Menopause occurs when your periods stop permanently around the age of 51 for Canadian women and is caused by declining ovarian function and estrogen levels. Natural menopause (i.e. not brought on by a surgical intervention) is preceded by the perimenopausal years, where hormone levels fluctuate and a number of symptoms may develop which impact quality of life. While some women transition into menopause with a minimum of symptoms, bothersome vasomotor symptoms such as hot sweats and/or night flashes can occur in up to 80% of women. In addition, 50-80% of women will experience the symptoms of the Genitourinary Syndrome of Menopause (GSM) such as vaginal dryness, pain with intercourse, urinary frequency, incontinence (loss of bladder control) and recurrent urinary tract infections (“bladder infections”). Other common complaints include sleep and mood disturbances, joint pains, memory problems, “brain fog”, changes in body fat distribution and changes in sex drive.
Many women are familiar with the term “hormone replacement therapy” or “HRT”. While this term is used in various countries and contexts, in Canada we use the term menopausal hormone therapy (“MHT”) to refer to the use of hormones to treat menopause and menopausal symptoms.
Systemic menopausal hormone therapy (MHT) is considered the most effective treatment for vasomotor symptoms. Non-hormonal options, while often less effective, are also available. Menopausal hormone therapy may also provide benefits to sleep, mood, bone health and to a woman’s quality of life. There are additional non-hormonal options available to address these symptoms which you can discuss with your healthcare provider.
Vaginal lubricants (used to decrease friction during sexual activity) and moisturizers (products to keep the vaginal tissues moist) as well as locally acting hormonal therapies are indicated and helpful for the treatment of GSM symptoms.
Patients are sometimes uncertain if their midlife symptoms are actually due to menopause or they may be reluctant to initiate a conversation with their healthcare provider. The MQ6 tool provides a quick and efficient screen for menopausal symptoms. Take a minute and complete the questionnaire here.
Speaking to your Healthcare Professional
If you completed the MQ6 tool, answered yes to any of questions 1-6, this indicates you are experiencing symptoms which we encourage you to discuss with your healthcare professional. If you are experiencing vasomotor symptoms or those of the genitourinary syndrome of menopause such as vaginal dryness, pain, bladder issues, recurrent urinary infections, etc.(i.e. have answered yes to questions 2, 3, and/or 4) specific menopausal therapies may be indicated. These include both menopausal hormone therapies (MHT) and non-hormonal treatment options. If you are struggling with sleep and/or mood (questions 5 and 6), while these symptoms alone are not indications for MHT there are still many interventions to be discussed.
Consider printing off your answers to the MQ6 tool and taking this to your healthcare professional to help start the conversation! You may point them towards this website where they can learn about the MQ6 along with other useful tools supporting the management of menopause.
About Hormone Therapy
Systemic therapies are therapeutic medications that are either taken orally or applied to the skin that get absorbed into your bloodstream. These medications affect hormone receptors throughout the body to provide for symptom relief such as reduction in vasomotor symptoms (i.e. “hot flashes” or “night sweats”). Systemic MHT also acts to preserve bone density and prevent bone loss which leads to osteoporosis and can help symptoms of GSM (see section on “About Menopause” above). MHT may also provide other health benefits.
Locally acting hormone therapies include hormone containing vaginal creams, tablets, or rings which release hormones directly into the vagina. This group of medications also includes oral therapies that provide benefit to the vagina and surrounding tissues, which can improve vaginal dryness, pain with sexual activity and some urinary complaints.
Guidelines recommend that when patients are having vasomotor symptoms (with or without symptoms in the vagina/bladder etc.), or require bone protection to prevent bone loss, or when treating menopause that occurs in younger women (<45 years of age), systemic MHT therapies are recommended. In contrast, when patients’ symptoms are isolated to those of GSM only then locally acting therapies are advised.
Menopausal scientific guidelines agree: systemic menopausal hormone therapy (MHT) is safest when initiated in appropriately screened women under the age of 60 or within 10 years of their final menstrual period. Treatment should be individualized with appropriate counselling in respect of risks of treatment and how these risks are affected by factors such as increasing age, duration of treatment and the specifics of the chosen product. There is no “5-year rule” or fixed duration of treatment. Some women can continue to use hormone therapy safely well into their 60’s under the supervision of their health care professional.
An excellent summary of the benefits and risks related to hormone therapy can be found here.
Menopausal Health Promotion
Is SIXTY the new 40? The perimenopause (and postmenopause) is an important time to review a woman’s preventive health profile and for identifying interventions to prevent illness, maintain quality of life, promote longevity, and address postmenopausal symptoms. What else can healthcare professionals suggest or women do to maximize postmenopausal health?
The postmenopause is associated with increased risks of cancer, osteoporosis and bone fracture, heart disease, diabetes, and the development of cognitive impairment or dementia. These are significant conditions that affect both longevity and quality of life.
For women: ask yourself if you are doing everything you can to age in the healthiest way? See the recommendations below.
For healthcare professionals: consider the following recommendations and interventions:
- Review your patient’s preventive cancer screening in accordance with your local health guidelines, such as pap testing, mammograms and colon cancer screening.
- Discuss bone health. Fractures in older women contribute significantly to both morbidity and mortality.
- Does your patient need a fracture assessment? Consider the FRAX tool and/or bone mineral density testing (BMD) to assess fracture risk. (eg. BMD in low-risk women starting at age 65).
- Discuss prevention: adequate dietary protein, adequate intake of calcium and Vitamin D, weight bearing exercise and resistance training. Women should calculate their present intake of calcium to assess the need for supplementation as most women’s intake is insufficient. More information and a calcium calculator can be found here.
- Consider cardiovascular health
- Assess smoking, alcohol consumption, diet and exercise habits.
- Assess for obesity. Aim to maintain an ideal body weight (BMI 18-25). Obesity is associated with risk of heart disease, venous thromboembolism and a variety of cancers including breast cancer.
- Take a waist measurement as central adiposity confers metabolic risk.
- Obtain annual blood pressure readings. Treat hypertension.
- Order blood tests for lipids (cholesterol and triglycerides) and diabetes (hemoglobin A1C) at a frequency consistent with local guidelines.
- Encourage heart healthy lifestyle interventions such as the American Heart Association’s “Life’s Simple 7”.
- Consider brain health. Many of the recommendations for brain health echo those for heart health! Evidence for some helpful interventions include:
- Healthy diet: consider a Mediterranean-type diet, superfoods, cruciferous vegetables.
- Promote adequate sleep duration: ideally between 7 and 8 hrs a night.
- At least 150 minutes a week of moderate intensity aerobic exercise. This increases BDNF, an important brain molecule related to learning and memory.
- Consider adding strength training for the large muscles of the upper and lower body (20 minutes 3 x a week) for further benefit.
- Stimulate the brain: learn new skills, listen to podcasts, develop new hobbies.
- Manage stress effectively.
- Treat depression.
- Encourage a positive/optimistic attitude.
- Engage in social interaction!
- Minimize exposure to air pollution.
Below you will find a list of professional resources for consumers with valuable written information, videos and podcasts.
Further information for Canadian consumers including advocacy resources can be found on the Canadian Menopause Society website.
There are a number of other consumer advocacy groups and resources that can be found by searching online using terms such as menopause, consumer, education, or advocacy.