MyMT™ Blog

Swollen ankles, fluid retention and why a long-haul flight needs managing in menopause.

It wasn’t their tired faces I was interested in. It was their swollen ankles. Mine were swollen too – but not as much as theirs were.

24 hours of flying across the world and as I got off the plane so too did three middle age women who were sitting across the aisle from me. As they walked to the baggage area in front of me, I was observing their swollen ankles. One of them was complaining that her shoes didn’t fit her. She was hobbling. When I shared this post with all of the amazing women on the MyMT™ Coaching Community, it got so many responses that I wanted to share it with you too.

I had spotted these ladies as I was up and down to the plane loo. Trying to drink my 2 litres of water and carrying back cups of green tea from the galley where the flight hostess had made me one in the night, I noticed that these ladies hardly moved for 12 hours. Tucked up behind their blankets they sat, and sat and sat. Albeit they might have got up when I was trying to get some shut-eye myself, but I didn’t see them move or drink the amount of water that I did. As I got off the plane and saw how swollen their ankles were, I hoped that they would focus on their water intake during the day – and putting their feet up to assist drainage of fluid back to their heart.

I bet they didn’t realise that as mid-life women, their blood vessels don’t dilate and constrict as readily as they did when we had oestrogen.

Known as ‘vascular stiffness’, this means that when we are sitting a lot or standing a lot or doing a long-haul flight, the return of blood back to the heart from our lower extremities isn’t as efficient. We need to help it along otherwise we get swollen ankles or as it’s medically known, oedema.


‘Vascular stiffness contributes to increased fluid retention as we go through menopause.

One of the very few studies in understanding fluid retention in long haul flights and the risk of blood clots was done in 2003 by a group of researchers in America. With more and more people flying for work or recreation, the incidence of a condition called Deep Vein Thrombosis (DVT) had sky-rocketed. In the past few years, interest has focused on a possible causal link between deep venous thrombosis (DVT) and long-haul flights.

Leg and ankle oedema is a sign of blood pooling in the veins. It is a well-known problem among passengers during and after long-haul flights. Earlier studies (prior to 2000) were mainly done under simulated conditions without the high humidity levels on real flights and without the lower oxygen levels that are present on the air craft as it travels at thousands of metres above earth. Even in these simulated conditions the average fluid accumulation is around 130 mls in the lower leg and ankles after 12 hours of flying.

That’s why the study in 2003 interested me. It was done on subjects on a real 12 hour flight between Vienna in Austria and Washington in America. The flight was 12 hours long and the subjects were monitored when they arrived and two days later when they returned. The average age of subjects (male and female) were 43 years.If you do a lot of flying or you sit all day with your legs hanging down or you stand a lot, then this study matters. With the variety of measurements that were conducted, the researchers found considerable retention of fluid in lower extremities and the head. They measured skin thickness in the forehead, the tibia (front of shin) and just above the ankle. A number of bloods were taken to look for clotting changes and subjects were allowed to drink 1 glass of alcohol. They ate the meals and drank the water offered with meals.

Not one person showed signs of DVT. But what researchers did find was something more interesting to me and I hope you too, even if you don’t fly much. It’s especially important for those of you who are exercisers and fly a lot or you are managing sports teams who travel. And it’s why you need to wear anti-DVT stockings during and for 2 days after a long flight, or if you are in situations whereby you sit for long lengths of time.

Over 1/3 of the superficial layer just under your skin consists of water that is continually exchanging in deeper tissues and cells. Researchers found that all the subjects retained water in these superficial tissues, thus increasing the thickness of the tissue on average 1.5mm. This calculated to fluid retention in each lower leg of about 190mls.

What was most important however was this fluid hung around for several days after the flight. And this increased blood viscosity or thickness (measured as haematocrit) and it’s this that promotes blood clotting or thrombosis for at least a week after a long-haul flight.The recommendation by the researchers is that all travelers on long-haul flights should wear individually adjusted support stockings before and after the flight. I would add, especially mid-life women who have changing oestrogen levels that is causing vascular stiffness. 😊

This is also the premise of why you now see athletes wearing support socks when playing. They are trying to decrease swelling and inflammation in tissues. But there’s more to this story too. With researchers finding that fluid retention in lower extremities (and the head) stays around for a few days, and risk for clots and blood pooling remaining high, it’s important to shift that fluid and improve blood flow back to the heart.

As I returned from my trip to London and Edinburgh recently (thank you to those of you who came to my Masterclass on Menopause seminar), I went for a swim rather than walk or push weights or do any other form of exercise. I could also have chosen to cycle. I chose non-impact aerobic activity on purpose. With swimming you are lying prone (face-down) and therefore your blood pressure doesn’t increase as much. You are also kicking your legs and therefore helping your veins to move fluid back to the heart. This is really important when managing swelling. Get more help via our menopause fitness programmes.

When I got home I put my feet up and drank lots of water. These things help to move fluid out of tissues as well. I know that some of you have high blood pressure or work in jobs whereby you are on your feet all day or conversely you sit all day and don’t move much. If so, then keep an eye on your ankles and shins.

As we move into mid-life, the key is to minimise the risk of problems occurring with our health. So many women arrive in menopause feeling swollen, bloated and not understanding how their muscles, blood vessels, joint and liver changes as we begin to lose oestrogen and enter our biological ageing and I didn’t either. That’s why understanding that fluid retention is worse when we move into menopause is important.

When we know that this happens, we can drink more water, get our feet up when we can, wear flight stockings (even at work) and for those of you doing lots of exercise, the same rules apply too. Exercise also puts up your blood pressure and causes interstitial tissue swelling, especially doing heavy weights, so if you find that your recovery after exercise isn’t so great, then come on board when you can. It would be my privilege to share my knowledge with you as I do with the hundreds of women who join me on the MyMT™ 12 week online programme.

I’ve done the research and teach you how to put your menopause transition into ‘wellness’ not ‘sickness’.


Please use the promo code RESTART 2019 to access your $50 discount making this fabulous online programme for women in menopause only $83NZ a month for 3 months. [Please note that MyMT™ Transform Me is the weight loss programme but this is not on sale]

Wendy Sweet, PhD/ MyMT™ Founder & Coach.

“If you have ever wondered if there was a clear easy plan to follow to sleep all night, reduce hot flushes and prevent or reduce your weight gain during menopause, then ‘welcome’ – you’re in the right place now.”

Discover how either of my two Menopause Transformation programmes might help you too or take my Symptoms Quiz below… 

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