Tag Archive for: perimenopause

2024 Women’s Health Research Symposium: Advancing Women’s Health Through Menopause Research

Author: Shayda Swann | Editors: Romina Garcia de leon (Blog Co-coordinator) and Katherine Moore (Director of Operations)

Published: April 4, 2024

On International Women’s Day (March 8th 2024), the Women’s Health Research Institute hosted the 9th annual Women’s Health Research Symposium, titled Midlife Women’s Health Research: Unpacking the Science of the Menopause Journey and its Health Impacts. In this blog, we’ll be highlighting the work shared by the keynote speaker, Dr. Susan Reed (MD, MPH). 

Why menopause matters

Perhaps the most obvious reason why menopause matters is because half of the world’s population will experience it. This ubiquitous experience brings bothersome symptoms that can reduce women’s quality of life, lead to work absences, and reduce overall productivity. Despite this, only a fraction of health funding goes towards menopause research. For instance, of the ~9,000 grants funded by the Canadian Institutes of Health Research from 2009-2020, only 5.9% evaluated female specific outcomes, let alone menopause-focused work. We encourage readers to review our three-part menopause series where we cover many of these topics in depth (Part 1, Part 2, and Part 3). 

Reviewing landmark studies in menopause research

The Study of Women’s Health Across the Nation (SWAN) began in 1994 and was a US-based cohort of 3,000 women aged 42-52. They identified that “menopause transition symptoms”, such as menstrual irregularity and vasomotor symptoms (i.e., hot flushes and night sweats) peaked between ages 46-56 and that most people experience menopausal symptoms for up to 10 years. They also reported that symptoms were typically most bothersome in the two years before and after the final menstrual period. Additionally, the SWAN study identified important predictors of vasomotor symptoms, such as adiposity (body fat), having less than a college education, stress, depression, and anxiety. The SWAN study also reported key findings around sleep, mood, cognition, cardiovascular disease, metabolic health, bone health, and sexual health. For instance, they found that low libido was associated with vasomotor symptoms and that bone loss is most rapid in the year preceding the final menstrual period.  

Another study, called MsFLASH, further advanced our understanding of this important phase in women’s lives, with a focus on alleviating menopause symptoms. First, they found that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrin reuptake inhibitors (SNRIs) have a modest benefit of reducing vasomotor symptoms in women who cannot or prefer not to take hormonal therapies. Unfortunately, exercise, omega-3s, and yoga were not found to be beneficial therapies. Similarly, they found that neither vaginal estrogen nor vaginal moisturizer decreased the number of moderate-to-severe vulvovaginal discomfort episodes compared to placebo. 

What do we know about treating menopause?

From the studies cited above and others, Dr. Reed shared the current evidence for menopause treatment options. This is a very brief overview and we encourage all women to discuss specific treatment approaches with a trusted health care provider. First, menopause hormone therapy can be initiated in most women with symptoms between ages 50-59 who are 1) low risk for cardiovascular disease, breast cancer, or venothromboembolism (blood clots) or 2) moderate risk based on informed decision-making. Treatments should be initiated within 10 years of the final menstrual period or before age 60. 

Knowledge translation

Dr. Reed also shared several useful patient-centred resources to help women navigate the menopause transition. For instance, the Menopause Priority Setting Partnership has a survey where women can share their priorities for future menopause research projects. The MsFLASH study also developed a fantastic website which includes a primer on menopause, an overview of treatment options, and a tool to build a personalized “menoplan”. 

Thanks to the organizers of the Women’s Health Research Symposium for another excellent meeting and for prioritizing mid-life women’s health! 

Menopause Series Part 2: All About Reproductive Hormones

Authors: Katrine Yare, PhD, Medical & Cognitive Research Unit (MCRU), Austin Health, Melbourne, Australia | Editors:  Romina Garcia de leon and Shayda Swann

Published: October 20th, 2023

*Throughout this series, we want to acknowledge that not all women will experience menopause, and not all folks who experience menopause identify as women. We understand that different terminology will suit different folks. We hope this information is helpful to folks of diverse genders and identities*

I’m a mum, a researcher, and I study the effects of the primary reproductive hormones, 17-beta oestradiol (also called E2) and cyclical progesterone (P4) on sporadic Alzheimer’s disease (AD) in women.

Before I progress, Alzheimer’s disease (also called AD) is more prevalent in women, with two-thirds of those exhibiting symptoms of AD being post-menopausal women. My research focuses on an earlier phase of the disease, called the preclinical AD stage (before a person develops symptoms). This can develop years earlier.

A little background on women’s hormones

Understanding our bodies and how our hormones work can empower us as women to make informed choices when discussing our menopausal concerns with our health professionals. Knowledge really is power.

There are three primary estrogens in women:

  1. 17-beta-oestradiol (E2) also called oestradiol or estradiol. It is the most potent estrogen and works together with a cyclical hormone, progesterone (P4), during the reproductive phase of women’s lives.
     
  2. Oestrone (E1) also called estrone. This is the menopausal hormone, which is much less potent than E2.
     
  3. Oestriol (E3) also called estriol. E3 is a pregnancy estrogen and is the lowest potency estrogen. It works together with P4 (and other hormones), to protect the developing baby and to maintain pregnancy.

For this blog, I will concentrate on the hormones E2 and cyclical P4, which are essential in maintaining health during the reproductive phase of women’s lives.

The actions of the primary reproductive hormones, E2 and cyclical P4, are not confined to reproductive functions such as the menstrual cycle and pregnancy but play a significant beneficial role in many bodily systems (e.g., central nervous system, cardiovascular system, gastrointestinal tract, urogenital system, muscles, bone, skin, etc.), as well as modulating numerous metabolic processes and neurotransmitters.

When the levels of these hormones fluctuate during perimenopause and drop markedly during menopause, this will impact a multitude of physiological, cellular, and metabolic processes that are modulated by these hormones. As a result, most women will be impacted by this change. Some women will choose hormone therapy (HT) to alleviate symptoms, some women choose to ride through menopause without treatment, and there are also a rare few who won’t experience any overt symptoms. With respect to the latter, even though these women don’t experience overt symptoms, they are undergoing changes on a cellular and molecular level.

As discussed in the menopause series blog 1, some symptoms women may experience due to a drop in E2 and P4 include difficulty regulating body temperature, hot flushes, night sweats, vaginal dryness, dry and itchy skin, joint pain, muscle aches and pains, digestive problems, weight gain, breast tenderness, loss of breast volume, gum changes, headaches, migraines.

E2 and P4 also modulate a number of neurotransmitters. For example, E2 is a serotonin, dopamine, and cholinergic modulator, and P4 (via its metabolites) is a potent GABA-A receptor modulator. Therefore, when the levels of these two hormones drop markedly during menopause these neurotransmitters will be impacted, and, as a consequence, most women will feel the effects. Some symptoms women may experience include anxiety, depression, restlessness, brain fog, difficulty concentrating, irritability, mood swings, dizziness, and insomnia.

Paying attention to your health and well-being as your body undergoes significant change is essential whether you choose to go on HT or not. Also, establishing a good relationship with your health professional where you can freely discuss your menopausal concerns and they can help by listening and offering options or solutions, including clearly outlining benefits and risks, is extremely important.

As a menopausal woman myself, I had a horrible time during the menopausal transition. Even though I chose HT to alleviate my symptoms, which used hormones that were molecularly the same as what our bodies produced during the reproductive phase (i.e., E2 & cyclical P4) and used a route of administration that closely approximates the way our hormones are metabolized in our bodies (this will be discussed more at length in the next blog), I am vigilant about my health.

I want you to be vigilant about your health, too.

Menopause Series Part 1: What You Missed Learning About Menopause

Authors: Shayda Swann, MD/PhD Candidate, University of British Columbia, Department of Medicine, Shannon Mahony, BSc, Human Biology, University of Toronto, Krembil Research Institute | Editors: Romina Garcia de leon (Blog Coordinator) 

Published: October 6, 2023

*Throughout this series, we want to acknowledge that not all women will experience menopause, and not all folks who experience menopause identify as women. We understand that different terminology will suit different folks. We hope this information is helpful to folks of diverse genders and identities*

What comes to mind when you hear “menopause”? Hot flashes? Night sweats? Irritability? Are these symptoms normal? And what age should you expect to experience them? Do you just have to live with this discomfort? In this 3-part deep dive into menopause, we hope to dive into the information we’ve learned from our fellow experts to ensure this is a time in your life where you can navigate (and maybe even celebrate) this unique phase of life! 

But first, let’s talk about what menopause actually is.Spontaneous menopause (often referred to as “natural” menopause) occurs when the ovaries gradually release lower levels of the reproductive hormones estradiol and progesterone. However, this process is not linear and hormone levels can fluctuate dramatically during this time (Figure 1). This transition phase is called perimenopause and typically occurs between ages 40-50. Because of the rapid and dynamic fluctuations in hormone levels, symptoms may be most severe during this time. Perimenopause typically lasts for 2-10 years and during this time women may have irregular periods, with shorter or longer cycles than usual. 

Figure 1. Stages of Menopause Image credit: hertilityhealth.com

When periods have stopped for at least one year (not due to pregnancy/breastfeeding, hormonal contraceptive / other medication use, or other underlying medical conditions), a woman is considered to be in spontaneous menopause. The average age of menopause in Canada is 51 and typically occurs between ages 45-55. If your periods stop before age 45, it’s worthwhile speaking with your doctor to determine if you are experiencing early menopause or if you have another underlying health condition.  In early menopause, individuals reach menopause before age 45 and progress through similar stages and hormone fluctuations as individuals in natural menopause. Premature menopause typically happens even earlier (before age 40) and diverges significantly from the typical menopause stages in that hormones fluctuate more erratically and some women may have return of menses. This type of menopause is the result of Primary Ovarian Insufficiency (POI), a condition where the ovaries stop working normally. It is believed that both premature and early menopause may be due to a variety of genetic and lifestyle factors. 

It’s also important to mention that menopause can be induced by the removal of both ovaries, known as a bilateral oophorectomy, which is also referred to as surgical menopause. This results in abrupt changes in circulating hormone levels within 24 hours. These surgeries can be to treat ovarian conditions such as endometriosis and/or for the treatment and/or prevention of cancer. Women that experience this type of menopause tend to report more severe and abrupt menopause symptoms compared to women that are spontaneously menopausal.

Lastly, we have spontaneous postmenopause (sometimes also called menopause). This is the time between the final menstrual period and the rest of a woman’s life. This is when estradiol and progesterone will be at their lowest. At this phase, some menopausal symptoms that are caused by hormone fluctuations, like hot flashes and night sweats, tend to subside. Other symptoms that are caused by low hormone levels, like vaginal dryness, might continue to worsen. The risk of cardiovascular disease, osteoporosis, and the genitourinary syndrome of menopause also tend to increase at this stage due to the loss of those protective hormones. 

Importantly, menopause will typically last for one-third to one-half of a woman’s life. So why don’t we know more about it? The Menopause Foundation of Canada decided to investigate this knowledge gap by surveying more than 1,000 Canadian women aged 40-60 from representative regions, educations, incomes, and ethnicities. Their results are summarized in the landmark 2022 report, The Silence and the Stigma: Menopause in Canada. Despite more than one quarter of Canadian women being perimenopausal or menopausal, they found that “menopause is overwhelmingly viewed as negative and remains shrouded in secrecy.” So let’s shed some light on this experience! 

First, the report dives into menopause symptoms that can occur with all types of menopause. You might be surprised to learn that there are more than 30 symptoms of menopause (Figure 2), and while 84% of women were aware of hot flashes and 77% about night sweats, the majority did not know that urinary tract infections, heart palpitations, body aches, headaches/migraine, anxiety, depression, memory issues, and pain during sexual intercourse were all potential symptoms of menopause. In the report, women reported experiencing an average of seven symptoms. Unfortunately, one-third of women felt that their symptoms were undertreated, despite the availability of effective treatments. 


Figure 2. Common Symptoms of Menopause Created using BioRender. Check out the

The Silence and the Stigma report also highlights the challenges women face within the medical system, in their intimate relationships, and in the workplace during menopause. More than half of respondents felt that menopause is “taboo”, and a similar proportion felt unprepared for their menopause journey, leading to feelings of isolation and loneliness. Unfortunately, only 40% of women sought treatment for their symptoms and 72% of those who did found that the medical advice was not helpful or only somewhat helpful. These experiences also impact women’s quality of life and relationships, with 41% of women reporting that menopause negatively impacted their relationship with their significant other. It also affects women’s experiences in the workplace, with three-quarters reporting that their employer was not supportive or did not know if they offered support in helping them to cope with symptoms. 

As Dr. Wendy Wolfman, MD, FRCS(C), FACOG, NCMP noted in the report, “Menopause is seen as something women must endure, like a woman’s burden. This is unacceptable.” In the next part of this series, we will go through the history of menopause hormone therapy and current research in this field. Our third blog will go more into detail about options for menopause treatments, including hormonal, non-hormonal, and lifestyle options. Stay tuned for these blogs and connect with us on social media to share your experiences of menopause, questions about treatment, or share feedback on this series! 

Behind the Science: Clearing the Fog of Midlife Ovarian Removal and Cognition

Interviewee: Alana Brown, Ph.D. Candidate, University of Toronto, Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: July 14th, 2023

Could you tell us about your research?

In Dr. Gillian Einstein’s Lab of Cognitive Neuroscience, Gender, and Health, my PhD work explores the relationships between ovarian hormones (e.g., 17β-estradiol) and cognition, specifically in women with breast cancer gene mutations who opt to have bilateral salpingo-oophorectomy, which is the removal of both ovaries and fallopian tubes. This surgery usually occurs for cancer prevention purposes around 10 years prior to the typical age of spontaneous/natural menopause (~51 years). Bilateral salpingo-oophorectomy results in an abrupt and early loss of ovarian hormones. Our group in Dr. Einstein’s lab is trying to understand the cognitive impact of this hormone loss, especially given that oophorectomy is associated with an increased risk of developing Alzheimer’s disease (AD) in later life.

What drove you to study women’s health research? 

There is a dearth of research examining factors contributing to cognition among middle-aged women. The spontaneous menopause transition is a time period often defined by self-reported brain fog. So, women are specifying that their memory is changing during this period. Not only is there a gap in research to try to understand this change, but this is also a unique opportunity to answer more nuanced questions about memory in a healthy population. This research gap is even wider for women with bilateral salpingo-oophorectomy.

It is really interesting that we can ask richer questions about memory by looking at an ovarian hormone shift that affects a large number of people in the world. For example, how can the memory changes associated with ovarian hormone loss be differentiated from the memory changes associated with aging? How can we use ovarian hormone-related structural and functional brain changes to answer questions about how the brain supports memory more broadly? In the realm of neuroimaging, menopause and sex-specific factors are conflated with aging and largely overlooked and disregarded. It is very common to see neuroimaging research focusing on aging by studying groups of young adults who are 35 or younger and comparing them to groups of older adults who are 65 or older. The large gap between those age groups, representing midlife, during which menopause is typically occurring, is often ignored. There is a really small percentage of research looking at female-specific outcomes during that time.

What impact do you hope to see with this work?

I hope that this work can contribute to a larger picture of precision medicine. Given that we are studying a group of women who are at increased risk for AD, there may be implications for AD biomarkers. Female-specific AD risk factors must be studied and clarified. I hope this work can contribute to a larger body of research focused on studying people and the complexities of their lives while integrating that complexity into neuroimaging. Further, I hope we know more about the functional effects of reproductive aging and/or ovarian hormone loss in the future, above and beyond the effects of aging. This is new territory for neuroimaging. Those considering bilateral salpingo-oophorectomy deserve to be fully informed and aware of what they may experience after the surgery.

Have you seen any interesting findings yet in your research? 

We are finding that oophorectomy without 17β-estradiol  replacement therapy is associated with decreased hippocampal activation, specifically while learning/encoding during a face-name pair memory paradigm that is thought to be sensitive to AD progression. The hippocampus is a brain area critical for learning/memory and is also among the first regions affected by AD. We do not see the same pattern in individuals with oophorectomy who are taking 17β-estradiol replacement therapy. It is possible that 17β-estradiol has a role in maintaining function in the hippocampus and potential markers of AD risk could be detected in midlife. 

Where can people find more about your work?

Twitter: @4alanabrown and @EinsteinLabUofT, 

Online: https://einsteinlab.ca

LinkedIn: https://www.linkedin.com/in/alana-brown-23544a111/

Check out this recent publication by Alana and the Einstein Lab on how midlife ovarian removal affects cognition!

Understanding the Lived Experience of Perimenopause, Menopause and Post-Menopause


Author: Bhairavi Warke, PhD Student, Simon Fraser University Editors: Negin Nia and Arrthy Thayaparan (Blog Coordinators)

Published: April 8th, 2022

What is lived experience of Menopause?

Menopause is when one has gone an entire year without a menstrual period. The average age for menopause is 51 years. It is preceded by Perimenopause, when women start noticing physical and psychological changes, and followed by post-menopause. This transition can be challenging for many due to symptoms like hot flashes, night sweats, mood swings, etc. Not only does it affect women’s physical and psychological well-being, but it may significantly affect their personal and social lives. For example, menopause symptoms can cause limitations in family life, relationships, professional activities, and more. Additionally, every woman’s experience can greatly vary in terms of the severity and duration of symptoms. For some, the symptoms of menopause can last over a decade and thus, significantly lower their Quality of Life (QoL). 

The World Health Organization (WHO) defines Quality of Life as, “an individual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns. QoL is a multi-dimensional concept affected in a complex way by the person’s physical health, psychological state, level of independence, social relationships, personal beliefs and their relationship to their environment.”  

Although it is a natural phase of life, most women struggle to find relevant information that may help them navigate the menopause journey. Women often feel a sense of isolation or lack of support in social settings. Now-a-days, women exchange information in smaller close-knit groups or over online menopause forums to seek help and support beyond their doctors. Despite the sheer number of people who experience menopause, it still seems to bear stigma and is not yet a commonplace topic in public discourses. Menopause is seen as a personal and private health condition than a regular aspect of life and women are expected to “just figure it out” themselves as they go through it. In addition, post-menopausal women are more vulnerable to heart disease, osteoporosis, and breast, ovarian, or uterine cancers. Thus, understanding the impact of the menopause transition on women’s day-to-day lives, i.e. the lived experience, is crucial to address some of the challenges they face.

Why is it important?

We know that menopause is influenced by more than the physiological changes associated with it. The socio-cultural understandings of menopause have a significant impact on women’s experience of it. However, we know little about how this affects women’s ability to adapt to the new phase of life. Menopause and aging women’s needs are often ignored or rarely discussed in mainstream healthcare product and service innovations. This makes it a hidden reality that not only impacts women’s preparedness for this journey, but it also influences how they can participate and contribute to society. Moreover, the socio-economic burdens and costs of healthcare for women in menopause can be very high. Studies have shown that education, appropriate guidance and effective management can have real benefits in improving women’s QoL as they go through this transition.

Opportunities in Personal Technology

Personalised self-care technologies are becoming more and more ubiquitous. For example, we are surrounded by a large number of fitness trackers and health apps. These technologies focus on tracking personal data like weight, energy levels, physical activities, time usage, sleep and learning strategies, and are intended for self-improvement and behaviour change. Despite their growing success, the existing landscape of interactive self-tracking tools for menopause care is sparse, often limited to period tracking, coaching and information sharing applications. There are a lack of meaningful interventions that could help women through their menopause journey, beyond just tracking symptoms, and seamlessly integrate it within their lifestyles to improve their quality of life.

Where can we start?

To design better self-care tools that are useful for women experiencing menopause, we need to: a) talk to experts in women’s health, and b) understand the lived experience of menopause from women themselves. 

In the initial stage of this research, we, the researchers at the Pain Studies Lab in SFU, are planning to conduct a participatory workshop to explore the lived experiences of menopause from experts in women’s health and from women who are experiencing perimenopause, menopause or post-menopause. The workshop will be conducted online via video conferencing (like Zoom) and participants will discuss how the different stages of menopause affect the day-to-day realities of someone’s life. The workshop will conclude with a short brainstorming activity to explore ideas of what may help women during this transition and benefit their long-term quality of life.

How can we get in contact with you?

If you are an academic researcher or professional expert working in fields related to women’s health or menopause care, WE NEED YOUR HELP! 

Please contact me at bwarke@sfu.ca if you would like to participate in this 2.5-hr online workshop. Participants will be compensated with $20 for their time and contribution.

(Note: We refer to all individuals experiencing symptoms of menopause as ‘women’ in this article. However, we acknowledge all individuals who may or may not identify as ‘women,’ but experience menopause or like symptoms, as a part of this research.)