Your Guide to Menopause

Menopause is a natural phase of every woman’s life, but many women are in the dark when it comes to what to expect. “We have a lot more answers now than we did 10 or 15 years ago,” says Dr. Janice Weiss, a family physician, director of Medcan’s Child & Youth program and a certified menopause practitioner with the North American Menopause Society. Dr. Weiss recently co-hosted a webinar called Medcan Talks Menopause with Dr. Beth Abramson, Medcan’s director of cardiology. Watch the webinar:

What is menopause?

Menopause – This occurs 12 months past a woman’s last menstrual period. The average age is 51-52 but it can range from age 40-58.

What is perimenopause?

Perimenopause – This is the period of time from the onset of cycle irregularities, and extends for 12 months from the date of a woman’s last menstrual period.

What might you expect once you’ve entered menopause?

Vasomotor symptoms include night sweats and hot flashes, which can be triggered by hot beverages, spicy foods, alcohol (particularly in the evening) and stress.

Genitourinary symptoms include stress incontinence (caused by coughing, sneezing or jumping), urge incontinence (inability to make it to the bathroom on time), pain with intercourse, irritation, dryness or discomfort. Unlike hot flashes, which subside over time, genitourinary symptoms become more progressive and worsen with time—so the sooner you can get treatment, the better your long-term results

What else?

Sleep disruption from night sweats is common, but sleep disruption may also be exacerbated by work stress, sandwich generation stress, joint aches and pains, nighttime bladder irritability, sleep apnea and mood problems like anxiety or depression.

Treatments for Menopause Symptoms

The gold standard to treat moderate to severe hot flashes is hormone therapy. Estrogen is the most commonly used and most effective hormone, but when used alone it can cause the lining of the uterus to build up and potentially increase one’s risk of uterine cancer. Dr Weiss says that all women with a uterus should also pair estrogen with progesterone (or other new agents) to avoid this. Both Dr Weiss and Dr Abramson discourage the use of over-the-counter supplements which have never been proven to work. They also suggest staying away from custom-compounded bio-identical hormones which are not regulated by Health Canada. Notably there are bio-identical hormones that are available by prescription and these are regulated and reliable. “Just because something’s deemed natural doesn’t mean it’s safe,” says Dr Weiss.

Benefits and Risks

The benefits of taking hormones in midlife include a reduction in hot flashes, reduced rate of diabetes, improved mood and sleep, improved fat distribution and reduced joint aches. And if you’re in early or premature menopause (defined as reaching menopause in your early 40s or before age 40, respectively), you may also get the benefit of reduced risk of cardiovascular disease, Alzheimer’s disease and osteoporosis.

The risks include a slightly increased chance of getting breast cancer in women who take both estrogen and progesterone for more than three to five years. If you do elect to take hormones, Dr. Weiss recommends having a conversation with your physician annually to assess whether it makes sense to continue. Another risk is blood clots. Post-menopausal estrogen creams may be a safer route, and if you have a history of blood clots, Dr. Abramson says physicians may discourage hormone therapy. “To put things in perspective, the typical dose of hormone therapy is one-quarter the dose of the birth control pill,” says Dr. Weiss.

Postmenopausal Health Concerns

Once you’ve passed menopause, your risk for numerous health conditions increases as a result of estrogen loss.

• Risk for osteoporosis, or bone density loss, increases three to five years after menopause. Aim to consume 1,200 mg of calcium a day, preferably from low-fat dietary sources like milk and yogurt, and 2,000 IU of vitamin D, taken with food. Workouts that involve weight bearing activity can also help prevent bone density loss.
• Cardiovascular disease, including heart disease and stroke, is the second leading cause of death among women ages 45 to 64 and the leading cause of death for women over 65. “We’re also seeing heart attack rates increasing in younger women, age 35 to 54, for the first time in four decades, secondary to obesity, diabetes and hypertension,” says Dr. Abramson. While younger women tend to gain weight across the hips, as they age, that weight distribution shifts to the mid-section, which increases risk for diabetes, high blood pressure and high cholesterol.

“It’s never too late to make a lifestyle change,” says Dr. Abramson. “You don’t have to run to the gym every day but incorporating healthy activity into your daily routine and aiming for a healthy body weight is important—particularly after menopause.”

Menopause resources

• Menopause and U, from the Society of Obstetricians and Gynecologists Canada: www.menopauseandu.ca
• North American Menopause Society at www.menopause.org
• The Menopause Manifesto by Dr. Jen Gunter