The health care and workforce needs of Canadian women over the age of 40 are largely being ignored, women are needlessly suffering, and their long-term health is potentially impacted because of the silence and stigma around menopause.
Those are a few takeaways from a new national study published earlier this month. ‘The Silence and the Stigma: Menopause in Canada’ report by the Menopause Foundation of Canada (MFC) is being referred to as a “landmark” report of the experiences of perimenopausal/menopausal women in this country.
Despite being an issue that affects every woman, the survey found that menopause continues to be shrouded in secrecy and considered taboo. The study’s authors say that’s negatively impacting women in the prime of their lives.
“We live in this world where no topic is off limits, and yet more than half of those surveyed (54%) believe that menopause is still a taboo subject,” Menopause Foundation of Canada president and co-founder Janet Ko said in an interview.
The Society of Obstetricians and Gynaecologists of Canada describes menopause as “the point in time when a woman has had no menstrual period for 12 consecutive months.” Perimenopause is defined as the lead-up to menopause, characterized by fluctuating hormone levels. Although it can happen earlier, most women can expect to experience the physical and emotional changes of perimenopause in their late 40s or early 50s.
The study’s authors found that silence around menopause leaves too many of the 10 million women in Canada who are over the age of 40 searching for answers about what’s happening to their bodies.
“A real myth around menopause is that you get a few hot flashes and then you’re done and you push through and it’s over. And that’s not the reality at all,” Ko said. “Menopause is a continuum.”
‘Not every woman will get pregnant, but every woman will go through menopause’
While the survey confirmed many things they already knew, Ko said there were some surprises. She was saddened to learn that 46% (almost one in two) Canadian women were unprepared for and blindsided by their menopause.
“When you’re in your forties and fifties and beyond, there’s a lot of silence related to menopause and that actually really hurts women’s health and it’s an equity issue that has to be dealt with,” Ko said.
“Why is it so misunderstood when other aspects of a woman’s life are not? Not every woman will get pregnant, but every woman will go through menopause.”
Unaware of the many available treatment options to alleviate their suffering, many women struggle. They’re also often unaware of the potential long-term health impacts.
The hormonal changes that accompany menopause can increase a woman’s risk for health issues such as heart disease, osteoporosis, and other issues that, if not managed in a timely manner, can worsen over time.
Most women surveyed (95%) said they experience menopausal symptoms. While 84% knew about hot flashes and 77% knew about night sweats, far fewer were aware of the other more than 30 symptoms most commonly associated with menopause.
These include sleep disturbances, fatigue, muscle and joint pain, hair and skin issues, low libido, and vaginal dryness/itching/burning.
The survey found that 82% of women were unaware that urinary tract infections were a symptom of menopause, and 75% didn’t know that heart palpitations could also occur.
Almost six in 10 (58%) of women didn’t know that headaches/migraines, anxiety, and memory issues were also menopausal symptoms.
Ko said all of these symptoms impact women’s relationships, work, and their physical health.
A health equity issue
“I have been treating menopausal women for decades and know the serious toll symptoms can have on their health and quality of life,” Dr. Wendy Wolfman, president of the Canadian Menopause Society and a member of the medical advisory board of the Menopause Foundation of Canada, said in a media release.
“Menopause is seen as something women must endure, like a woman’s burden. This is unacceptable. Women deserve to feel healthy and they should not suffer in silence. There is preventative care, lifestyle choices, and safe and effective treatment options to help women thrive during their menopausal years.”
Despite the fact menopause is going to happen to 50% of the population and is a universal experience for all women, the survey also found that 40% (four in 10) Canadian women indicated they felt alone during their menopausal years.
“It just makes you stop and say ‘How can something that happens to half the population, that is a universal experience, be such a mystery to so many women and why do so many women feel alone,” Ko said.
“That leads to really looking at the ageism and the sexism that permeates our society and that creates silence and stigma around menopause, which I think is very different than other times of a woman’s life.”
Although 77% of women surveyed had a high level of trust in their family physician and saw them as the most trusted source for information about menopause, only 27% indicated their physician proactively addressed the issue of menopause with them.
Among respondents who approached their physician for advice and information, 72% reported that the advice they received was unhelpful or only somewhat helpful.
In addition, 38% felt that their symptoms were under-treated.
“So here you have women not prepared for menopause, silence around menopause, and not understanding the signs and symptoms,” Ko said.
“And then you go to your doctor and you’re getting not particularly helpful advice and you’re feeling like your symptoms are under-treated, which leads to poor health outcomes for women. That’s why we think it’s a health equity issue.”
Don’t accept feeling unhealthy
Ko said the knowledge gap that exists means women often don’t know when they’re in perimenopause and may be unaware of the symptoms of menopause. She said if you don’t understand what’s happening to you or why, you won’t know what questions to ask when seeking help.
“We really want women to understand what menopause is all about, to understand that this is going to happen in your forties and that it will last your entire life. Knowledge is power,” Ko said, urging women to “not accept” feeling unhealthy in the prime of their lives.
Ko points to the fact that 55% of survey respondents indicated they wished they’d learned about menopause earlier in life. Only 23% considered themselves very knowledgeable about the signs and symptoms of menopause, while 18% considered themselves very knowledgeable about perimenopause.
That’s why Ko encourages women to visit the MFC website for free, evidence-based resources and information, including a downloadable symptom tracker. She said the non-profit is guided by a medical advisory council that includes some of Canada’s leading medical menopause experts who ensure the information is current.
“There’s a lot of information out there on social media that is not evidence-based, so it’s important that women do go to credible sources,” she said.
Women over 40 in the workplace
Ko said the negative impacts of this menopause knowledge gap on women over the age of 40 doesn’t just affect their health. It also has repercussions for their work life.
Working women make up almost half Canada’s workforce, and more than five million (one quarter) are over the age of 40.
“That means an estimated one-quarter of Canada’s 19-million-person labour force are going through the menopause transition or are postmenopausal,” the study noted. “Almost two million working women in Canada are between the ages of 45 and 55, the age when most women reach menopause.”
The study found that workplace stigma also exists when it comes to menopause.
“We live in a society where youth is valued, and that’s particularly harsh against women, more so than men,” Ko said.
Three in 10 working women were fearful they’d be perceived as “weak, old, or past their prime” when in menopause.
In addition, 74% of menopausal working women indicated their employer was not supportive helping them cope with their symptoms, or they didn’t know if they even had support.
“We know from other research that one in 10 women will leave the workforce because of menopause,” Ko said. “This has been taken very seriously in the United Kingdom where they’ve done a great deal over there.”
Ko points to menopause-related concerns in the workplace being identified as an issue for gender equality in the UK, noting that women can now file lawsuits for menopause-related cases associated with age or sex discrimination. In addition, a parliamentary cross-party committee looking at menopause recently recommended menopause health checks for women at the age of 45 in addition to more workplace support and training for health care workers.
“They’re doing a lot more because I think they’ve started to recognize that not just for your economy, but for your country to remain healthy and your communities to remain strong and your families to remain strong, we want to make sure that women are healthy and they deserve to have all the support they need as they go through menopause,” Ko said.
Discussion with Dr. Deshwal
Bedford family physician Dr. Natasha Deshwal is founder and director of the Bedford Basin Women’s Medical Clinic. As someone who regularly sees women dealing with these issues and is passionate about empowering women and sharing knowledge, she described the MFC report as a “landmark study.”
“I was tickled that this was actually done on Canadian women,” Deshwal said in an interview. “So many times we’re challenged with finding studies that I feel are really applicable to us as Canadians…We really needed it.”
Deshwal sees many perimenopausal and menopausal women in her practice. Although they often show up to discuss their intense hot flashes, they frequently leave with the realization they have many more symptoms. She calls these “the hidden things” patients don’t realize are menopause-related until Deshwal starts asking questions about general things like memory, concentration, and mood.
“There is also something that we call genitourinary symptoms of menopause,” Deshwal explained. “It sounds really frightening, but what it really is are things like vaginal dryness, painful intercourse, recurrent yeast infections, recurrent bladder infections, discharge.”
Some patients who aren’t sexually active will express surprise about experiencing vaginal dryness. Deshwal said women need to know that particular issue doesn’t have to be connected to sexual intimacy.
“I’ve had women come in and say ‘When I walk, it’s like sandpaper down there,’ and to me, that was a great way to describe it,” Deshwal said. “And I use that analogy now when I talk to other women because they will actually relate to that.”
Sleeplessness, migraines, and other issues also tend to frequently crop up once Deshwal starts prompting patients for information about their experiences.
“Once you get in and you do that deeper dive. People are like, ‘Wow, I didn’t realize all these other things. That’s me,’” she said.
Deshwal stressed there are “some real serious ramifications” to menopause, noting that it can have “huge’ mental health impacts and also affects things like a woman’s heart, cholesterol, and liver profiles.
Menopause also increases the risk of osteoporosis. That’s why Deshwal recommends that women at this stage of their lives ensure they’re getting the recommended 1200 mg per day of calcium and 1000 mg of Vitamin D.
Many treatments available
Because menopause is a normal part of a woman’s life, Deshwal said it’s critical women, their families, and employers understand it and are supportive of it. She stressed that while the topic is still embarrassing for many women, they shouldn’t be left feeling miserable. Because a woman hopefully spends a good half of her life going through menopause, Deshwal said it’s critical they discuss it, ask questions, and seek help when needed.
“We as women, that’s something we do not do well,” she said. “We are so busy trying to manage our careers, our families, our extended families, that we fall last on that list of things that need to be getting done.”
There are many treatments available to help with menopausal symptoms, and Deshwal said women need to be aware they exist. Due in part to the “taboo nature” of menopause, some believe only estrogen and progesterone replacement therapy are available. Some can’t take it, while others don’t want to.
In any case, Deshwal said that particular therapy is only helpful for women experiencing hot flashes and night sweats. It won’t alleviate other symptoms like heart palpitations, anxiety, depression and vaginal dryness.
“So for people who have those type of symptoms we talk about vaginal estrogens sometimes being the right treatment, and I say sometimes being the right treatment because it also depends upon (taking) the careful history,” Deshwal said.
“Is there any breast cancer that we need to be aware of? You have to do the proper screens, so asking more questions. Sometimes people say ‘You know what? I don’t know if I really want a prescription. What about other things?’ So then we talk about other things.”
While each treatment is as unique as a patient, Deshwal said there are several non-pharmaceutical medications and even natural remedies known to be helpful for women experiencing other symptoms.
“You have to get in touch with somebody who knows what they are and ask the questions and don’t be shy about asking questions and don’t feel necessarily that if something doesn’t work, that is the end,” Deshwal said.
“There are other ways for us to help you. There are other things for us to try.”
Recognizing the shortage of primary care providers in the province, Deshwal said women can start by getting help and information from online resources. But she stressed it’s important they go to the right places.
In addition to the MFC website, she suggests women turn to the online menopause information and resources site managed by the Society of Obstetricians and Gynaecologists of Canada.
“You’re really looking for a website that’s going to provide you with trusted information,” Deshwal said.
“You want something that’s not pharmacological based, you want something that is non-branded, you want something that is Canadian because there is nothing worse in the world than looking at a website and finding out the recommendations are in some other country and we do not have them here.”
Advice for employers
To mark Menopause Day on October 18, HR Consulting and Health and Safety Outsourcing firm Peninsula Canada offers advice for employers on how they can support menopausal women in the workplace.
Breaking the silence and stigma of menopause
The Menopause Foundation of Canada’s report also contains calls to action for government, employers, women, the health care community, and society. Ko is hopeful it opens up a broader conversation.
“It’s just so important that we break the silence and the stigma of menopause to ensure that we’re having health equity, gender equity for women as they move through this time of life. Women deserve to feel healthy,” Ko said.
“They deserve to make the contributions that they would like to make in their communities, in the workplace, and it’s time that we brought menopause into the light and out of the shadows. It’s really, really important for women and for all of us.”
The MFC survey was conducted by Leger Canada between Aug. 2 and Aug. 11 and involved 1,023 Canadian women between the ages of 40 and 60 representative by region, ethnicity, education, and income of women in that age range.
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So grateful for this spotlight on menopause. I know this is a state I am entering, know I am on the highway headed that way, have seen some of the billboards and early landmarks, and yet, I have no idea what kind of toll I’ll have to pay going through… to belabour a metaphor. My (male) doctor is really lovely but just handing me a prescription for steroid cream when I asked about weird new skin conditions, and a referral to a specialist when I mentioned heart fluttering, and saying my new edema would ‘go away’ does not recognize that all of these could be related to menopause and just leaves me feeling like this machine I’m in is breaking and I have no control to stop it. 🙁
Thanks for the coverage, very useful information here. I also suggest taking a look at information provided by the British Menopause Society and Women’s Health Concern (https://www.womens-health-concern.org/help-and-advice/factsheets/hrt-know-benefits-risks/) in the UK, which has much more comprehensive research and advice on menopause and HRT than anything found in Canada. But, there is little research done on long term effects of taking HRT and there is debate over whether this is efficacious or not (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259599/). I have been taking HRT for five years and I am in my mid-60s, but I have absolutely no idea whether and how long I should continue to take it, and neither does my family doctor or gynecologist.
Hot flashes for over 15 years here (69 and they never stopped, although they have slowed down and are less severe!) but I just wanted to remark that I think it is important to take into account that this study was funded by Lupin Pharma Canada, Organon, Astellas Pharma and Searchlight Pharma… all with some skin in the pharma game… although maybe not directly selling HRT. As a result, I take the recommendation (whch would increase their bottom line) to use HRT with a bit of a grain of salt… Also, there is a real tone here of “menopause” — a natural state that everyone who has or has had ovaries, goes through — being treated like a disease?? Menopause is not a disase and the “symptoms” reported in this study are Canadian, not universal – e.g in Japan women have more “menopausal shoulder pain” and fatigue, than hot flashes. In China – memory issues are the most reported.