Heart disease and bone and sleep health can play a role in women's midlife symptoms in addition to menopause.Illustration by The Globe and Mail/iStock
Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
Recently, when a patient came to me for help with menopause symptoms such as hot flashes, I outlined the treatment options and then raised some of the other physical and emotional shifts that hormonal changes can produce. She was surprised and said she had always thought menopause was “just hot flashes.”
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Menopause is finally getting the attention it deserves – but its full-body implications often remain overlooked. We tend to focus on hot flashes, night sweats and sleep issues that accompany perimenopause and menopause but not the other, less obvious health shifts happening under the surface. While these symptoms deserve attention, midlife is also an opportunity to understand other changes that can occur in the body at this stage – and how women can take preventive steps to future-proof their long-term health.
Here are the key areas I cover with my perimenopausal and menopausal patients.
Heart health
Heart disease is the leading cause of death for women in Canada, but the reassuring news is that 80 per cent of premature heart disease and stroke is preventable.
As estrogen declines, heart disease risk factors increase. Talk to your doctor about checking your blood pressure, blood sugar (glucose) levels and cholesterol levels. This way, you can discuss whether lifestyle changes or medication interventions are needed.
Small lifestyle modifications such as eating fibre-rich foods can make a real difference to protecting your heart health. Aim for 25–30 grams of fibre a day from sources including whole grains, beans, fruits and vegetables.
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It’s also important to get regular movement or exercise – ideally, two-and-a-half hours a week of moderate physical activity.
Stress management and focusing on sleep health benefit your heart, too.
Bone health
Many people are surprised to learn how important bone health is in midlife. Women can lose up to 20 per cent of their bone density in the five to seven years after menopause, increasing the risk of fracture.
This stage in life is an important time to think about bone protection so I suggest:
- Speak with your doctor about bone density testing and a fracture risk assessment. Osteoporosis Canada recommends combining the results of a bone density test with other comprehensive risk assessment tools. Bone density testing typically begins at 65, but earlier testing is appropriate when risk is high.
- Review your calcium, vitamin D and protein intake. Osteoporosis Canada is a good resource for learning about bone building nutrients and also has a nutrient calculator to help you assess if you are getting enough.
- Add weight-bearing exercises to your exercise routine; consider two sessions a week.
- Talk to your doctor about whether menopause hormone therapy, which can help prevent osteoporosis, is right for you.
Sleep health
Sleep issues are extremely common in midlife and are important to address because beyond energy, sleep affects heart health, mood, weight and cognitive function.
If night sweats disrupt sleep, addressing this with menopause hormone therapy or other, nonhormonal medications can help.
If you are having trouble sleeping in other ways, small habits can help, such as maintaining a consistent sleep and wake time, and reducing caffeine and alcohol. For persistent insomnia, Cognitive-behavioural therapy for insomnia (or CBT-I) is the most effective treatment.
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It is also worth checking in with your primary care physician to rule out sleep disorders, such as sleep apnea, which are more common as we get older.
Brain health
Brain fog is one of the most common concerns I hear from patients. It is understandably unsettling, especially while juggling work and personal life responsibilities. I always reassure patients that while cognitive symptoms are common in menopause, they do not predict dementia risk.
So what can you do when brain fog is affecting your day-to-day functioning? Focus on the things we know have an impact on our long-term brain health: sleep quality, heart health, mood, movement and social engagement.
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Small changes can make a big difference
When discussing midlife health, many women tell me, ‘I don’t have time for a huge lifestyle change.’ I feel this deeply, as someone navigating perimenopause myself. The good news is that meaningful change comes from small, sustainable habits, added in gradually.
While this time of life can feel overwhelming, I invite you to choose one thing to do this week that feels doable, such as:
- Book an appointment with a primary care clinician to get your blood pressure, blood sugar and cholesterol checked.
- Add a 20-minute brisk walk to your lunch break.
- Plan two protein-forward meals.
- Pick one night to prioritize sleep: put screens away early, find a calming activity before bed and set a consistent wake time.
- Reconnect with a friend you’ve been meaning to call. Social connection is one of the strongest predictors of long-term health.
Dr. Sheila Wijayasinghe is a menopause-certified family physician practising at St. Michael’s Hospital in Toronto and the medical director of primary care outreach at Women’s College Hospital. She is also the resident health expert on CTV’s The Social and co-host of The Doc Talk Podcast.