Our expert shares lifestyle changes and other approaches to improve your well-being in midlife.
Menopause is a natural part of aging that marks the end of ovulation. While menopause is a universal experience shared by everyone with ovaries, it comes with a variety of experiences that affect each person differently. Vancouver Coastal Health Research Institute researcher Dr. Lori Brotto explains the impact of hormone decline through the menopause transition on sleep, sex and mental health, and shares approaches to advocate for care during this transitional period of life.
Q: At what age does menopause start and how do I know if I am in or transitioning into it?
A: In North America, menopause typically occurs around 51 years of age. However, some may experience menopause earlier or later in life. All individuals assigned female at birth — except for those whose ovaries were removed before puberty — will experience menopause at some point in their lives, either naturally or when induced by treatment.
There are three important life stages to think about, and these can vary in duration between individuals:
- Perimenopause is the transition leading up to menopause that can last anywhere from four to eight years. During this time, estrogen fluctuates (sometimes wildly) and progesterone declines. Similar to how hormones change in preparation for the first period in puberty, perimenopause is the phase at the other end of the reproductive timeline. For some, hormone fluctuations in perimenopause can lead to changes to mood, sleep and bleeding.
- Menopause itself is a single point in time marked by the cessation of menstrual periods for 12 consecutive months. This is the perfect opportunity to get curious, learn and make a health plan for postmenopause.
- Postmenopause is every day after menopause for the rest of one’s life. Symptoms can persist during postmenopause, and some symptoms — such as bone loss, vulva/vaginal dryness or recurrent urinary tract infections — can worsen over time, especially if they are not addressed with a prevention or treatment strategy. For most women, vasomotor symptoms last around four to five years after their final menstrual period. Therefore, postmenopause is an optimal time to invest in your cardiovascular, brain, bone and genitourinary health.
Q: How might menopause impact my daily life?
A: The symptoms associated with perimenopause can have a significant impact on various aspects of daily life. Vasomotor symptoms — characterized by the contraction or dilation of blood vessels resulting in the sudden intense sensation of heat in the upper body — affect 60 to 80 per cent of people in the final few years of perimenopause. These are often referred to as “hot flashes” and “night sweats.” After menopause, the increased risk of insomnia, sleep apnea and physical symptoms such as frequent urination and bone or joint pain can interrupt regular sleep cycles. Fluctuating hormone levels can lead to mood swings, depression and difficulty with memory or concentration.
In terms of sexual health — which is my own area of research focus — vaginal dryness due to reduced estrogen can lead to discomfort or pain during sex. Reduced sexual desire is also common. Emotional changes can directly impact a person’s willingness to engage in sex, or ability to experience sex as arousing and rewarding.
Q: Does menopause put me at a higher risk of developing certain health conditions?
A: Menopause can increase the risk of developing certain health conditions due to the decline in estrogen levels. Osteoporosis, which involves bone density loss and an increased risk of fractures, is one such health condition to be aware of during menopause. There may also be an increased risk of cardiovascular disease, weight gain, metabolic changes, urinary changes and pelvic floor dysfunction, in addition to increased rates of depression, anxiety and cognitive changes.
Q: How should I adjust my lifestyle habits during menopause?
A: Throughout the perimenopause transition and after menopause, certain activities can help improve overall well-being, while others might exacerbate symptoms. Maintaining a regular exercise routine, including cardiovascular activity, strength training and balance work supports both mental and physical health. Staying hydrated and eating a balanced diet rich in calcium and vitamin D is important for strengthening bones. Prioritizing iron-rich foods, checking ferritin levels and considering an iron supplement may also be important for women experiencing iron deficiency. As this may be a period of significant change, effectively managing stress is also critical. Research-proven tools such as mindfulness meditation and cognitive behavioural therapy have been shown to relieve stress. Maintaining an active social network can be beneficial for those experiencing menopause to know that they are not alone.
In terms of what to avoid, Canada’s Guidance on Alcohol and Health recommends no more than two alcoholic drinks per week. It is also recommended to quit smoking, as it is associated with an increased risk of osteoporosis, heart disease and other health issues that are risk factors for people in midlife.
Q: What are some approaches that I can take to advocate for myself when seeking care for menopausal symptoms?
A: Not all health care providers are trained in menopause care; so, it is crucial to advocate for yourself to get the best possible support. The first step is to find out how your hormones work in your 20s and 30s, which puts you in the best position to plan for when cycles are no longer regular. You can learn about menopause by reading guidelines from leading societies who specialize in menopause care such as The Menopause Society and The Canadian Menopause Society. Menopause Chicks, founded by our lab’s patient partner Shirley Weir, is an education-based community focused on bringing clarity to an often-confusing topic. Some helpful books include “The Menopause Brain” and “The New Menopause.”
Additionally, establishing clear and open communication with your health care provider makes it easier to ask questions about the best treatment options and evidence to support your decision-making process. Tracking symptoms’ frequency, severity and possible triggers for a short period of time can help you convey your needs more effectively. Most importantly, learn to tell a strong health story that summarizes your experiences, the impact on your quality of life and an invitation to your health care provider to help you decide the best way forward. Understanding all the approved, evidence-based treatment options available puts you in a better position to work with your health care provider to make the best decision for your health.
Q: What is being done to help improve the quality of life of people going through menopause?
A: Improving quality of life for people transitioning to menopause involves a multifaceted approach. As public dialogue progresses, there is hope that medical schools and residency programs will increase the amount of time devoted to menopause education. We are also seeing more workplace education to teach employees about managing symptoms and to foster a supportive work environment. Another way of overcoming barriers is ensuring that everyone has access to care. By establishing specialized clinics, women can receive targeted and comprehensive support. At a policy level, there is a dire need for more investment into menopause research so that the safety and efficacy of treatments can be established.
Collaboration among health care providers, researchers, policymakers and community members is essential to achieving these objectives. My research team recently completed the HER-BC study to better understand the barriers to care; impacts to work and caregiving; and influences on daily living and quality of life associated with menopause. The results of this study, which are scheduled for release in fall 2024, will inform recommendations and strategies to support aging from perimenopause and beyond.
