Exercise at Menopause: A Critical Difference

Margaret Burghardt, MD


Medscape General Medicine. 1999;1(3) 

In This Article

Hot Flashes at Menopause: The Effect of Exercise

Up to 75% of women in the climacteric menopause years experience hot flashes, and up to 10% are still experiencing them 15 years later.[4] These uncomfortable vasomotor episodes can impair sleep and affect mood and overall well-being, even to the point of decreasing a woman's activity level. The origin of hot flashes is not completely understood and may well be multifactorial, with contributing factors of a hypoestrogenic state, lower levels of beta-endorphins, and decreased central opioid activity. Alterations in gonadotropin-releasing hormone and luteinizing hormone levels may also play a role. Exogenous estrogen administration increases endogenous opioid levels, which may account, in part, for the effectiveness of estrogen treatment for hot flashes. Estrogen replacement therapy (ERT) also decreases the incidence of insomnia and dyspareunia at menopause and afterwards.[5]

For some women, regular exercise appears to be a promising alternative or adjunct to estrogen therapy: It, too, increases central opioid activity and thus may decrease the incidence and/or severity of hot flashes. Wallace and associates[6] found that both premenopausal women (mean age, 43.1 ± 2.8 years) and postmenopausal women (mean age, 53.7 ± 3.7 years) showed increased levels of estrogen after participating in an aerobic training program, and 55% of the postmenopausal women experienced a decrease in the severity of hot flashes.

In a Swedish study, Hammar and colleagues[4] found that the incidence of moderate-to-severe hot flashes in a physically active group of women (n=142) was nearly half that reported by the control group (n=1246) (22% vs 44%).This cross-sectional study did not look at the physical activity level of the control group, however, and there may have been a self-selection bias among the subjects, with the degree of physical activity somewhat contingent upon and secondary to the magnitude and effects of vasomotor symptoms in individual menopausal women.

Prince and coworkers,[5] in a 2-year study of 120 women and 42 controls, found that fewer postmenopausal women (mean age, 56 years) in the exercise-plus-ERT (n=40) group had hot flashes than in the exercise-only and the exercise-plus-calcium groups (n=41 and n=39, respectively). However, the proportion of women experiencing hot flashes decreased significantly in all 3 groups. Sleep disturbances and dyspareunia (both considered to be prevalent in menopause) were only reduced in the exercise-plus-ERT group, suggesting that estrogen may play a prominent role in the alleviation of these symptoms. The symptoms and their reporting is subjective.