Societal attitudes about menopause are changing as more women speak up about their needs.iStockPhoto / Getty Images
Millions of women are going through menopause in Canada right now – but only a small percentage will ever receive treatment.
Symptoms such as hot flashes, night sweats, insomnia, lack of energy, depression, muscle pain and bladder control issues often negatively impact their quality of life and reduce their ability to work to their full potential. It’s a serious health issue that can last up to 10 years, with symptoms beginning at the onset of perimenopause (when hormones fluctuate in the years leading up to the end of menstruation) and lingering for years after a woman’s last period. Some women may stop working permanently due to debilitating symptoms.
Yet because of lack of education, stigma and health system inequities, many women believe menopause is something they must just endure.
Dr. Wendy Wolfman, director of the Menopause Clinic and the Premature Ovarian Failure Clinic at Mount Sinai Hospital.Supplied
Dr. Wendy Wolfman, director of the Menopause Clinic and the Premature Ovarian Failure Clinic at Mount Sinai Hospital in Toronto, has been treating menopausal women for decades, and she has seen the toll symptoms can take on their physical and mental health, their careers and relationships. Here, she busts common misconceptions about menopause and shares the latest insights about treatment options:
Why is it important that women seek treatment for menopause symptoms?
Every woman who lives long enough will go through menopause. You’re talking half the population, 80 per cent of which will have symptoms. Women spend 30-50 per cent of their lives after menopause. This time of life can be extremely productive, especially if one is not hampered by symptoms.
Why do so few women receive treatment for their menopause symptoms?
For over a decade, maybe longer, the attitude persisted that hormone therapy was dangerous. Women stopped taking it in droves. Physicians had very little training in the use of good options for treatment. So, women were left high and dry, and then they sought alternative treatments, which really weren’t very effective.
Recently there has been a re-analysis and new recognition in studies that have shown the risks of menopause hormone therapy to be very small for women aged 50-59. Now it’s accepted that menopause hormone therapy should be the first treatment for women who have no contraindications.
The primary reason is to treat symptoms like hot flashes, brain fog and fatigue. Local estrogen therapy can treat vaginal symptoms.
How can contraindications be an issue for some women? And are there science-based alternatives for them?
If you had a woman who was symptomatic and had an absolute contraindication to taking menopause hormone therapy, such as invasive breast cancer or other gynecologically-dependent malignancy, a recent stroke or heart attack, the options were limited until recently.
We’re very excited to have some additional non-hormonal therapies we didn’t have before in neurokinin-targeted therapies.
What happens during a hot flash is this thermostat in your brain is being inappropriately stimulated, saying ‘hot, hot, hot.’ And then you undergo lots of different processes in your body to cool. It’s actually quite a big physiologic event. And that makes people sweat. These new medications are not hormones – they’re brain drugs that work on the temperature centre, and they work to block that signal.
This is a huge advance and another option for women.
The first line of treatment is still menopause hormone therapy, but many women don’t want to take hormones. Their mothers may have had breast cancer, which is not a contraindication to taking menopause hormone therapy, but they have fears. And we also have a small group of women where menopause hormone therapy doesn’t seem to work. We’re hoping we will be able to treat their symptoms with these new medications.
Can dietary changes, supplements or other therapies help to reduce symptoms?
The scientific data is not there. It’s very small. Obviously, we think good lifestyle habits are important, like adequate vitamin D, adequate calcium through your diet, exercise, not smoking and reducing alcohol intake. There’s good evidence about cognitive behavioural therapy, which has no side effects, and it has been shown to improve symptoms. There’s a little bit of evidence for hypnosis.
But many other things that are being recommended are about the same as placebo. A lot of people are making a lot of money pushing supplements because women are desperate. They don’t know where to go. And they’re afraid to take something like menopause hormone therapy because of the previous bad publicity. And they’re not being given the option to use it.
How can health care providers be better empowered to support women during this transition?
I have run a fellowship since 2006 to train OB-GYNs in menopause and menopausal medicine, and we also train family doctors in women’s health. But there needs to be an increase in focus on menopause in the general curriculum for medical students and nurse practitioners. Currently, there’s [training] devoted to pregnancy, maternal and fetal medicine and general gynecology, but more instruction about menopause has to be added as well. We have 2,000 patients waiting to see us [at the Menopause Clinic]. The demand is there. I know so few women who have not been impacted and who have not felt symptoms. We’re trying to see how we can help all those people who are waiting.
Is stigma around menopause another reason women haven’t gotten help in past? And what can we do to help change these attitudes?
Traditionally there has been a perception that it’s a woman’s lot to have these symptoms as they go through menopause. That attitude towards women has changed and women themselves have become more vociferous and stronger about speaking up for their needs.
The Menopause Foundation of Canada has good educational materials. They are trying to do advocacy work in parliament and businesses to improve the workplace for women. It’s a fantastic organization.
In the past, we’ve been invisible. We don’t count. There’s a lot of discrimination with ageism, and for women in particular, it’s been very difficult. But I think that’s changing, and strong vocal women are changing it.
Advertising feature produced by Globe Content Studio with Bayer Canada. The Globe’s editorial department was not involved.