What doctors recommend to treat symptoms of menopause transition

What doctors recommend to treat symptoms of menopause transition

The menopause transition is a natural part of a woman’s life, yet many say they don’t get the help or advice needed to navigate this change.

It’s a subject that is still considered taboo, “overwhelmingly viewed as negative and remains shrouded in secrecy,” according to the non-profit Menopause Foundation of Canada.

As a result, some doctors say many don’t know where to start when it comes to getting help during this time of their life.

“The number one question that women ask when it comes to perimenopause and/or menopause is whether or not their symptoms are actually related to this transition in life, or is this a symptom that might be more concerning for maybe another chronic medical condition,” Dr. Shafeena Premji, a family doctor and medical director of Mahogany Medical Clinic in Calgary, told CBC’s The Dose host Dr. Brian Goldman. 

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This week, we’re answering your questions about perimenopause and menopause symptoms and treatments. Dr. Shafeena Premji, a family doctor and medical director of Mahogany Clinic in Calgary, shares her best advice on how to manage symptoms and when to speak to a health-care provider.

That’s why experts like Dr. Rebecca Thurston recommend women suffering from symptoms that may or may not be linked to menopause speak to their health-care provider. 

“You probably can get help with many of these symptoms that you’re experiencing and there’s no need to do it alone,” said Thurston, a psychiatry professor at the University of Pittsburgh who has done extensive research on the connections between menopause and women’s cardiovascular health. 

Experts say it’s important to know that there isn’t a one-size-fits-all approach to symptoms or treatments. But here is what they say you should know in response to your questions about the treatment of menopausal symptoms.

What are the stages?

Premji, who is also a North American Menopause Society (NAMS) certified menopause practitioner, believes that it’s really important for women to understand the terminology. That’s because if they understand the terminology, then “she will have more confidence in opening up a conversation with her health-care provider,” Premji added.

There are three stages in this natural change in a woman’s life. 

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Perimenopause is the time when women start to have symptoms and will notice changes in their menstrual cycles. It can last anywhere from six-to-eight years on average, according to the Menopause Foundation of Canada.

Menopause for most women is “the one-year anniversary of her last menstrual period,” Premji said.

Postmenopause is the day after her one-year anniversary of no periods and the rest of a woman’s life, she added.

How do I know if I started perimenopause?

Most women go through perimenopause between the ages of 40 and 50. 

Dr. Jerilynn Prior, a professor of endocrinology and metabolism at the University of British Columbia, says there are no tests to tell if a woman has entered perimenopause. 

“The doctor is going to have to believe the woman.”

There are more than 30 symptoms of perimenopause identified by the Menopause Foundation of Canada, like hot flashes and heart palpitations. Those symptoms can sometimes continue until the end of life.

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But it’s important that women raise these symptoms with their health-care provider, according to Teresa Isabel Dias, a pharmacist and a certified menopause practitioner based in Toronto.

That way a doctor can rule out any medical conditions that may have similar symptoms to the menopausal transition, she said. 

How can I deal with night sweats or hot flashes?

Premji says night sweats and hot flashes “are essentially the same but present differently.”

These vasomotor symptoms are related to fluctuating hormone levels, which affect the part of your brain that regulates body temperature.

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The available treatments for hot flashes do not cure them, according to the North American Menopause Society, but they can provide relief. 

Premji recommends making lifestyle changes as a first step.

“I do find that women who stop smoking or limit their alcohol or caffeine intake will usually find improvements in their vasomotor symptoms,” she said.

Dias suggests going to bed cold by using lighter blankets, wearing pyjamas made out of cotton and keeping a glass of water nearby. Women have also used a cold compress for relief. 

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But, she says, for some, those methods aren’t enough.

“If you really have a hard time with night sweats, you’re going to have to do something else.”

Hormone therapy — systemic estrogen therapy and estrogen-progesterone therapy for those with a uterus — are the standard treatments, according to Dias and Premji.

There are non-hormone options as well. Selective serotonin-reuptake inhibitors (SSRIs) “have been found to be effective in treating hot flashes in women who don’t have depression,” according to the North American Menopause Society.

Some women try out herbal remedies like black cohosh or evening primrose oil, Premji said. But studies on the effectiveness of these products are either small or limited, so she doesn’t recommend these products to manage symptoms. 

How can I deal with migraines and brain fog?

Migraines are a common symptom during this change, which is likely due to the drop in estrogen during this transition, Premji said.

There aren’t any Health Canada-approved hormone products to prevent or treat migraines, she added, but sometimes hormone therapy is used to help “minimize those huge fluctuations in the hormones,” she said, and that can sometimes help with migraines.

Brain fog is another common symptom discussed in Premji’s office, she said. Many women have told her about lapses in memory and complaints from partners about changes to memory. 

“This can be very disabling for a woman when she has otherwise been very high-functioning,” she said.

The good news is that the brain fog experienced during this transition usually lasts for a short time and does not lead to dementia, she added. To help with brain fog, Premji recommends cutting down on smoking, alcohol and caffeine. She also recommends socializing in a new way by volunteering or learning a new skill. 

Are yeast infections and bladder issues symptoms?

The short answer is yes.

When Premji explains to women what happens in menopause — specifically with estrogen deficiency — she draws a stick figure to point to the places in the body where there are estrogen receptors. 

A stick figure showing where on the body there are estrogen receptors.
The drawing Dr. Shafeena Premji creates for patients when describing the estrogen receptors in a woman’s body. (Submitted by Shafeena Premji)

“We have estrogen receptors in our bladder, in our vulva, vagina and urethra. So when a woman is going into menopause, the estrogen deficiency can lead to changes in bladder function,” she said.

Women have told her about bladder infections, burning when urinating, dryness and abnormal discharge, which could all be due to estrogen deficiency. 

She says there are treatments — hormonal and non-hormonal — available for many of those symptoms, such as antibiotics for urinary tract infections. 

How can I manage weight gain?

During this time, many may experience weight gain, which can be caused by many factors. According to the North American Menopause Society, “there is no scientific evidence that menopause or hormone therapy is responsible for midlife weight gain.”

The society went on to say on its website that this natural change may be related to changes in body composition and fat distribution.

“The key to managing weight in this time of life is really exercise,” Premji said, adding that 150 minutes per week of physical activity and weight training up to three days a week are important.

“We know that muscle utilizes more calories more efficiently, and so that would really help a woman to maintain her weight during this transition.”

A big hindrance to getting active is the fatigue that may come with the change. Women may experience it because of sleep disturbance, stress or because of inflammation caused by the changing estrogen levels. 

Dias says she recognizes it can be hard to get a workout in when you’re fatigued, but to try to exercise as much as possible and to eat well.

“All these adjustments help a bit,” she said.

What should I know about hormone therapy?

Experts say it’s not a one-size-fits-all approach to menopausal hormone therapy as every woman has their own risk profile. Speaking to a health-care professional is essential. 

Menopausal hormone therapy for most women will generally include estrogen and progesterone, Premji said. Women who have had a hysterectomy will only receive estrogen. 

Premji and Dias say the general guidelines on who can take hormone therapy to manage symptoms are: women who are younger than 60 with no medical conditions that preclude them from taking hormones, and women who are less than 10 years post-menopause.

“It doesn’t mean that every woman needs to go on hormone therapy, but if they have symptoms which would be improved with hormone therapy, then it is absolutely a safe option,” Premji said.

Women who should not be on hormone therapy are those who have:

  • A personal history of breast cancer
  • A blood clot in the lung or deep leg veins
  • A history of a stroke, or liver disease
  • Undiagnosed vaginal bleeding
  • Severe migraines with aura

Declining levels of testosterone during the change can be behind a number of symptoms, including lack of sex drive, experts have said. Unfortunately, it’s not that easy for women to get their hands on appropriate testosterone treatments in Canada. 

Women can get testosterone through compounding pharmacies, but a precise dose isn’t always guaranteed, costs tend to be higher and it can be difficult to get coverage from insurance companies.