My Active Menopause success at Loughborough Wellbeing Centre

'To create a space where women feel empowered to take control of their menopause journey by prioritising their health and wellbeing, understand the power that physical activity can have in helping to manage their symptoms, and feel genuinely supported by honest, passionate professionals and subsequent programmes that demonstrate longevity and advocacy for women's health.'

This was the original vision for 'My Active Menopause'. Four months later, we have hosted two successful events in collaboration with Hinckley Leisure Centre and Loughborough Wellbeing Centre. Those involved, who openly shared their own struggles with menopause, have been instrumental in the programme's outcomes.

The latter of the two events began on Thursday 9^th November, where we welcomed 27 ladies, including health professionals, into Loughborough Wellbeing Centre.

Each week we spent an hour having open and honest discussions around the challenges ladies face during this phase of life, complex and often shared symptoms, and importantly how physical activity, simply moving more in ways right for you, can help to manage these symptoms.

A common mistake, and often unconscious bias, is to assume all women experience menopause in the same way. As such, a first step for us was to move away from defining menopause in clinical terms, to simply 'your menopause'. This recognises that every woman's menopause journey is nuanced and different and is language that better reflects the person-centred treatment we should provide.

So, what happened on week 1? We had Nat from 'The Female Physio' deliver a fantastic strength and resistance session, where the women got to use resistance bands, dumbbells, kettle bells; some for the first time in their lives; in a supported way. We focused on the 'how to' and the 'why', not only developing safe practice (particularly around maintaining pelvic floor health and function when lifting weights), but encouraging better knowledge around why regular strength and resistance activity is important during menopause. We know that regular strength activity is vitally important for any adult, but this importance increases for ladies during menopause due to the declines in oestrogen that can cause brittle bones, increased fracture risk and increased risk of osteoporosis. We practiced various exercises for the main muscle groups that could be repeated in the gym or at home. The tip, 'just 2 x 20 minutes a week' seemed to really resonate with the group.

Then in week 2 we shifted the focus to more aerobic and flexibility work, equally important in managing symptoms such as anxiety, insomnia, weight gain, fatigue and less commonly known symptoms such as dizziness and muscle soreness. Paula, a menopause yoga specialist from Yogi Bird, focused the session on restoration and breathing techniques to slow down, be mindful, and take a few minutes for ourselves. Admittedly, this felt unnatural at first as the ladies confessed that 'me time' is far down their list of priorities amongst childcare, hectic work lives, and other commitments, but the session opened their eyes to the benefits that just 10 minutes a day can have. It was clear we were breaking down common assumptions that exercise had to be really hard, really time-consuming, and really unenjoyable. During the session, one lady commented 'this is the least pain I've been in all day', which requires no further comment.

Interestingly, diet and nutrition presented as a popular topic, particularly around the 'right' things to eat during this phase of life. Sadly, a lot of misconceptions and harmful assumptions arose such as 'carbs are bad for me so I cannot eat them', 'I've been told to try X diet', 'menopause makes me gain weight which means I have to restrict what I eat'. We explored these points in depth in week 2 through the expertise of Paula. We listened and provided helpful and relatable advice, mainly around how simple changes can go a long way, and that ultimately, all food is fuel for our body. More specifically, Paula spoke about the role of phytoestrogens, natural chemicals found in foods, but which act in a similar way to oestrogen to provide better hormonal balance, and how simply adding a handful of flaxseeds in our smoothies can provide this benefit. Another important point was breakfast, and that prioritising protein can keep us fuller for longer, reduce cravings, and better regulate our blood sugar levels. This was heavily caveated with the recognition that everyone is different when it comes to food, and therefore it's our responsibility to find what works for our body. Other simple tips included reducing caffeine and alcohol and adding some pre/pro biotics into our diet. This was an unexpected conversation but something the ladies suggested had a big impact on their self-esteem and therefore in its own right presented itself as a barrier to getting active.

Anxiety, insomnia, and PTSD also presented as common symptoms. This should provide 'food for thought' that menopause isn't just 'hot flushes' and mood swings. In fact, symptoms can present as far more complex and intersecting, affected by hormonal changes but also sociological, economical and cultural factors. For a lot of women these factors lurk under the surface, hijacking thoughts, feelings and emotions that manifest as someone unrecognisable to the woman you 'used' to be, but often totally imperceptible to others. Women can be incredibly good actors! We therefore need to consider how for some, physical activity is not the driving motivation for getting out the door, but it is the vehicle to meet others also on the menopause journey, the safe space to share lived experiences, and the opportunity to find something the creates enjoyment and happiness. We have learnt that it is those wider factors that will motivate a woman to attend a physical activity session.

We were grateful to receive so much support from partners at this event. On both weeks we had a table full of literature and merchandise that went down extremely well and hopefully allowed the women to reflect on the information presented orally at the sessions. Of particular interest was the 'Your Guide to an Active Menopause', which provides summaries of strength and resistance and aerobic activity, alongside flexibility, balance, desk-based, impact, functional and pelvic floor health. These fall alongside pictorial 'how-to' guides that can be followed along to at home or in the gym. We have also tried to provide a 'one-stop-shop' for this information on our Active Menopause webpage, where you can also download the guide for free. Some key highlights and takeaways from each of our partners included:

• Social Prescribing and Local Area Coordination teams – Available to provide women with support to access appointments for menopause consultations, alongside accessing holistic health and wellbeing services complimentary to physical activity.
• Active Charnwood – Support with getting active locally and finding an activity that is right for you.
• Charnwood Primary Care Network – A local GP spoke openly and honestly about barriers women may face during GP menopause appointments. This was extremely refreshing to the group and the women were able to feedback points of change they wanted to see within the primary care space which will be fed down to local teams.
• Age UK Menopause Awareness Raising Service – Providing local opportunities to become menopause champions and 'Menopause Friendly Spaces'.
• LLR Mind – Through their Supported Self-Help (previously Active Monitoring) offer there is a menopause specific pathway that offers mental health advice and supported signposting.
• VitaMinds Talking Therapies – Providing free webinars on common issues such as sleep. Provided helpful tips around managing anxiety and insomnia and spoke about their CBT offers.
• Fusion Lifestyle – Support with accessing the gym and overcoming barriers experienced before we even get there including car parks, entry and negative perceptions.

Through the breadth of individuals above, it is clear how much energy there is around this work. The passion, expertise and empathy of those that supported the event made for a really empowering space.

In terms of immediate next steps, Loughborough Wellbeing Centre will be running regular (and hopefully weekly) menopause sessions through the funding received by Active Together. The ladies will be connected with the professionals in attendance and added to a group WhatsApp to encourage further communication and support the new friendships made. Primary Care are making strides to incorporate Active Menopause into their consultations across LLR through incorporating web links and hard copy resources into their consultations.

The comment that has and will continue to stick in our minds was from a lady in her 40s who, unbeknown to anyone had been severely struggling and when this opportunity arose, she very nearly didn't attend due to anxiety and imposter syndrome but, after the session said:

'I finally feel seen'.

It is with this feedback in mind that we will continue to refine and shape 'My Active Menopause' to the needs of women, exploring how we can tailor it to other areas and link in with sustainable, trustworthy and motivating exit routes, and simply show women across LLR that they have a team of people advocating for their health, wellbeing and happiness.