10 things women want to know about menopause

With some 2.7 million Canadian women now in their 40s, menopause is about to become very common. Apparently we're looking forward to it. Or at least half of us are.

A recent survey of 2,049 Canadian women over 40 and 125 general practitioners, conducted by Leger Marketing and the Federation of Medical Women of Canada (FMWC), shows that 84 per cent of us become more confident as we age, and 53 per cent see menopause as “the beginning of an exciting new phase of life.”

But menopause still comes with symptoms that can make life uncomfortable for a while. We asked Canadian menopause experts to share their insights on the top questions women ask about “The Change.”

1. When will it start and how long will it last?
The menopause process can take several years. You have actually reached menopause when you have not had any kind of period for one full year. For most Canadian women, that happens around age 51. But the hormone changes that kick off menopause start in your late 30s to your mid-40s.

The early symptoms are barely noticeable: the time between periods becomes slightly irregular; you'll have minor variations in blood flow; and you'll see more hair strands in your comb. Most women experience about two years of the major menopause symptoms, such as:
-erratic periods
-hot flashes
-night sweats
-moodiness
-poor sleep and;
-fatigue.

These symptoms usually start before your periods end, and will decrease in frequency and gradually fade away within a couple of years after your last period.

2. Will my menopause be like my mother's?
Maybe, but don't count on it. Genetics are less important than lifestyle factors such as weight, activity level, diet and smoking habits. If yours differ from your mother's, expect a different menopause.

3. How bad will it be?
As with other inconvenient and stressful events in life, there are strong personal and psychological grounds upon which each woman evaluates her own menopause experience. Lifestyle and social expectations are more important than genes.
If you come from a family where it's fine to discuss your aches and pains in public, then you'll probably think your menopause symptoms need attention. How you perceive the severity of the symptoms is cultural, and some cultures are more stoic, says Dr. Shelley Ross, a physician in Burnaby, B.C., and past president of FMWC and the Medical Women's International Association, and the current secretary-general of the Medical Women's International Association.

4. Can I predict how severe my symptoms will be?
Women with poor social support and a history of emotional problems earlier in life are more at risk for feeling anxious or depressed during menopause. Several studies confirm that smoking tends to increase the risk of hot flashes, but there are few other reliable ways to predict individual menopause experiences.

Women who had severe problems with PMS when they were younger may have more trouble with the hormonal changes of menopause, but there isn't much scientific research on links to PMS.

Not surprisingly, says Dr. Barbara Sherwin, a professor of psychology and obstetrics and gynecology at McGill University in Montreal, “The intensity and duration of symptoms are highly individual. There's no way to predict how long they'll last, or how severe they'll be.”

The theory that heavier women have milder hot flashes (because fatty tissue stores more estrogens) is not substantiated by scientific studies.

Some research suggests differences across different ethnic groups -- black women may experience menopause earlier and have more hot flashes, while some Asian women have weaker symptoms. However, Ross, whose multicultural practice in Vancouver includes many Asian patients, doesn't agree: “I don't see any evidence of an Asian diet [or ethnicity] making any difference,” she says.

5. Which symptoms are temporary? And which are part of the permanent reality of aging?
Sherwin, who specializes in the effects of hormones on the brain, says much that's attributed to menopause is just normal change that comes with age. Weight-gain battles may seem especially tough during menopause, but the cause has to do with both hormonal changes and aging. “Our rate of metabolism decreases as we get older, so we should eat less and exercise more,” says Sherwin.

Difficulty sleeping is probably the most common complaint for people over 40 -- that goes for men, too. But menopausal night sweats (hot flashes that wake you up at night) cause added sleep deprivation, making you tired at work and cranky with family.

Your sleep will improve when the hot flashes fade -- usually within two years after your last period. However, by that time you may also start having new age-related sleep problems not caused by menopause.

It's true that up to 10 per cent of women experience bouts of depression and anxiety during menopause.

“It's hard to know what's causing what,” says Dr. Fay Sliwin, the medical director of the Health Watch Clinic at Women's College Hospital in Toronto. “There are so many life transitions happening at the same time as menopause, such as worries about elderly parents.”

The Society of Obstetricians and Gynecologists of Canada now tells doctors to look at sleep problems and family situations when treating depression and anxiety in women over 40, and to prescribe an antidepressant, not hormone replacement therapy (HRT), when the medical history points to depression.

And the fuzzy thinking and sudden memory gaps that many women notice at menopause? Blame it on the same changes that cause men over 50 to lose their car keys: ordinary aging, aggravated by poor sleep.

Click to continue...

6. What about HRT? Is it safe for anyone?
Since 2002, several studies linking HRT to higher rates of cancer, heart disease and stroke caused women to abandon HRT at record speed.

While 16 million HRT prescriptions were written in the U.S. in 2001, those numbers sank to six million in 2006, as new research linked HRT to increased rates of breast and uterine cancer, stroke and, possibly, heart disease (research on heart risks is inconclusive).

Drug companies and independent researchers continue to reanalyze the risks and benefits, but the Society of Obstetricians and Gynecologists of Canada now recommends that HRT should be prescribed only for a short time, and only for women with moderate to severe symptoms.

7. So what's severe enough to merit HRT?
If you wake up four times a night and stumble through work the next day, and this goes on for months, then, “it's important to get some relief, so you can function,” says Sherwin.

Ross describes patients who are “melting away on the floor in front of me from the hot flashes,” but who are frightened by the negative findings on HRT. “Those who say ‘no hormones' are really desperate to find out what else they can use. They say ‘I can't sleep. I can't concentrate. What can I do?'”

The truth is that HRT is still the most effective way to reduce hot flashes, which will result in more sleep, less fatigue and a sunnier disposition. A low dose, for a short time (one to five years), works for women who really need relief, and who have no other medical conditions or history that would advise against HRT.

8. What about herbal remedies, special diets and other “natural” alternatives?
In the FMWC study, a whopping 97 per cent of doctors and 69 per cent of patients wanted proven nonhormonal therapies. Millions of women are eager for new, nonhormonal ways to ease menopausal symptoms, and drug and natural supplement companies are eager to accommodate them.

Meanwhile, Ross reports that most of her patients “have been to the health food store before they come to me. Some tell me black cohosh or evening primrose was helpful. Others say they've tried everything, and nothing did anything. Basically, there is no evidence that any [nonprescription alternatives] help, and we're not sure how safe they are.”

A quick Internet search will turn up a bewildering variety of alleged menopause remedies described as natural, herbal, complementary and/or alternative, as well as so-called “bio-identical hormones,” and phytoestrogens and isoflavones (based on plant estrogens mostly from soy). But buyer, beware: Dosages are inconsistent; few randomized, scientific studies have been done on efficacy and long-term safety, and they can have serious side-effects when taken in large amounts or interact with prescription drugs.
“Don't waste your money” is the blunt recommendation from Sherwin, who points out that, despite repeated studies, “none of the ‘natural' alternatives have ever done better than placebo.”

9. Will menopause make my sex life suffer?
Some women worry about lower libido, but an equal number feel sexier after menopause. Not having to worry about periods, pregnancy and birth control can be a huge relief.

Reduced libido and vaginal dryness are also part of normal aging. Special vaginal creams can help add temporary lubrication. Ask a pharmacist about the nonprescription creams. For more severe vaginal dryness, hormone-based prescription topical creams, tablets or vaginal rings may be helpful.

10. What does help?
The diet secrets for an easier menopause are easy to find in Canada's Food Guide: drink alcohol moderately, and choose more plant-based, lower-fat foods that are high in fibre. If you eat few milk products, consider calcium and vitamin D supplements. Do weight-bearing exercises and go for walks to improve bone health. (Exercising outside will give your mental health a lift, too.)

When the hot flashes hit, go for low-tech solutions: dress in layers, use a fan and reach for a cold drink. To fight off age-related weight gain, eat moderately throughout the day (don't skip meals -- you'll feel tired and moody) and exercise more (at least half an hour every day).

---

Aim for a stress-free change with Zen menopause: the calm, cool change.

How do you deal with your menopause symptoms? Share your experiences by clicking on the microphone icon and posting your feedback.