Menopause can affect much more than the symptoms people most readily recognise.
For physiotherapist Suzy Shutt, some of the changes that catch women most by surprise involve their muscles, joints and pelvic floor.
Alexander Clementine founder Alex Perry spoke with Suzy about the physical changes she sees in women going through menopause, why some women find exercise feels different, pelvic-floor symptoms that shouldn’t simply be accepted, and why sometimes it is okay to slow down.
Suzy is lecturer at the University of East Anglia, teaches physiotherapy and founder of The M-Word Physio. She describes her work as covering almost everything beginning with “M”: musculoskeletal health, menopause and maternity.
Key takeaways
Women shouldn't simply accept menopause symptoms; muscle change can be an unexpected part of the experience; pelvic-floor symptoms including changes to continence deserve attention; exercise should suit the individual and be something they can sustain; partners should be included in menopause education; and sometimes it is okay to slow down.
What is the biggest misconception about menopause?
For Suzy, one of the biggest misconceptions is that women simply have to accept what is happening and get on with it.
“I think women just accept it when actually I think understanding it would be better.”
She encourages women to understand their bodies and learn more about the changes they are experiencing.
Her physiotherapy background means she particularly looks at physical activity, exercise routines and how those routines may need to change.
Rather than simply accepting symptoms, her emphasis is on understanding what is happening and looking at practical things that may help.
What is one of the most unusual menopause symptoms?
When Alex asks Suzy which symptom women might not associate with menopause, her answer is muscle change.
“I think muscle change, I think that’s what catches a lot of women out.”
She says she particularly sees this in women who have previously been fit and active and suddenly find things they used to do easily have become more difficult.
Suzy explains that muscles rely on hormones for processes including muscle repair, growth and maintenance.
She says:
“Muscle mass drops quite significantly.”
For Suzy, this can make maintaining or building muscle harder than it was previously.
It is one reason she talks to women about balancing cardiovascular exercise with strength work rather than relying entirely on one form of activity.
Why can women experience more joint pain and aches during menopause?
Suzy connects some of the joint and muscle problems she sees with changes in both inflammation and muscle mass.
She explains that hormonal fluctuations can affect the inflammatory system. At the same time, even relatively small changes to muscle mass can alter the support surrounding a joint.
As she puts it:
“Muscles support joints.”
If those muscles are not doing their job as well, Suzy says that can mean greater stress through the joint.
Her approach is therefore not to look at the painful joint alone.
“You have to look not just at the joint, you have to look at the tissues around that.”
What happens to the pelvic floor during menopause?
Suzy describes the pelvic floor as another group of muscles — and says they can experience changes just like muscles elsewhere in the body.
One of the main signs she tells women to be aware of is changes to continence.
Symptoms can involve urinary or bowel control, and Suzy strongly advises against ignoring them.
“Please don’t ignore it.”
She says seeking help earlier is important because there is then less likelihood of more invasive treatments being required later.
Pelvic-floor muscles are also easy to forget because, unlike a bicep or leg muscle, they are not readily visible.
“I think they often get forgotten.”
For Suzy, that does not make them any less important to train and understand.
Do women simply have to accept leaking, pelvic discomfort or painful sex?
Suzy's answer is very clear:
“No, not at all. Not at all. There’s so much that can be done.”
An important distinction she makes is that pelvic-floor dysfunction does not always mean the muscles are simply weak.
They can also be too tight.
Suzy explains that muscles do not work well if they are very tight, just as they do not work well if they are weak. Understanding which problem is present therefore matters because the approach will be different.
She also discusses painful sex, saying pelvic-floor dysfunction and dryness can both be involved.
Her message is:
“Don’t just accept it.”
She encourages women to have symptoms checked and says there are a range of treatment approaches available.
What type of exercise does Suzy recommend during menopause?
Suzy does not believe there is one single form of exercise that is right for everyone.
“I think it’s very much dependent on the person you’re seeing.”
Rather than prescribing a routine someone is unlikely to follow, her preference is to incorporate exercise into something that person already enjoys.
“If I can incorporate it into something you’re already doing, that you enjoy, that’s probably going to be the best type of exercise.”
She talks about combining pelvic-floor work with other muscle groups rather than always training muscles in isolation.
Suzy also discusses using Pilates, strength work and cardio together.
Earlier in the interview she describes getting a good balance of:
“Strength work, Pilates, bit of cardio.”
Pilates is something she returns to particularly because its slower pace can give people more time to think about how they are controlling and using their pelvic floor during movement.
What should men understand about menopause?
Suzy believes menopause education should not be directed solely at women.
She says men can be surprised when they understand how widely hormonal change can affect the body.
Her advice is that partners should make an effort to understand what is happening.
“I think we need to include partners in that.”
Rather than treating menopause as something a woman goes through alone, Suzy says:
“There’s something you’re going to go through together, and it’s better if you can both understand it.”
She extends the same principle to education more broadly, arguing that girls and women should be prepared for changes across their lives rather than learning only about the beginning of menstruation.
What advice would Suzy give someone starting perimenopause?
Suzy's first message is:
“Never think that you’re too young.”
She says she hears women saying they are too young, or that they have been told they are too young.
Her advice is to trust what you know about yourself.
“You know your body best.”
She encourages women to use trusted sources, learn more about what is happening and recognise that menopause can involve more than periods, hot sweats, brain fog, mood changes and anxiety.
From her own professional perspective, that includes muscle and tendon problems that may take longer to recover.
Her advice is to be patient with your body and understand it rather than ignoring changes.
Why Suzy says it’s okay to slow down
Suzy finishes the conversation with a different kind of exercise message.
Being active does not always have to mean doing something fast or intense.
“It’s okay to slow down.”
She talks about supporting the mind as well as the body and says that if someone needs rest, or a week of slower exercise, that is completely fine.
Her final advice is perhaps the simplest:
“It’s being kind to yourself a little bit.”
That captures much of Suzy's approach throughout the interview: understand what is happening, don't simply accept symptoms, find movement that works for you and allow your approach to change when your body changes.
About Suzy Shutt
Suzy Shutt is a physiotherapist and lecturer at the University of East Anglia and is also the founder of The M-Word Physio.
Her work spans musculoskeletal health, menopause and maternity. She teaches physiotherapy and also contributes her pelvic-health expertise across other health disciplines.
Suzy's interest in menopause developed after noticing that women around menopausal age with tendon and joint problems could take longer to recover, prompting her to undertake further training in menopause and women's health.
This conversation is part of Alexander Clementine's Expert Conversations, speaking directly with people working across menopause and women's health about the questions women are asking.
