Opinion

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This article was published 31/10/2022 (212 days ago), so information in it may no longer be current.

A new national report from the Menopause Foundation of Canada (MFC) found that nearly 50 per cent of women feel unprepared for menopause. In fact, many women are experiencing it without the basic knowledge of symptoms that can negatively impact their day-to-day living.

Of the respondents who approached their physician for advice and information, 72 per cent said the advice they received was “unhelpful” or only “somewhat helpful.” In addition, 38 per cent felt that their symptoms were undertreated.

The average age of people with menopause in Canada is 51.5 years, and more than 90 per cent are menopausal by their mid-50s, according to Mount Sinai Hospital’s Menopause Clinic in Toronto. Technically, menopause refers to the point when menstrual periods stop completely for 12 consecutive months. The lead-up to this, which can last four to eight years, is known as perimenopause.

Menopause is a very personal subject that can be uncomfortable to speak about publicly. Some of the women who participated in this article requested to remain anonymous.

Most people view menopause strictly through a narrow gender focus, associating it with cisgender women (those who are assigned female at birth and identify as a woman), but it can affect individuals of all genders, including trans men and non-binary people.

“Folks who are on testosterone who transitioned later in life, especially near or after the age of menopause, may experience symptoms of menopause, and folks who are on a low dose of testosterone may also experience menopause symptoms,” says Bre Calma, training and education co-ordinator at the Rainbow Resource Centre. “Additionally, folks who are on estrogen and are stopping or decreasing their dose may also experience symptoms of menopause.”

Menopause that occurs between the ages of 40 and 45 is called early menopause, while menopause before the age of 40 is premature menopause.

“(Menopause) is this interesting area where you can take women who are living their lives and doing fine and then menopause sort of knocks them on their butts,” says Dr. Debra Evaniuk, an obstetrician-gynecologist and assistant professor with the department of obstetrics and gynecology at the University of Manitoba. “(My work) is an opportunity to keep these women well and healthy into their older years.”

Evaniuk says there’s been a recent shift in the conversation when it comes to both menopausal and perimenopausal symptoms.

“There’s been a long-learned acceptance of symptoms and now we are starting to attribute more to perimenopausal transitions and menopause itself,” says Evaniuk, who is also on the medical advisory board of the Menopause Foundation of Canada.

Some research suggests that HRT (hormone replacement therapy) can help manage ongoing menopausal symptoms as well as decrease the risk of certain health conditions, such as dementia and heart disease. One woman interviewed for this story has begun looking into HRT because of this research, hoping it may help her menopausal symptoms.

“It wasn’t until I was into menopause that I’ve come to understand that a lot of the things I was struggling with were probably related to the change in my hormones,” the 49-year-old Winnipegger says. “I’ve been researching HRT for ongoing menopausal symptoms and long-term health benefits.”

Fully menopausal now, her perimenopausal symptoms began when she was 41 and lasted seven years.

“(There was) declining estrogen, change in frequency of my periods and a hot mess of other symptoms, like chronic leg pain at night.”

She says everybody hears about hot flashes but it’s not widely understood just how many menopausal symptoms someone may experience.

“Some things lead to other things. If you’re not sleeping at night, you’re exhausted. And if you’re exhausted, it can lead to difficulty concentrating. I had all of that,” she says. “Memory challenges, difficulty multitasking and analyzing complex information, which is what I do (in my job). It’s like you find yourself unable to function at the superior level that you’ve been able to for your entire life.”

Many people often don’t know when they’re in perimenopause — if you don’t understand what’s happening to you or why, you won’t know what questions to ask when seeking help.

The 49-year-old was short-tempered, which wasn’t like her.

“It took me six years of suffering to connect everything,” she says. “The symptoms come and go and they change. They’re not all the time so they can really make you feel like you’re going crazy. You start to feel like a hypochondriac.”

While 84 per cent of MFC survey respondents knew about hot flashes and 77 per cent knew about night sweats, far fewer were aware of the more than 30 other menopause symptoms. These include troubles with sleep, low libido, vaginal dryness/itching/burning, muscle and joint pain, hair and skin issues and fatigue.

The woman says her doctor wasn’t particularly helpful and had trouble believing she was beginning menopause at 41.

“It was old-school thinking. Every doctor should be well versed in this,” she says. “Half of the population are women or trans folks who are going to experience this at some point in their life. We’re at the peak of our careers and potentially parenting children right when our body’s falling apart.”

She began seeing a naturopathic doctor, changed her diet and started taking supplements, all of which have helped manage some of her symptoms. She says a health care centre that specializes in women’s health issues would have been beneficial.

“We shouldn’t have to do the amount of research we do for a basic human condition that all of us go through, if we live to be this age.”

It can be difficult to untangle menopausal and perimenopausal symptoms from any number of other things that could be going on.

“It’s a stressful time for some people, and when your body is stressed, your moods can change,” says Dr. Carol Scurfield, medical director of the Women’s Health Clinic in Winnipeg. “Sometimes women think it’s menopause, when really, it may be perimenopausal symptoms.”

Menopause can also cause symptoms that affect productivity at work. The national MFC survey revealed that three-quarters of working women felt their employer wasn’t supportive in helping them manage this stage of life.

Forty per cent of the survey respondents reported feeling alone through their menopause experience.

Another woman, who also requested anonymity, had her final period about seven years ago. Now 62, she remembers first experiencing symptoms in her early 40s and how it became challenging to navigate at her workplace. There were mood swings, anxiety and she went through a period of depression, which she believes was connected.

“Nobody talks about it. As a (then) 40-year-old, you don’t hang out with 60-year-olds that can give you information,” she says. “And then, when you try to broach the subject, it’s taboo.”

At the time, she was in a high-level management position.

“I’ve always had a fantastic memory. And suddenly, it was failing me,” she says. “I started getting performance-related conversations at my job, which I never had.”

Research suggests there is a strong relationship between estrogen and the neurotransmitter serotonin. As estrogen falls, it can decrease serotonin levels, which can lead to depression and other mood concerns.

After running some tests, the woman’s doctor diagnosed her with depression and suggested she go on antidepressants. She was 43.

“I said, ‘OK, fine’ because I had two kids, was travelling constantly for work and was under a lot of pressure. I thought, ‘I just need something,’” she says. “So, I tried it and hated it. I felt like I wasn’t living. I was on it for about nine months. I went back to my doctor and said, ‘I just can’t do this anymore.’”

It wasn’t until a few years later that her doctor suggested she might be perimenopausal. This almost came as a relief as she became more aware of her symptoms. However, with this new self-awareness came social withdrawal.

“It was very isolating. But it was the only way I could maintain the (work) reputation I’d worked so hard to make,” she says. “I kept things more on a business level and allowed very few people in. It takes a lot of hard conversations with yourself.”

Now retired, she believes she still suffers bouts of depression and has more anxiety now — postmenopausal — than she had before.

“There needs to be more proactive conversations around mental health and menopause,” she says. “Let’s stop making it a taboo subject and bring it to the forefront, not only for women, but for men, too. And for professional men managing people going through it, to bring more compassion and understanding around it.”

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