Lori Brotto is the principal investigator of the study called Health and Economics Research on Midlife Women in British Columbia and a professor of obstetrics and gynecology at the University of British Columbia and executive director of the Women’s Health Research Institute.

Image Credit: www.loribrotto.com

The first large Canadian study on menopause, which looked at a range of symptoms, what people turn to for help and how much they pay out of pocket, found that most people in B.C. who go through menopause are still “unprepared and disoriented” by this stage of life.

This disruption affects women’s mental, physical and social health, as well as their professional life as they are pushed to miss work, cut back hours and turn down promotions right at the peak of their careers, said Lori Brotto, principal investigator of the study, professor of obstetrics and gynecology at the University of British Columbia and executive director of the Women’s Health Research Institute.

The study, called “Health and Economics Research on Midlife Women in British Columbia,” or HER, was published Nov. 1 and produced by the WHRI, a UBC faculty of medicine research centre and an affiliate program of the Provincial Health Services Authority.

Researchers interviewed 2,133 people who were assigned female at birth, including cisgender women, trans men and non-binary and gender-diverse people, aged 39 to 60, between Nov. 10, 2023, and April 7, 2024. They asked how menopause affected their health, their work and their personal lives.

Study participants reported feeling disoriented by menopause symptoms and unsupported by health-care workers and their workplaces. The more severe the symptoms, the more likely a person was to experience depression, anxiety and loneliness. In contrast, people with milder symptoms experienced a higher quality of life.

Brotto said she was surprised that 92 per cent of study participants said they had experienced moderate to severe menopause symptoms and that 17 participants reported being fired for menopause-related symptoms.

“When you scale that up across the general population it’s a huge number,” she said.

The symptoms of menopause

Perimenopause is the first stage of menopause. It generally occurs during the decade before a person’s period ends, most often starting in their 40s when their period becomes irregular.

Perimenopause symptoms include changes in menstruation; hot flashes; night sweats; sleep disruptions; pelvic floor disorders; changes to sexual health, mood, cognition and memory; and genitourinary symptoms such as vaginal dryness, discharge, genital itching, burning or urgency when peeing and recurrent urinary tract infections, according to the study.

Fluctuating estrogen, which affects the brain’s centre for thermoregulation — causing hot flashes and night sweats — causes perimenopause, Brotto said.

Menopause proper is defined as the date of the final menstrual period; post-menopause refers to the years following that final period.

During this time a person’s estrogen levels have “bottomed out,” which can cause symptoms such as vaginal dryness, pain during sex and recurring UTIs, Brotto said.

Low estrogen levels are also associated with an increased risk of osteoporosis and reduced cardiovascular health, Brotto said.

Hormone therapy can reduce these risks, she added.

Symptoms of menopause are highly stigmatized and people often don’t seek care because they feel it is just a part of aging they have to endure, the study found.

Women are fed a narrative their whole lives that their bodies have to endure pain: you get your period, you have sex, you have a baby, you go through menopause and you just have to suffer, said Shirley Weir, founder of Menopause Chicks, an online community that works to improve knowledge and care of people experiencing menopause.

Weir said it’s important to push back against that narrative and to recognize that everyone deserves to feel well, which is the first step in helping people identify how they are being affected by menopause.

How menopause impacts a person’s income

Middle-aged women make up just under half of B.C.’s paid workforce, and 46 per cent of working women are mid-life, according to the study.

One-third of the HER study participants reported that menopause had impacted their job, and a quarter said it made them miss workdays within the last year.

One in 10 study participants said they had to turn down a promotion and 17 per cent said they had to cut back on work hours in the last six months because of symptoms.

A 2023 report from the Menopause Foundation of Canada calculated that untreated menopause symptoms cost the economy $3.5 billion per year and were associated with $237 million in lost productivity. The report also found one in 10 Canadian women leaves the workforce entirely due to unmanaged symptoms.

A lack of research

Despite menopause affecting more than 875,000 British Columbians who are currently between the ages of 40 and 65, there’s still a “paucity” of research on menopause and how to support healthy aging, the study says.

This lack of research is “the patriarchy rearing its ugly head again” and also has elements of ageism, Brotto said. She said only seven per cent of the national health research budget gets allocated to women’s health, and menopause gets an even smaller fraction.

The bulk of women’s health research goes towards contraceptives, fertility and pregnancy, she said. “They invest as far as it makes women able to be fertile and contribute to furthering the species. After that they don’t care so much about them.”

An example of this research gap can be seen on PLOS One, a peer-reviewed open-access journal. Searching “erectile dysfunction” turns up 46,739 studies. Searching “menopause” turns up 4,681.

How to support healthy aging and treat menopause symptoms

The study made five recommendations to improve menopause health outcomes in B.C.

They include public health campaigns about menopause, improving how health-care providers are taught about menopause, improving workplace supports, improving workplace accommodation and reducing discrimination, and increasing research.

These are “minimal investment recommendations” that could have big impacts, Brotto said. Workplace accommodations could be as simple as offering flexible work schedules so people can go to doctor’s appointments or wait out a hot flash if needed, she said.

More than one-quarter of study participants said they used medications to treat symptoms, but many women were unable to access hormone therapy because family doctors were unwilling to prescribe it.

The BC NDP pledged to make hormone replacement therapy free to treat menopause, but if many doctors aren’t trained in how to treat menopause they may be reluctant to prescribe it, Brotto said. This links back to the need for better education for health-care providers and a need for more British Columbians to have family doctors they can turn to for diagnosis and prescribed treatment options, she said.

Weir said she teaches people how to advocate for themselves in health-care settings. She recommended cutting small talk and identifying what symptom is bothering them, how long they’ve had it and how it is affecting their life (for example, how many days they’ve missed work due to lack of sleep and what that means financially). Including their age, when their last period was and what research they have done is also important, she said.

While hormone therapy is considered the gold standard for menopause symptom treatment, and is quite safe, it isn’t recommended for some people, for example those with a higher risk of breast cancer, Brotto said.

Fezolinetant is a non-hormone-based medication that has been approved for use in the U.S. to treat severe vasomotor symptoms like hot flashes and night sweats, and hopefully will be approved by Health Canada next, Brotto said.

Cognitive behavioural therapy can also be helpful for people experiencing stress or anxiety around hot flashes and sleep disruption, she said.

Menopause flim-flam

Brotto said she’s happy to see more people talking openly about menopause, but she has also seen social media create “a breeding ground” for people selling unproven therapies.

Be cautious of herbs, supplements and nutraceuticals that claim to fix symptoms but have not been tested, she said. It’s better to spend the time and energy seeing a doctor and, if needed, getting a second medical opinion rather than “paying out of pocket for something with no scientific evidence.”

People going through menopause need to keep speaking out about their symptoms and solutions, Weir said, because silence enforces the narrative that women are meant to suffer.

“We need to tell all women: You are not on your own,” she said. “There is a community that has your back.”

— This story was originally published by The Tyee

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