Massage & the Menopause

Connections Magazine, Spring 2011

A client of mine recently put it very well, & with permission Iím quoting what she said. Talking about the effects of age & ageing gracefully - or not - she said, ďIíd just about got used to puberty when the menopause came along!Ē And thatís the way it seems. One of lifeís phases that we all know are coming but which always manage to take us by surprise. In all the time Iíve been massaging I can honestly say that no one has come along & said they want a massage because they are going through the menopause.

The menopause has got a bad press. Weíve read all about it. The beginning of frumpishness, feeling unattractive, loss of fertility, hot flashes and mood swings, the beginning of the end of our lives. A reminder of the ageing process, in particular our own, and nothing we particularly want to shout about. In a youth driven society we can keep the tell tale signs of age under wraps for a whole lot longer with HRT & cosmetic surgery should we wish. The menopause is an unwelcome guest, a label, often derogatory, we donít want. And we donít want to be defined by a life stage in a way, despite evidence of the ďmale menopauseĒ, that men are not. So no one has ever said they need a massage because they are going through the menopause but dig a little deeper and you will probably unearth a few areas, which could do with a little help.

The word menopause comes from the Greek word men meaning month and pausis meaning stop. As the name implies itís the time that a woman ceases menstruation, usually between the ages of 45 - 55, although earlier menopause may occur naturally. Levels of the female hormones oestrogen and progesterone fall and the body stops producing eggs. A woman is said to have been through the menopause once she has not had a period for a year. The perimenopause is the period of time leading up to the menopause, some 3 - 10 years, where changes are beginning to take place, such as periods becoming more irregular, lighter, or heavier and other indicators of hormonal changes such as hot flashes may begin. Menopause may be induced surgically as the result of hysterectomy or chemotherapy treatment where not only the effects of menopause occur abruptly but there is the trauma of illness to deal with as well.

Addressing menopause is a relatively recent phenomenon as women live longer beyond their childbearing years. A womanís life is governed by her hormones, from puberty, when everything starts kicking off, monthly PMS, through pregnancy when there is life & hope through to perimenopause, menopause and post menopause where beyond the hormonal turmoil there seems to be only some kind of desert lying in wait.

With later motherhood a woman may be going through menopause at the same time her daughter is entering puberty. Ouch! This is also the Pill generation where motherhood may have been delayed or missed out altogether with accompanying social pressures. However, natural menopause isnít a disease or an illness, rather a phase of life. The changes in hormonal levels will affect every woman differently, both physically and emotionally. But how can we, as massage practitioners, help? Following are some of the common complaints, which I believe can be helped through massage:


Dry skin. An assistant at the beauty counter once told me the menopause plays havoc with a womanís skin. How true. As we age the skin naturally becomes thinner. Collagen production slows & elastin fibres, which give the skin its elasticity, start to degenerate. Declining levels of oestrogen mean it becomes harder for the skin to retain moisture, often becoming drier, less elastic, itchy, flaky or red. Massage provides the perfect opportunity to provide some much needed moisture and nourishment. The heat generated by working the oil into the skin promotes absorption and helps slough off dead cells, at the same time increasing local blood supply which in turn helps stimulate cell regeneration. Facial massage treatments are particularly good, working on connective tissue, the muscles of expression & imparting a healthy glow to the skin. Make a note of your clientís skin type and select accordingly. Oils may be for example fat or dry. Those which work well for mature skin include macadamia (macadamia tetraphylla) & thistle (carthamus tinctorius) for the body & apricot (prunus armeniaca) & evening primrose (oenothera biennis) for the face. Adding some vitamins or essential oils to the blend may be beneficial. The oil then provides not only the right amount of slip but ďfeedsĒ the skin as well. Much of the efficacy of essential oils comes from their inhalation. Those having a beneficial effect on the skin are geranium (pelargonium graveolens), palmarosa (cymbopogon martinii), galbanum (ferula galbaniflua) & frankincense (boswellia carterii.). Indian head massage with appropriate oils may enhance dry, brittle hair. Choosing oils specifically suited to your clients adds an extra, pleasurable, dimension to the massage treatment. Work around the neck & shoulders also helps reduce crepey skin.


Hot flashes. Characterized by a sudden upwards heat rush, reddening of the skin particularly around the cheeks, neck & chest, perspiration, & a general feeling of being unwell, or sometimes of panic and suffocation. Probably the least welcome symptom of hormonal changes & the most difficult to disguise. These episodes usually pass relatively quickly but may produce acute embarrassment particularly in social situations. Wearing layers of clothing that can be removed discreetly to reduce heat, keeping fit through exercise & avoiding triggers such as caffeine, spicy foods & alcohol is beneficial. Anxiety, feelings of vulnerability, loss of control & dread can heighten the severity of these symptoms. The mental relaxation produced by massage reduces anxiety, helps the body regain equilibrium & improves perceptions of well-being. Excess liver heat is said to produce these symptoms so acupressure techniques may help. However, donít be alarmed if your client experiences a hot flash while on the massage couch - the last thing your client needs is to feel anything other than at ease by your simply taking it in your stride. And while any massage room is usually well heated, be sensitive to your client, turn the heating down, reduce the number of towels & ensure there is plenty of fresh air.


Irregular menstruation. In the years leading up to the menopause fluctuating hormones cause irregular menstrual cycles. Along with lower levels of oestrogen comes a lowering of progesterone & testosterone & rising levels of FSH (follicle stimulating hormone) & LH (luteinising hormone) sent out via the hypothalamus but to which the ovaries increasingly fail to respond. Normal periods with the release of an egg from the ovaries & the subsequent development & degeneration of the corpus luteum take place on a less regular basis. Cycles where lowered oestrogen levels result in an ovulation become more frequent. As oestrogen, which thickens the uterine lining before ovulation, declines the lining is often shed irregularly and can lead to heavy bleeding. And lowered progesterone, which stimulates shedding of the uterine contents after ovulation and regulates the heaviness and length of bleeding, contributes to the problem. During an ovulation, where the egg is not released, progesterone is not produced leading to oestrogen build-up. 14-day menstrual cycles, increased menstrual flow, scanty or missed periods are all part of the pattern. With heavy menstruation comes exhaustion, depletion & loss of iron, not to mention the inconvenience of unpredictability. Scanty menstruation or missed periods are accompanied by feelings of PMS or anxiety. With increased menstruation the focus is on relaxation and balance. Work on meridians & pressure points to balance the reproductive system is beneficial along with reflex points on the feet. The abdomen may often feel too vulnerable to be touched. With scanty flow stimulation in the form of additional work on reflex zones, lower back & abdominal massage plus stretches promote circulation. Release of tension from lower back muscles provides relief & increases flexibility, again promoting circulation. Advice on rest, warm baths & nutrition may be useful in improving the clientís overall health.


Mood swings. Women during the menopause & the years leading up to it may be prone to mood swings. The severity differs from person to person but those who have suffered from PMS or post partum depression may be most affected. Tiredness from reduced sleep, excess menstrual flow & the inconvenience of hot flashes all take their toll & contribute to feelings of mild depression or irritability through to outbursts of anger, sadness & tears. Fluctuating hormones levels, in particular of oestrogen, are thought to affect production of serotonin, the hormone that exerts a balancing effect on mood. Massage may not cure mood swings but through calming the mind & inducing physical relaxation may lessen their effect. There is some debate as to whether the stimulation of massage increases the secretion of endorphins to produce a feel good factor, but release of muscular discomfort & the calming effect of the strokes reduces stress & provides emotional balance. Quiet focus on the body is also grounding. Using essential oils in the treatment room helps to uplift mood, in particular bergamot (citrus bergamia), sweet orange (citrus sinensis) or lime (citrus aurantifolia). Oils to burn at home, put in the bath or dab on a tissue under the pillow may help recreate the memory of relaxation.


Backache. Massage keeps muscles and joints flexible by stimulating normal body processes. Waste products are released from muscle fibres promoting circulation & allowing ease of movement. Range of movement is increased through passive exercise of the joints. Important at any time but particularly more so as we age, posture deteriorates & we become less active. During menopause lower levels of oestrogen may cause muscle cramps & an increase in aches & pains including joint pain, headaches & lower backache. Cortisol levels may rise causing the muscles to feel fatigued. With sensitivity to appropriate pressure, various techniques such as deep tissue, trigger points, steady friction or simple effleurage may help relieve the pain. Pain relief lowers stress levels & lowered stress levels lessen the perception of pain. Backache related to menstrual problems can be relieved by massage over the lower back, sacrum & abdomen, followed by gentle traction to take pressure off the lower back. Headaches related to postural tension respond well to the massage process, while working on the muscles, tendons & ligaments above & below painful joints stimulates better function. Loss of bone density may also be an issue. Keep pressure sensitive to your clientís tolerance & range of movement & work to release & strengthen supporting muscles. Care should be taken to avoid pressure near the spine - muscle lifting techniques may work better here than simply applying pressure.


Night sweats. The nighttime equivalent of hot flashes night sweats affect women to varying degrees. Characterized by a sudden rush of heat, sweating, chills, & sometimes nausea they are thought to be produced by a drop in oestrogen levels affecting the hypothalamus, regulator of body temperature. Sleep may be disturbed adding to general tiredness & bedclothes may be drenched in sweat. Advice on triggers to avoid such as caffeine, alcohol, spicy foods or synthetic sleepwear may be appropriate but anxiety can make things worse. In particular anxiety over the sweats. Massage may not be able to alter the occurrence of these episodes but the reduction in anxiety levels along with altered perception of the problem helps. Stimulation of the nervous system via the peripheral nerves in the skin affects the autonomic nervous system, whose functions include temperature regulation. The soothing effect of massage can reduce increases in heart rate, which often accompany the sweats. Itís worth remembering chronic muscular tension can produce flu like symptoms, which also include aches, pains & sweats. The body is always adapting and deep relaxation enhances the bodyís ability to react to a changing internal environment.


Fatigue. A sense of fatigue during the menopausal years is common. Lethargy & an unwillingness to try new things contribute to a downward spiral. Lack of sleep, anxiety, fluctuating hormones, heavy periods, issues with food, either loss of appetite or reliance on sugary comfort foods with the subsequent weight gain & highs & lows, all play their part. Lower levels of testosterone are also thought to influence general energy levels. Stimulation of the muscles and the processing of metabolic wastes may help, together with the subsequent increase in circulation taking nutrients to organs, muscles & joints. Some clients enjoy soothing strokes while others find the pressure of deep tissue massage more restorative. The relaxation process can induce a state of complete rest, which should continue after the treatment. One of the effects of massage is to increase energy levels even though this may at first produce feelings of increased tiredness. As muscle fibres are freed of wastes & flexibility increases so slowly exertion becomes easier & physical enjoyment is increased. Internal energy levels can be balanced via pressure point stimulation while the therapeutic exchange between client & practitioner acts as a catalyst, kick starting a positive reaction & uplift of mood.


Weight gain. As we age our metabolism slows down. We tend to move more slowly & find it harder to burn off weight. Around the menopause as oestrogen levels decline women lose muscle mass & more calories are turned into fat. This is typically stored around the waist, a risk factor in heart health & diabetes. Increased levels of androgen are also thought to play a part. As practitioners it is up to us to alert our clients to healthy lifestyle choices. There is a relationship between diet & menopausal symptoms with certain foods acting as triggers. Or eating may be a way of dealing with emotional turmoil, which becomes a vicious circle - the worse we feel about ourselves the more we comfort eat. However what didnít matter 10 years ago now does. How much massage alone can help reduce weight or change body shape is hotly debated, but combined with a healthy lifestyle, diet & exercise it can certainly make a difference. More vigorous techniques such as kneading or percussion stimulate sluggish circulation & speed the removal of wastes but where there are accumulated fat deposits care needs to be taken. These areas are usually colder to the touch but are also much more sensitive. While energetic, stimulating techniques over the area may be used along with cleansing citrus essential oils the key is improving circulation to the system as a whole. Where fluid retention plays a part lymphatic drainage is of great benefit.


Low self image. The ageing process which gradually produces loss of skin radiance, wrinkles, drier hair, weight gain, change in body shape, loss of muscle mass & tone, decreasing flexibility, aches & pains combined with what may be embarrassing episodes of hot flashes plays havoc with positive self image. At any age the non-judgmental massage environment can help clients who have an issue with body image feel comfortable within their skins. Concentrating on the feel of massage, focusing attention on individual areas, the overall relaxation process not to mention sheer pleasure of massage all produce a sense of well being & acceptance of a body that may be felt to be less than perfect. Massage relies on the sense of touch rather than sight, usually the cause of dissatisfaction or distress. Once your body feels better you feel better about your body and more able to enjoy the moment. Reassurance and acceptance by the practitioner are paramount. Many women actually look better as they age; itís just a case of making the best of oneself at any given moment and enjoying the spontaneity of life.


Depression. We can all feel a bit low from time to time. Hormonal fluctuations during the time leading up to the menopause can cause mood swings and adapting to changing life stages may cause confusion & stress. Relationships may break down, there may be issues with loss of self-esteem, feelings of unattractiveness, and the mind may feel cloudy & unfocussed. But depression is something else, can be debilitating & something we may not just be able to snap out of. It may manifest as loss of interest, an inability to make decisions, being under a black cloud or feelings of pointlessness. A drop in oestrogen levels is thought to play a major part. There are various ways of dealing with depression including counseling, natural therapies and/or medication. But how can massage help? Regular massage can alleviate the symptoms of depression through a positive effect on mood. But probably the most important thing we as massage practitioners can do is listen. Non-judgmentally, giving clients time to express their fears & feelings in a supportive healing environment. Once feelings are expressed the client may then relax deeply into the massage & feel restored. Or as muscles relax it feels safe to experience & come to terms with feelings. With depression often comes exhaustion & massage provides a regenerative period of rest. Massage cannot cure depression but the positive effect of the professional relationship provides the space to be, feel & share in safety, and in some cases provides a stepping-stone on the way back to improved emotional health.


Insomnia. As we grow older we need less sleep. Sleep may be broken - for example, needing to get up in the middle of the night. With menopause gradually come changes in the urethra and reduced bladder capacity. Declining hormone levels plus loss of muscle tone can contribute to the problem. We may have worries that keep us awake. Financial worries, worries about elderly parents, children making their way in the world, the health of our partner or spouse. An accumulation of responsibilities which all crowd in when trying to get a good nightís rest. Coupled with anxiety about not getting enough sleep & constant updates on how much sleep we should be getting. Throw in some night sweats & it can make for a wretched night. Regular massage sessions help alleviate the problem. The relaxation process helps reduce muscle tension, has a balancing effect on the autonomic nervous system and encourages the mind to calm down. The body starts to feel heavy & by resting after the treatment the result is usually an improved nightís rest. Herbal teas such as chamomile or lime flower can help. Essential oils such as lavender (lavandula angustiflolia), clary sage (salvia sclarea), marjoram (origanum marjorana ) or vetivert (vetiveria zizanoides) are useful in scenting the treatment room. Above all reassurance and the sensory memory of relaxation reduces anxiety & promotes rest.


At first glance it may seem a bleak picture but menopause isnít the cause of ageing, rather one of its signs. Itís part of a bigger scenario & a lot about change and loss. But itís also about new beginnings. How women cope with these changes is part of their individual journey but it doesnít have to take over a womanís life. Massage is a positive influence & we as massage therapists can be there for our clients at this time just as much as we are at any other, listening, trying to improve quality of life, offer inspiration, advice and above all learn.

© Susan Mumford, 2011