Understanding Menopause

Menopause is a period of 12 consecutive months without menstruation, referred to as amenorrhea. It occurs following a spontaneous decrease in the level of hormones needed to ensure proper ovarian activity, for which there is no other obvious cause. The average age of menopause is 51, but it can occur anywhere between the ages of 46 and 56. Menopause is characterized by the end of your menstrual period, but it can only be diagnosed with certainty a year later. [1, 2, 3]

Menopause is said to be “induced” when it occurs after the surgical removal (exeresis) of the ovaries, or in the case of induced cessation of ovarian function (as a result of chemotherapy or radiation therapy to treat cancer). Menopause is referred to as “early” when it occurs before the age of 40. [4]

Perimenopause starts with the first clinical, biological and endocrine signs of menopause, including vasomotor symptoms (hot flashes and night sweats) and menstrual irregularity, and ends 12 months after the last menstrual period. Perimenopause is only possible in the case of spontaneous (non-induced) menopause). [4] Up to 85% of women have hot flashes and night sweats that can last a shorter or longer time depending on the individual, but on average for less than five years; however, these symptoms can persist after the age of 60. They reach a peak during the year following the last menstrual period (before menopause is officially diagnosed). Obesity, smoking and the consumption of hot drinks or alcohol can increase the frequency or intensity of these symptoms. [4, 5]

What causes menopause is the cessation of ovarian reproductive function, which leads to a decrease in estrogen levels. Normally, the transition between the fertile period and postmenopause (perimenopause) starts with less frequent menstrual periods and the onset of associated signs: hot flashes, night sweats, vaginal dryness, urinary urgency (pressing need to urinate) and repeated urinary infections that can have an impact on sexuality and quality of life. Frequent sleep disorders can cause insomnia, fatigue, irritability, memory problems and difficulty concentrating. Headaches and migraines can become more intense. Menopause can also cause bone and muscle pain. The symptoms of menopause are often associated with weight gain, but age and the decrease and ultimate cessation of ovarian function (and estrogen secretion) can also explain the increase in body mass index (and weight). [1, 3, 6, 7, 8, 9]

Premenopause is the fertile period (ability to become pregnant), which extends from the first menstrual period (menarche) to the last (menopause).

Perimenopause starts with the first clinical, biological and endocrine signs of menopause, including vasomotor symptoms (hot flashes and night sweats) and menstrual irregularity, and ends 12 months after the last menstrual period. Perimenopause is only possible in the case of spontaneous (non-induced) menopause).

The menopausal transition is the period preceding the last menstrual period, when the ovarian cycle (the period between menstrual periods) becomes increasingly variable.

Postmenopause is the amount of time elapsed since the last menstrual period (preceding the one-year period with no menstruation). Bleeding after this period is not physiological and you should consult a doctor. [1, 3, 4]

Women are usually at less risk of heart disease (myocardial infarction, stroke) than men the same age because of the protective effect of female hormones. When the first signs of menopause appear, however, and estrogen levels in the blood decrease, women run the same risk of cardiovascular complications than men. This is compounded by the risks related to menopausal symptoms such as obesity and excess weight and the associated complications (diabetes, hypertension, hypercholesterolemia) and sleep apnea.

Osteoporosis, defined as bone fragility that can lead to fractures, increases with age, but becomes more frequent after menopause and is impacted by a history of fragility fractures (e.g., stress fractures), a parental history of hip fractures, smoking and current corticosteroid (cortisone-based) treatments.

Sleep disorders are frequent and can lead to complications such as mood disorders and depression, chronic fatigue, decreased quality of life, absenteeism from work, brain fog and difficulty concentrating, and memory problems. [2, 3, 6, 7, 8, 9, 10, 11, 12, 13]

The signs of menopause can be the same as the signs of other medical or psychiatric conditions (such as hypothyroidism or depression) or other pathologies; it is important that you discuss them with a healthcare professional (your family doctor, for example), who will be able to differentiate between the signs of menopause and signs of other conditions by prescribing the necessary tests, including blood tests, urine tests, imaging (X-rays, ultrasounds, scans) and other analyses based on your personal and family history, history of pregnancy and situation (weight, age, medical condition). [4, 6, 7]

Adopting healthy lifestyle habits during and after menopause can help prevent complications. The Society of Obstetricians and Gynaecologists of Canada recommends maintaining a healthy weight, adopting good sleep habits and managing sleep apnea, eating a balanced diet with as few processed foods as possible, quitting smoking, drinking a reasonable amount of alcohol and practising regular weekly physical activity (about 150 minutes of moderate to intense physical activity in 10-minute sessions or more). [1, 3]

Available treatments for menopause include hormone therapy, non-hormonal drugs and complementary treatments. Like all medical treatments, hormone therapy, although effective, can have side effects and contraindications. Before making any decisions, it’s important to have an informed discussion with your family doctor or gynecologist, and it’s essential to manage every symptom or complication that impacts your quality of life (personal, professional, sexual). The duration of hormone and other treatments depends on the changes in your health, your environment, and your compliance with the Society of Obstetricians and Gynaecologists of Canada’s recommendations. [1, 2, 3, 4, 9]

Alternatives to hormone therapy, if you decide not to go that route or if there are contraindications, include different classes of antidepressants and antihypertensives, but their effects are less wide ranging and more symptom specific. Some complementary therapies (hypnotherapy and cognitive behavioural therapy or CBT) have also been shown to be effective (proved and published in the scientific literature) in helping prevent vasomotor symptoms (hot flashes and night sweats). However, other therapies, such as plant-based supplements, acupuncture, chiropractic and homeopathy, remain unproven (no studies in the scientific literature). [1, 2, 3, 6, 12]