three times a week, I’m in pain and my joints and muscles stiffen up. Exercise has literally been my saviour through my scoliosis journey both physically to help with my posture and to keep my bones strong, retaining muscle-tone. When training clients, preventing osteoporosis is always at the front of my mind.

You encourage women to try weight training and also yoga. How do they complement each other?

Weight training is proven to increase bone density and yoga is great for improving flexibility and balance. Both methods can also use our own body weight, depending on the exercise being performed, which increases the quality of bones. Combining weight training and yoga will therefore complement each other, giving positive results.

Another advantage is an increase of endorphins, this leads to improved mental health and can benefit mood swings, a common symptom amongst many women suffering from imbalanced hormones due to the menopause.

What small steps could women do to get started with increasing their bone and muscle density?

Start walking and introduce a really short load-bearing and weight-training program into your day. Even if you just start with 15 to 20 minutes, at a time, to avoid the pressure of the ‘one hour exercise session.’ Many women are too self-conscious to go to the gym, but they can always find a beginner class online or swap weights for household objects, such as reusable water bottles.

If women suffer from joint pain, how can they alleviate this?

For instant relief, I find that a hot shower or bath as soon as I wake is an essential start to my day and this is what I recommend my clients to do. Heat warms up our muscles and joints, helping to relax our bodies. Also, starting the day by keeping hydrated helps prevent joint inflammation.


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Caroline Freedman’s Recommended Exercises for Menopause Warriors

The reps and sets of the below exercises will be determined by your fitness levels. If you are just starting out, try each exercise for 1-3 sets of 4-5 reps. Begin with a weight that you feel comfortable with. Over time, increase the weight in small increments and add further reps and sets.