WELCOME TO RE-Balance
A Treatment Framework for Navigating Perimenopause/Post-Menopause
Empowering women experiencing hormone changes through wellness and fitness
THE BIG CHANGE
(And we’re not just talking about hormones!)
Hormonal changes are a reality for women, and no period of life is more dramatic in its effects on the life of a woman than the transition to menopause. Hormones affect many functions of the human body and when those levels change there is going to be disruptions in those functions. As women go through perimenopause common symptoms include, sleep disturbances, hot-flashes, changes in body composition, mood changes, and muscle and bone loss among other things. Historically this time of life has been under-researched, mis-understood, and mis-treated with many women just told to “deal with it.”
The Big Change is that today’s women are not satisfied with this answer and we want to help empower women in this time of life to meet this journey with intentionality, grit, and grace. We want to change this attitude of just dealing with menopause and moving through this time of life with purpose.
With the help of those who understand the problem we have developed a program to make sure women can move forward with a new sense of balance in their lives, stronger and better than before.
HORMONES AND YOU
Understanding the role of hormones and what they do for the body helps you understand WHY the symptoms of perimenopause and menopause are occurring. Once you understand WHY your body is responding the way it is, it allows you to take proactive measures to ensure you maintain health and wellness throughout this time of life.
As women go through this time of their life the levels of both the hormones estrogen and progesterone start to decline. This decline leads to some predictable changes in the women’s body. For example, estrogen and progesterone both function as systemic anti-inflammatories. When those levels start to reduce, women become more susceptible to joint and muscle pain, impaired gut performance, and puts women at a higher risk for things such as frozen shoulders. Estrogen also helps regulate your body temperature which is why women experience “hot flashes” as these levels decrease. Estrogen also helps increase chemicals in your brain that keep you calm which is why it is common to see mood changes, irritability, and difficulty relaxing. Progesterone assists with these things and more and is also involved in your pain response. Fluctuations in progesterone in women with chronic pain disorders or fibromyalgia altered pain levels as much as 25%. These are just a few things that are commonly seen in perimenopause and menopause as these hormone levels are fluctuating. There are many more!
When you understand how these hormones work and what they do, the recommendations being made to help you out will make much more sense. We want to help Empower you RENEW your sense of well-being as you navigate this time of life so these common challenges will not negatively affect your life.
QUICK TIPS to start to RE-Balance your life
Balance means many different things to many people. We strive to help promote physical balance, neurological balance, and overall well being in all of our patients. The hormonal fluctuations described above as a women enters perimenopause can challenge that balance in many ways. Based on some of the latest research and blending postural restoration thought processes, here are a few…
HRUSKA CLINIC Recommendations for Perimenopause and Menopause
SLEEP
Sleep disturbance is a common symptom in perimenopause due several factors including poor temperature regulation and metabolic and neurotransmitter changes. To help with sleep we would recommend:
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- Avoiding alcohol for an hour before bedtime as alcohol shortens your REM sleep and can exacerbate hot-flashes
- Turn off electronics 30 minutes before bedtime. Blue light from screens reduces melatonin production which is already reduced in menopause.
- Tart cherry Juice enhances your body’s own melatonin production and has anti-inflammatory effects. Drink 30 minutes prior to bedtime. For more tips see our full list of recommendations.
HYDRATE
During menopause it’s important to drink fluids as you might not feel thirsty as often due to the withdrawal of hormones. Drinking 48-60 ounces of water a day is great, but remember your body is not made up of pure water. Dr. Stacy Sims recommends consistent low-intensity hydration during the day by mixing 1 teaspoon of maple syrup and 1/16 teaspoon of salt (Redmond’s real salt, or Baja Celtic Salt) with 10 oz of water.
EAT MORE PROTEIN
Protein is an important muscle building agent and is important in improving brain health and function. Both of these things are important in perimenopause as women withdraw from Estrogen especially. Protein is a key component of neurotransmitters like serotonin (helps you feel calm and happy), dopamine (motivation and mood regulation) and oxytocin (social bonding and mood regulation) among others. Consuming enough protein is vital in maintaining healthy blood pressure, improving fatigue, hot flashes and brain fog.
It is recommended that during perimenopause and menopause to eat 1 gram of protein for every pound of your IDEAL body weight per day.
Watch your Nutrition
Nutrition can be a big factor in keeping you feeling good at any time of life but may be more important to address during perimenopause and menopause.
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- Consider upping your fiber intake. A minimum of 25 g/day is recommended
- Improve polyphenols like in apples, berries, and dark chocolate for antioxidant effects
- Consider an anti-inflammatory diet if you are dealing with systemic inflammation common in perimenopause
- Consider working with with an MD or dietician for specific supplementation ideas with your diet
Menopausal Hormone Therapy (MHT) or Hormone “Replacement” Therapy (HRT)
The unfortunate history of hormone replacement therapy is that the initial research done on the risks of hormone replacement therapy specifically with breast cancer rates was poorly done and misinformed a lot of women and practitioners about the potential benefits of hormone therapy. The lack of research over the next several decades has led to a generally poor understanding even within the medical community about the benefits of hormone therapy. We highly recommend all women discuss this topic with a qualified MD or menopause specialist who understands all of the recent research so appropriate decisions and recommendations can be made. For more information on this research see our full recommendation handout.
ADAPTOGENS
Adaptogens are plants that can increase your body’s resistance to stress. They can be a helpful addition to your nutritional supplements in perimenopause. We would recommend you explore adaptogens with a Functional Medicine Provider to assist you with this.
ADDRESS PELVIC FLOOR DYSFUNCTION
Due to the changes in muscle mass (due to low levels of estrogen), strength, tissue mobility (affected by progesterone) and hormone levels pelvic floor dysfunction is common in this age group. Addressing the position and strength of your pelvic floor is needed not only for pelvic floor health but also to allow you to tolerate exercise. Physical therapy at the Hruska Clinic is a great way to improve pelvic floor function from the outside in to improve symptoms such as urinary incontinence, prolapse, rectocele, painful intercourse etc. Click the button below to access our PELVIS page. Having this “core” strength is also a key component to allow you to progress to higher level exercise programs.
RESISTANCE TRAINING**
Weight training is important for increased metabolic rate, improved joint strength and stability, stronger bones, improved blood pressure control, improved muscle strength, maintenance of lean muscle, reduction of fat gain, and improved immunity. Initiating a resistance training program is KEY for any of the below recommendations to be done well.
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- **Prior to starting resistance regaining we recommend completing the Hruska Clinic Functional Self-Screening Assessment to ensure you are safe to initiate these activities. (See Below)
- Minimum 2x/week with a goal of 3x/week, Lift Heavy weights
- Recommend 3-5 exercises per session to work arms, legs and core
- We recommend consuming 30-40 grams of protein 30 minutes after exercise to assist with recovery
HIGH-INTENSITY INTERVAL TRAINING (HIIT) and/or SHORT/SPRINT INTERVAL TRAINING (SIT)**
Working hard with increased effort for short intervals has been shown in research to improve insulin sensitivity, improve oxygen consumption, burn fat (both adipose and visceral fat) and improve mitochondrial function (necessary for energy). Traditional cardio training, keeping your heart rate elevated at 90% max effort for longer than 10 minutes, has been shown to burn through muscle and slows your metabolism which can actually lead to higher body fat percentages and make it harder to lose weight correctly.
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- **Prior to initiating HIIT training please complete the Hruska Clinic Functional Self-Screening Assessment to determine what level of HIIT training you should start with.
- We recommend doing HIIT or SIT training 2x/ week
- For protocol ideas see our full recommendation handout or see us in the clinic
WEIGHTED VEST**
Wearing a weighted vest for normal daily activities has been shown to improve bone and muscle strength through multi-directional force through bones and muscles, enhances cardiovascular health and improves balance and coordination.
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- **Prior to starting a weighted vest protocol please complete the Hruska Clinic Functional Self-Screening Assessment to determine what protocol to follow
- The goal is to wear a weighted vest around the house for normal activities such as house cleaning, cooking, walking the dog etc. It is not recommended to wear during other exercise performance as it can increase your risk of injury
PLYOMETRIC/JUMP TRAINING**
Jump training has been shown to increase muscle strength, bone health, body composition, posture, and physical performance. Plyometrics can trigger epigenetic changes that actually change the way your genes express themselves in muscle power, strength and integrity of the muscles and bones.
- **If you have been diagnosed by your MD with osteoporosis, please consult with your MD prior to starting plyometrics . If you have joint issues from arthritis or injuries please consult with your MD or a Physical Therapist prior to starting plyometrics.
- **Prior to initiating plyometrics training please complete the Hruska Clinic Functional Self-Screening Assessment to determine your ability to safely start these types of exercise.
- Goal is to work up to 3 circuits of 45 seconds of activity and 15 seconds of rest 3-5x per week
- Plyometric Training can be combined with HIIT training. For more ideas of specific activities see our expanded guide or see us in person
There is a lot you can do and this can be overwhelming to try and change all of this at once. Pick one or two things to start with and be consistent and slowly add other recommendations. YOU HAVE THE POWER TO DO THIS! You can enter this stage of life stronger and better than ever! Remember its progress over perfection.
BE RELENTLESS!!
** Prior to starting resistance training, HIIT/SIT, weighted vest or plyometric training The Hruska Clinic has developed a Functional Self-Screening Assessment tool with recommendations to ensure you are safe and ready to perform these tasks and to reduce the risk of injury. We think these activities are vital for optimizing women’s health so we have developed this with the help of other health professionals to assist you moving forward.
HRUSKA CLINIC FUNCTIONAL SELF-SCREENING ASSESSMENT (FSSA)
This screening tool can be done on your own or with the help of another person or with one of our therapists. Based on how well you do with this assessment determines what level of activity we feel you are safe to perform, limiting risk of injury and maximizing your potential for success. We feel taking positive action in your health journey is important we want to help empower women to feel safe and comfortable in this process.
General guidelines will be provided at the end of the screening assessment.
If you have questions please do not hesitate to contact us.
STANDING REACH TEST*
Positive Test (+): Unable to Touch Toes
Positive Test (+): Able to place palms fully on the floor with no tension in back of thighs
Negative Test (-): Able to barely touch toes or top of foot and can feel tension on back of thighs
Red Light: Positive test
Green Light: Negative Test
*Adapted and used with permission from Postural Restoration Institute®
FUNCTIONAL SINK SQUAT (FSS)*
Level 1= Ability to sense pressure through heels and tuck ribs and bottom (inability = level 0)
Level 2= Ability to maintain level 1 position and squat down to 45 degrees with knees coming slightly forward over toes and senses front thigh muscle engagement
Level 3= Ability to keep level 1 and 2 and squat down to 90 degrees (bottom level with knees)
Level 4= Ability to keep level 1-3 and be able to squat all the way down so your bottom is below the level of your knees
Red Light: Level 0 – 2
Yellow Light: Level 3
Green Light: Level 4
*Adapted and used with permission from Postural Restoration Institute®
SIDE-LYING KNEE TO KNEE*
Level 1= Ability to press left hip into floor (unable = level 0)
Level 2= Ability to keep level 1 and shift top knee/hip ahead of bottom knee while keeping top heel close to the wall
Level 3= Ability to keep level 1-2 and lift top knee up and level with top hip. Must also keep a sense of top leg arch/big toe and ability to feel top legs glute muscle engagement
Level 4= Ability to keep level 1-3 and lift bottom knee off of the floor sensing bottom inner thigh engage and keep top knee ahead of bottom knee.
Red Light: Level 0-2
Yellow Light: Level 3
Green Light: Level 4
*Adapted and used with permission from Postural Restoration Institute®
INTERRUPTED STEP THROUGH*
Level 1= Ability to shift body weight forward on front leg with seam of pants oriented to that same side with trunk and head over front leg and opposite arm forward and sense of front hip engaged (unable = level 0)
Level 2= Ability to keep level 1 and side bend trunk of front led to same side with ribs. Example: Left leg front, side bend to the left with left ribs
Level 3= Ability to Keep level 1-2 and left back leg off floor slightly
Level 4= Ability to Keep level 1-3 and slowly bring back leg forward simultaneously with weight-bearing side’s arm, and non-weightbearing side’s arm back
Red Light= Level 0-2
Yellow Light= Level 3
Green Light= Level 4
*Adapted and used with permission from Postural Restoration Institute®
INTERPRETING THE RESULTS
Based on your testing on the FSSA we make the following recommendations. See video below to hear from Lori. For specific activity recommendations in each category see our full recommendation handout. (coming soon!)
RED LIGHT
You are a red light individual if you have pelvic floor symptoms or score a Red Light Result on any of the FSSA assessments.
We strongly recommend you work with a Hruska Clinic Physical Therapist to start on your wellness journey for an individualized program to assist you with pelvis and trunk stability. There are concerns that if you just jump into harder activities without first ensuring you have proper mobility, stability and position of your body you are putting yourself at risk for injuries or set-backs. These sessions will be highly valuable in symptom reduction, injury prevention and will allow you to move and function at a higher level.
YELLOW LIGHT
You are a yellow light individual if you have no RED LIGHT results on the FSSA but have at least one YELLOW LIGHT result.
We would recommend a few visits with a Hruska Clinic Physical Therapist for an individualized program as there are some concerns that you may need some instruction or stability work with proper biomechanics prior to working with resistance, and to prep your body for HIIT/SIT and plyometric workouts. Once this is established, based on your desire, you can start unsupervised training with a workout program designed by your PT, on your own, or with a Personal Trainer.
GREEN LIGHT
You are a green light individual if you score green lights on all of the FSSA assessments. Congratulations! YOU ROCK and are ready to roll!
You are ready to begin supervised or unsupervised training on your own or with a trainer. You may still consider a personalized training session with a Hruska Clinic Physical Therapist for 1-2 visits to instruct in proper biomechanics to go under load with resistance training, starting a HIIT/SIT program, and proper jumping for plyometrics or alternatives based on your unique history. A specific program can be designed by your PT, or you can workout unsupervised, or work with a Personal Trainer. BE RELENTLESS!
COMING SOON
If there is demand for additional information we plan to be able to provide (for a fee) a more comprehensive guide with more in depth recommendations, and further guidance for setting up your own workout program. If you are interested in hearing more about this as we develop these resources sign up here.
What you will get.
- In Depth discussion and tips about all the discussion points above including tips from some local professionals
- Specific recommended activities for resistance training, HIIT, weighted vest use, and plyometrics specifically designed from yellow and green light individuals
- A sample week of workouts
- Exercise videos
- Opportunity to receive updated information and workout tips to keep you motivated
- Potential for online support group (if we have enough interest)