Tag Archive for: reproductive medicine

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! 

Thinking About Egg Freezing? Here are Some Things to Consider

Authors: Maryam Fatima, BHSc (Hons) & Samantha Yee, PhD, MSW | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators) 

Published: July 14, 2023

What is Planned Egg Freezing?

Planned egg freezing, also known as social or elective egg freezing, involves administering fertility drugs and using assisted reproductive technologies to retrieve and cryopreserve eggs for future use. It is an elective medical procedure utilized by women without an imminent fertility threat (e.g., cancer treatment), to preserve healthy eggs before age-related fertility decline. Elective egg freezing is an expensive uninsured medical procedure ranging from $12,000 to $15,000 CAD, although some of the costs may be covered by insurance plans. Since the American Society of Reproductive Medicine (ASRM) declared egg freezing an established clinical procedure in 2012, electively cryopreserving eggs has gained popularity. Additionally, the social distancing measures implemented during the COVID-19 pandemic presented a unique circumstance in which single women had limited opportunities for dating, prompting more women interested in preserving eggs proactively as evidenced by a drastic increase in planned egg-freezing cycles at fertility centers during the pandemic. 

Why Do Women Pursue Planned Egg Freezing?

The current societal shifts and increased accessibility to contraceptives have contributed to a trend of delayed parenthood in developed countries. In Canada, a woman’s average age at first birth has increased steadily since the 1970s, from around 24 years to 31 years in 2021. However, fertility and egg quality decline drastically beginning around the mid-30s, leading to heightened interest in cryopreserving eggs to prevent future unintended childlessness or smaller-than-desired family size due to secondary infertility. Contrary to popular belief, research has shown that career development is not the primary reason women want to freeze eggs. Instead, other factors play significant roles, such as the absence of a committed partner to start a family, being in an unstable relationship, wanting a backup plan against age-related fertility decline, alleviating the pressure of the “biological clock”, and avoiding future regret for not making use of available cryopreservation technology. 

Why Are Women Late to Planned Egg Freezing?

A Canadian study conducted at an in-vitro fertilization (IVF) centre found that women underwent planned egg freezing at a mean age of 37, and four in five only completed one egg freezing cycle. This is problematic as the highest likelihood of live birth is when egg-freezing is performed before age 35. Since eggs cryopreserved after this age have much lower quality, older women are often recommended to freeze more eggs by undergoing more freezing cycles. An alternative for older single women is to cryopreserve embryos using donor sperm, as frozen embryos have a higher success rate than frozen eggs. An estimation prediction model suggested that at age 34, one would need to freeze 10 eggs to have a 75% likelihood of at least one live birth, and the projection increases to 20 eggs for 37 years and 61 eggs for 42 years. It is plausible that women may be waiting until they reach mid-35 before considering egg freezing. Affordability is another main reason why this uninsured procedure is out of reach for some women.

A lack of knowledge regarding fertility decline also leads to delayed planned egg freezing. A survey conducted by a Canadian IVF center reported that almost half of the respondents felt inadequately educated on fertility decline before pursuing planned egg-freezing, and only half could correctly identify the age range where fertility decline begins. Concerningly, 37% of respondents obtained egg freezing information from mass media, while only 12% received education from their primary healthcare practitioners.  Some practitioners hesitate to initiate the planned egg freezing conversation with their healthy patients due to insufficient knowledge or feeling skeptical of the procedure’s success. Furthermore, if family planning is not included in the annual checkup discussion, patients are left unaware of their fertility options. Canadian ethicists have also raised concerns about the invasive nature of the procedure, although it is no less risky than patients undergoing IVF. There is also a lack of established studies about the long-term safety of offspring. The procedure may be unnecessary for older women whose egg quality has already been compromised, or if cryopreserved eggs end up unutilized. Most importantly, planned egg freezing may offer women false security about their fertility since there is no guarantee of a successful live birth from cryopreserved eggs. Studies have indeed reported low utilization rates of cryopreserved eggs, from 2.3 – 20.9%, but the follow-up period was often a short 2 years, and it is likely that most women were still attempting to establish a stable relationship or conceive naturally during this time.

The decision to pursue planned egg freezing is highly individualized and influenced by various factors.  By improving communication between practitioners and patients on fertility and family planning matters, enhancing counselling, and providing accessible information, women can make informed decisions about their reproductive futures and avoid future regret.