There’s more to menopause than hot flashes! Estrogen acts on many organs and when it starts to decline you may experience a myriad of changes.

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Estrogen affects the reproductive and urinary tracts, the heart and blood vessels, the brain, bones, breasts, skin, hair, and more. That’s why menopause can bring physical, emotional, and cognitive changes. Contact me to learn more.



Are your periods becoming irregular? If you’re in your 40s you may be in perimenopause. Perimenopause is the time leading up to menopause. It may last several years as the body starts to change due to hormonal fluctuations. Irregular menstrual periods, hot flashes, vaginal dryness, palpitations, fatigue, irritability, anxiety, memory loss, sleep disturbances, and mood swings are common during perimenopause. A woman can still become pregnant during perimenopause so contraception is advised until one year after menopause.



If you live long enough you’ll go through menopause! Menopause is reached when a woman hasn't had a menstrual period for 12 consecutive months. Menopause is not a disease, for most women it is a natural, spontaneous, permanent ending of menstruation and fertility. The average age of menopause in North America 52 years of age. Postmenopause is the time after menopause.


Induced Menopause

Women who undergo chemotherapy and radiation treatments that seriously damage ovarian function or surgery to remove both ovaries may experience induced menopause. Induced menopause usually occurs at a younger age and the abrupt decline in estrogen causes more severe symptoms. These women are more likely to benefit from hormone therapy  (if their cancers aren’t estrogen-sensitive) or other available treatments  to ameliorate symptoms and to prevent osteoporosis and dementia.


Early Natural Menopause

Some women may have early menopause due to poorly functioning ovaries. Women with Primary Ovarian Insufficiency (POI), and women with early menopause may experience symptoms of menopause at an earlier age. Women who undergo menopause before the age of 40 have a higher risk of cardiovascular disease, osteoporosis and related fractures, and dementia, as well as premature aging, than women who undergo natural menopause at a later age. These younger women, as long as they don’t have any contraindications, will benefit from hormone therapy and the most effective dose may be higher than for older women. Questions? [...]


Vasomotor Symptoms

Hot flashes are the most common symptom reported during peri and postmenopause. Hot flashes during sleep are called night sweats. Some hot flashes are mild others are so severe they can be debilitating. There’s no reliable way to tell when they will start or end. For most women they start during perimenopause and may last several years. Sorry! Lifestyle changes, exercise, prescription and non-prescription therapies may be helpful.


Sleep Disturbances

Woke up at 3 AM and can’t get back to sleep? During the menopause transition many women have difficulty falling asleep, others staying asleep. Night sweats may also disturb sleeping and many women experience lack of energy during this time. Treatment of sleep problems should start with good “sleep hygiene”: avoid heavy meals, caffeine, and alcohol in the evening. Regular exercise, not too close to bedtime, and staying cool at night may also help. Prescription and non-prescription therapies to treat sleeplessness are available.

Menopause and mood

Memory and Concentration

Forgetting words? Forgot why you’ve walked into a room? Worried about Alzheimer’s disease? Don’t be! Mental abilities and memory change throughout life and decline with age. Difficulty remembering and concentrating are common complaints during perimenopause and in the years right after menopause. Symptoms may improve after menopause and it’s very rare for women to be diagnosed with dementia during this time. Coping strategies may include a lighter workload, avoid multitasking, and making lists.


Emotional Health

Crying one moment and laughing the next? It’s not at all weird if you’re in your 40s and are perimenopausal! Women may experience mood swings, tearfulness, palpitations, anxiety, panic attacks and feeling “blue” in the years leading up to menopause due to fluctuating and erratic hormonal levels. Sleep deprivation due to night sweats may also be responsible for fatigue, irritability and moodiness. Menopause can contribute to depression. Women with a history of depression earlier in life, or longer menopause transition, or more severe symptoms are more likely to develop depression.


Vulvovaginal Symptoms

If “Not tonight honey!” has become an often mantra in your bedroom we need to talk. Is sex causing more pain than pleasure? Don’t let vaginal dryness keep you from being intimate. There’s help! Decreased estrogen levels may cause thinning of the tissues lining the vagina and cause loss of elasticity and vaginal lubrication. Vaginal pH may increase and the flora of the vagina changes mostly after menopause. Vaginal atrophy, can cause painful sexual intercourse, lead to increased incidence of urinary tract infections and vaginal yeast infections. This group of genital and urinary symptoms is called Genitourinary Syndrome of [...]

Incontinence and the need to know where the bathrooms are

Urinary Concerns

Do you know where all the restrooms are in your favourite mall? Do you pee when you laugh or sneeze? You’re not the only one! It’s just that no one talks about it. Up to 50% of midlife women have urinary incontinence and only less than half seek medical help due to embarrassment or the false belief that there’s nothing they can do about it. Bladder control issues are more common with age. During menopause, decreased estrogen can cause thinning of the lining of the urethra. With aging the pelvic muscles surrounding the bladder (pelvic floor) may weaken and as [...]


Sexual Function

Is low sex drive threatening your marriage? Sexual drive decreases with age in both men and women. Hormonal changes, fatigue, social changes, “empty nest syndrome”, return of grown children to the home, caring for ill parents, stress, loss of a partner, health of a partner, medical conditions, medications, substance abuse, changes in body image and self-esteem are some of the factors that can affect women’s sexual function. Yes, women are complex beings! An expert healthcare professional can help identify these factors and provide counselling and education about lifestyle changes and treatments.


Diet and Exercise

Your clothes don’t fit the way they used too? Welcome to the club! Women generally gain weight during menopause, body fat distribution changes and waist circumference increases. This body shape increases the risk of cardiovascular disease. But weight gain during the menopause transition can be avoided by eating a varied, wholesome, low-fat, healthy diet, rich in fruits and vegetables, and by exercising regularly. You don’t have to hit the gym if you don’t like to (but if you do, go ahead!). Exercises like brisk walking, for example, improve physical and emotional health, reduce stress, help with weight management, and build [...]


Hormone Therapy (HT)

The National Institutes of Health launched the Women’s Health Initiative (WHI) study in 1993 to study hormone effects on preventiva of disease. In 2002 the study was stopped because some of the participants who were taking estrogen plus progestin had an increase in hearts disease and stroke compared to those taking placebo. The media jumped on the news, omitted some of the details, exaggerated others, and women (and healthcare providers alike) became very scared of HT. And what a disservice to women’s health and quality of life that was! In fright one of my patients threw her estrogen tablets [...]


Complementary and Alternative Medicine (CAM)

What herbs can I take for my hot flashes? A million dollar question! I wish I had an easy answer. Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are generally not considered to be part of conventional therapy. Some women choose CAM because they feel it reflects their values and beliefs; others choose CAM because conventional therapy dissatisfied or is not recommended for them. Consumers in general believe that “natural” products are safe but that is not always the case. In fact, it’s not possible to have a treatment [...]


Non-Hormone Prescription Therapy

Some women cannot, or prefer, not to use hormone therapy (HT) to treat hot flashes. In Canada anti-depressants are used off-label (meaning these drugs weren’t approved for this condition) to treat severe hot flashes. These therapies may be useful for women who cannot take hormone therapy, and may have anxiety and depression as well. However, antidepressant medications aren’t as effective as hormone therapy for severe hot flashes, and they do not treat or prevent osteoporosis or GSM.


Bioidentical Hormone Therapy

This is probably the most controversial topic! PLEASE don’t believe everything celebrities tell you about bioidenticals! There’s so much misinformation out there! The term “bioidentical hormones” for some means that they are chemically identical to hormones that are produced by the human body (“human-identical”). Contrary to popular belief bioidentical hormones have to be produced in the lab and do not occur “naturally” in plants or other sources. Plants aren’t humans, are they?! Hormones compounded by pharmacies have the same effects and adverse effects as commercially-available hormones. But women aren’t usually informed about it. That’s because, unfortunately these products are generally [...]


Heart Disease

After age 50, about the age of natural menopause, nearly half of all female deaths are due to some form of cardiovascular disease. There are a number of risk factors for cardiovascular disease. Some are modifiable, like smoking, excess weight, excess alcohol intake, sedentary lifestyle, diabetes, high blood pressure, and cholesterol for example. Other risk factors are non-modifiable, like family history of heart attack or stroke, ethnic background, age, and sex. Women seem to be at higher risk of heart disease after menopause due to decrease in estrogen levels and blood pressure tends to increase with menopause. [...]



Don’t like to drink milk? There are other things you can do to strengthen your bones. Osteoporosis is characterized by low bone mass and strength with a consequent increase in bone fragility and risk of fracture. Bones grow during childhood and adolescence, reach their peak between 20-30 years of age, and then plateau. During the first five years after menopause there’s a rapid decrease in bone mass. Osteoporosis can be prevented or the severity reduced with a well-balanced diet, adequate intake of calcium and vitamin D, weight-bearing exercises, and hormone therapy. Postmenopausal women should be assessed by a healthcare professional [...]



Menopause doesn’t increase the risk of diabetes but weight gain during menopause, and especially weight concentrated around the abdomen, with consequently decreased insulin (the hormone that controls sugar) sensitivity increases the risk of developing diabetes. Obesity and diabetes increase the risk of heart disease. Diabetes can cause vision problems, kidney failure, gallstones, nerve damage, cancer of the uterus and early menopause.



Every women’s biggest fear (even though heart disease is more deadly). The risk of many cancers increases with age. Hormone therapy can increase the risk of certain types of cancers and decrease the risk of others. Alcohol increases the risk of breast cancer. Women who drink alcohol should restrict alcohol intake to no more than one drink per day, on average. A diet rich in fruits and vegetables decreases the risk of colon cancer and a diet low in fruits and vegetables increases the risk of breast cancer. Obesity increases the risk of cancers of the breast and the endometrium [...]

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If you have questions, want to book an appointment, or would like more information contact me.