Frequently Asked Questions

False – Estrogen plays a significant role in the immune system, and as estrogen levels drop during perimenopause, inflammation – a key part of the body’s immune response – increases.

True – research has shown that people who are obese or overweight have different levels of inflammatory cytokines compared to non-obese people. However, changes to your diet, restricting calories and getting more exercise is proven to reduce the inflammation associated with obesity.

Not really.

Supplements like vitamins can be good for you if you lack vitamins and minerals in your diet. Otherwise, there is no proof that supplements of any type help or improve the actions of the immune system

False – high quality sleep is necessary to support your body and the actions of the immune system.

No. Sexual activity can increase the risk for a UTI but does not directly cause the UTI. Sexual intercourse can introduce bacteria close to or into the urethra, which can lead to an infection in the urinary tract. You can lower your risk by urinating before and after intercourse, and by drinking plenty of water after intercourse to increase the volume of urine and help flush bacteria out of the system.

No.

UTIs are not contagious or passed between partners by sexual or casual physical contact.

No. Antibiotics are the most common treatment, used when there are painful or bothersome symptoms, and bacteria present in the urine. However, some UTIs have no symptoms, and these infections usually go away on their own because the person is unaware they even have a UTI.

There are many non-antibiotic treatments being explored. The most promising is to take increased amounts of D-mannose is a type of sugar found in many fruits. It also exists naturally in the body. A recent study supports consuming d-mannose to keep bacteria from sticking to the walls of the urethra and bladder. It has also been suggested to be a promising alternative to antibiotics, but more research is needed. [7] [10]

No. While most UTIs cause symptoms, like pain or burning when urinating, sometimes, there can be bacteria in the urinary tract without any UTI symptoms. This is called asymptomatic bacteriuria. It is most common in older adults or people using catheters to empty their bladders.

Chronic UTIs don’t go away, often occurring when an infection enters the lining of the bladder. Properly diagnosing chronic UTIs requires detailed tests and, once diagnosed, the treatment is a long-term (up to 6 months) antibiotic.

It is very unlikely that supplements will help ease GSM symptoms. Even cranberry supplements (that many people are familiar with) have no scientific support for their effectiveness. Unfortunately, we live in a time when many celebrities and ‘health’ experts promote products that have no scientific basis for working. These supplements may cause a placebo effect (where you feel better simply because you think you feel better – there is no scientific basis for the improvement), may have no effect, or, in some cases, may be dangerous. Remember that many supplements are unregulated, so there is no guarantee that they contain the ingredients they advertise at the stated levels. Even worse, untested combinations of ingredients are common, and these could cause worse health issues than the original symptoms being treated.

Yes, it should help. The cause of GSH is reduced levels of estrogen due to perimenopause and that is irreversible. However, HRT can be used to increase your estrogen levels and that may ease your symptoms.

Yes, absolutely. If you have been formally diagnosed with ADHD, you may be prescribed medications that will impact your brain chemistry and improve your symptoms. Medication is rarely enough on its own, however, so talk therapy, especially cognitive behavioural therapy (CBT) can be very helpful as well.

ADHD is a neurological development condition, and to receive a diagnosis, symptoms have to have been present in childhood. However, estrogen is involved in the production of the neurotransmitters that can cause ADHD symptoms, so changes to your estrogen levels can affect whether or not you experience symptoms. The root cause is different, but the effects and the symptoms show up in the same way.

No it isn’t. Some people with ADHD also have learning challenges (including dyslexia), but those have no impact on IQ. People with ADHD are absolutely capable of being CEOs, surgeons, academics, and entrepreneurs, just like any other non-ADHD person.

No, although for many years boys received almost all of the ADHD diagnoses. This is because ADHD presents differently in boys and girls. For example, hyperactivity in boys is obvious – they can’t sit still or pay attention. Hyperactive girls, on the other hand, typically internalize their hyperactivity so it shows up as a chaotic mind (which they usually hide) and / or a hyperverbality where they talk all the time.

It is uncertain whether MHT will increase your personal risk of breast cancer since breast cancer risk varies based on the type of MHT plus a woman’s family history and overall health.

To date, the evidence shows that in North America, the estrogen in MHT does not cause, nor increase the risk for breast cancer overall.

In menopausal women, short-term MHT using estrogen will not increase a woman’s risk of developing breast cancer. However, MHT may slightly increase the risk for breast cancer in late menopause after 4 or more years of continuous use.

Some women are at high risk for breast cancer. Please discuss your personal risks when discussing MHT with your healthcare provider.

Risk Factors for Breast Cancer:

• Age (your risk increases significantly after age 55)
• Family history / genetics (e.g. BRCA 1 or 2; PALB 2 variants)
• Previous breast biopsy that showed abnormal cells
• Increased breast density on mammography
• Not bearing children (or having first child after age 30).
• Lifestyle
• Lack of exercise
• Excessive alcohol intake
• Obesity and weight gain after menopause
• Smoking
• Lack of breast-feeding after childbirth

Short-term use of MHT for symptom control and quality of life will have little effect on personal breast cancer risk. Longer use of MHT does increase breast cancer risk. Currently, the only proven strategy to reduce breast cancer deaths is early detection through mammography in women over 50.

Yes, they are a relatively common symptom seen in perimenopausal women – women who are transitioning between their reproductive years and menopause (the life stage when a woman is no longer able to conceive). Once menopause occurs – defined as starting twelve months (one full year) after your last period – estrogen levels stabilize and mood swings will improve.

The exact cause isn’t fully understood, but rage is correlated with changing estrogen levels that then impact the production and use of serotonin and endorphins, both of which are natural emotion- and mood-boosters. Menopause rage is also correlated with the quality of your relationship with your partner. In fact menopause rage is very typically directed at husbands. You may consider seeking counseling if your relationship is suffering or if it needs improvement to become more supportive.

There are things you can do as part of your self-care routine to help with mood swings. In particular, finding ways to calm and soothe yourself with meditation, breathing exercises, spending time in nature, and ensuring you are eating a nutritious diet and getting sufficient physical activity will help. A lack of sleep can make your moods worse and more volatile, so work to manage night sweats and anything else that may be impacting your quality of sleep. If your moods are disruptive and impacting the quality of your life, speak to your healthcare provider. You may benefit from medications or other therapies such as counseling and talk therapy.

The timing of increased or more intense mood swings is unpredictable. If you are experiencing these as a disruptive symptom of perimenopause, you are not alone. It is clear that mood swings become more common and are often accompanied by intense emotional changes and outbursts, starting when a woman enters the menopausal transition. Mood swings and emotional changes do level out and calm down once estrogen levels stabilize in menopause, indicating that it is the change in estrogen levels, not absolute estrogen levels that impact mood and emotions.

Yes and No.

There are natural treatments (such as drinking cranberry juice and urinating frequently) that may help either the vaginal or the urinary symptoms. However, the cause of GSM is reduced levels of estrogen, so it is unlikely that the improvements will be maintained. As estrogen levels continue to decline, the condition will continue to develop.

It may, but only if you are using Menopause Hormone Therapy (MHT) to increase your estrogen levels. The cause of GSM is reduced levels of estrogen due to perimenopause and that is irreversible.

MYTH

The inside of your vagina is a carefully balanced natural environment with a unique microbiome (good bacteria and other microorganisms, just like in your gut) that works to keep it healthy. It is also a very sensitive area that can be easily harmed. Steam is very hot (by definition!) and it can easily burn the vulva and the interior of the vagina (ouch!). The herbs that are used in the steam or rinse can also cause problems if they create an imbalance in the microbiome that causes bacterial or yeast infections. There is also a possibility that bacteria can get introduced into the vagina from the equipment being used. Not recommended.

The roots of most male male menopause symptoms are usually related to lifestyle and behaviour problems. The first step for men experiencing symptoms in midlife is to check their testosterone levels in case that is a factor. But typically lifestyle changes such as improving diet, sleep, and exercise habits as well as treatment for any anxiety, stress or depression will help manage or even correct the symptoms.

The most common andropause symptoms include:

• depression
• loss of sex drive
• erectile dysfunction
• mood swings and irritability
• anger
• loss of muscle mass and reduced ability to exercise
• fat redistribution, such as developing a large belly or “man boobs” (gynaecomastia)
• a general lack of enthusiasm or energy
• difficulty sleeping an/or or increased tiredness
• night sweats
• hot flashes
• poor concentration and short-term memory challenges.

The most common male menopause symptoms include:

• depression,
• loss of sex drive,
• erectile dysfunction
• mood swings and irritability
• anger
• loss of muscle mass and reduced ability to exercise
• fat redistribution, such as developing a large belly or “man boobs” (gynaecomastia)
• a general lack of enthusiasm or energy
• difficulty sleeping an/or or increased tiredness
• night sweats
• hot flashes
• poor concentration and short-term memory challenges.

Many men will experience male menopause symptoms in their midlife, starting in their late 40s and 50s.

For true diagnosed andropause, caused by low testosterone levels, the treatment is testosterone replacement therapy (TRT). Many men experiencing andropause symptoms, however, are not actually low in testosterone. In these cases, lifestyle changes such as improving diet, sleep, and exercise habits as well as treatment for any anxiety, stress or depression will help manage or even correct the symptoms.

Yes, they can be. They may be caused by low testosterone, but more commonly they result from anxiety and/or stress, medication side-effects, alcohol consumption, diet, or a side effect of sleep apnea.

Yes, they can be. They may be caused by low testosterone, but more commonly they result from anxiety and/or stress, medication side-effects, alcohol consumption, diets, or a side effect of sleep apnea.

Here are the top six symptoms women experience during the menopausal transition:

2. Irregular periods – every woman will experience these as their bodies shift from the reproductive years (with regular periods) into menopause (with no periods). 
3. Hot flashes and night sweats – 75% of women will experience hot flashes, usually for less than 2 years.  Hot flashes feel like a strong wave of heat travelling through the upper body and face.  When hot flashes happen at night while you are sleeping, they are called night sweats. 
4. Insomnia and sleep difficulties – Up to 60% of women experience difficulty sleeping during the menopausal transition, including trouble falling asleep, staying asleep, and having a poor quality of sleep. Sleep problems often result from other menopausal transition symptoms, especially night sweats.
5. Vaginal dryness – Up to 35% of women will experience vaginal dryness. This can be painful, especially during intercourse, but there are solutions.
6. Bladder issues – Over 50% of women will experience problems with their bladders starting in the menopausal transition. Leaking urine (when you exercise or sneeze) and urinary urgency (when you can’t hold your pee) are the most frequent urinary issues. 
7. Mood changes and mood swings – About 50% of women in the menopausal transition will experience sudden, random mood swings. You may find yourself bouncing between feeling wonderful, tearful, angry, sad, or irritable, all because of changing hormone levels. 

Visit Herstasis.com to learn more about these symptoms and how to manage them successfully. 

Hot flashes can be very disruptive to your daily life. They feel like a strong wave of heat travelling through your body followed by sweating and sometimes chills when the hot flash is over. You may also have feelings of anxiety, a rapid heartbeat, or your heart skips a beat or two.

It is impossible to predict exactly how long you will experience hot flashes, but menopause symptoms can last for many years.

Menopausal hormone therapy (MHT) is the gold standard treatment for hot flashes, and you and your doctor can determine which type of hormone therapy is the best for your body and your symptoms. Self-care includes dressing in layers, staying hydrated and avoiding spicy foods and hot drinks that can be triggers.

If your vaginal dryness is caused by low estrogen levels, your healthcare provider may prescribe topical estrogen therapy. There are three methods of applying vaginal estrogen:

• Ring: You or your doctor can insert a soft, flexible ring into your vagina. It releases estrogen directly to the vaginal tissues. The ring lasts about three months so it will need to be replaced regularly.
• Tablets: These tablets are inserted into your vagina with a disposable applicator.
• Cream: The cream is inserted into your vagina using an applicator.

There are over-the-counter vaginal moisturizers as well. Speak to your pharmacist or your healthcare provider to get a recommendation. Water-soluble lubricants (such as Astroglide or K-Y Jelly) can also be used on an as-needed basis. Non-water-soluble lubricants, such as Vaseline, are not recommended if you are using condoms for either contraception or for prevention of STIs because they can weaken latex and reduce the effectiveness of the condom.  [5]

Therapy for Vaginal Dryness

During the menopausal transition, the state of the vagina often changes. Vaginal dryness and pain are symptoms of vaginal atrophy (atrophic vaginitis) that occur as a result of lowered estrogen levels. The tissues in the vagina weaken, get thinner, dryer, and may get inflamed, causing pain, burning, or discharge.

Yes, it can be a contributing factor.

The lining of the outer urethra is estrogen-dependent. During the menopausal transition, this lining thins and may become weaker than the pressure in the bladder. It is this imbalance that leads to involuntary loss of urine.

Read more on the science here

Yes, it can be a contributing factor.

The lining of the outer urethra is estrogen-dependent. During the menopausal transition, this lining thins and may become weaker than the pressure in the bladder. It is this imbalance that leads to involuntary loss of urine.

Check out the science here

It was found to be the decline in estrogen.

One study found that the post-menopausal age group is at greater risk of peripheral neuropathy and determined that declining estrogen levels, as seen during the menopausal transition, critical in the development of the condition. [2]

[2] Singh A, Asif N, Singh PN, Hossain MM. Motor Nerve Conduction Velocity In Postmenopausal Women with Peripheral Neuropathy. J Clin Diagn Res. 2016 Dec;10(12):CC13-CC16. doi: 10.7860/JCDR/2016/23433.9004. Epub 2016 Dec 1. PMID: 28208850; PMCID: PMC5296423.

The “tingling” sensation can be felt anywhere on your skin, even your face.

One study found that the post-menopausal age group is at greater risk of peripheral neuropathy and determined that declining estrogen levels, as seen during the menopausal transition, critical in the development of the condition. [2]

Any type of neuropathy is a symptom of some other problem occurring in your body. There are multiple causes of peripheral neuropathy, including cancer, cancer treatments, diabetes, infections, poor circulation, or low vitamin B levels. If you have or may have any of these conditions it is important to talk to your healthcare provider to rule out any serious underlying problems that may be causing your tingling or electric shock sensations.

[2] Singh A, Asif N, Singh PN, Hossain MM. Motor Nerve Conduction Velocity In Postmenopausal Women with Peripheral Neuropathy. J Clin Diagn Res. 2016 Dec;10(12):CC13-CC16. doi: 10.7860/JCDR/2016/23433.9004. Epub 2016 Dec 1. PMID: 28208850; PMCID: PMC5296423.

One study found that the post-menopausal age group is at greater risk of peripheral neuropathy and determined that declining estrogen levels, as seen during the menopausal transition, critical in the development of the condition. [2]

Any type of neuropathy is a symptom of some other problem occuring in your body. There are multiple causes of peripheral neuropathy, including cancer, cancer treatments, diabetes, infections, poor circulation, or low vitamin B levels. If you have or may have any of these conditions it is important to talk to your healthcare provider to rule out any serious underlying problems that may be causing your tingling or electric shock sensations.

[2] Singh A, Asif N, Singh PN, Hossain MM. Motor Nerve Conduction Velocity In Postmenopausal Women with Peripheral Neuropathy. J Clin Diagn Res. 2016 Dec;10(12):CC13-CC16. doi: 10.7860/JCDR/2016/23433.9004. Epub 2016 Dec 1. PMID: 28208850; PMCID: PMC5296423.

During the menopausal transition, some women find that they experience pain – either new pain or more pain than usual – in different areas of their bodies. This pain is almost always neuropathic pain and it happens because lowered levels of estrogen are associated with chronic low-grade inflammation. Inflammation results in the buildup of fluid that pushes against nerve endings and results in neuropathic pain of various types (constant, throbbing, etc.) and severity. It appears that changes in estrogen levels, not the absolute levels themselves, are associated with increased levels of pain.  [8]

[8] Dennis, C. Surging hormones blamed for pain. Nature (2005). https://doi.org/10.1038/news050822-6

Breast pain is common for many women as part of their menstrual cycles and it results from hormone activity. Estrogen and progesterone both increase during the second half (days 14 to 28) of a typical 28 day menstrual cycle. Estrogen causes the breast ducts to get larger and progesterone causes the milk glands to swell. This type of neuropathic pain can cause your breasts to feel painful, tender, and swollen.

The changing hormone levels during the menopausal transition alter your regular cycle and this in turn alters the effects of estrogen and progesterone on your breasts. While the pain itself may not be much different from your normal monthly episodes of breast tenderness, irregular menstrual cycles means that breast tissue is also affected at unpredictable times and for unpredictable durations. [3]

[3] https://www.webmd.com/menopause/guide/breasts-menopause

Many women experience joint and muscle pain and stiffness around the time of menopause, and in many cases this is pain that they haven’t experienced before. There are many causes of joint pain, and for mid-life women, hormones play a significant role. Estrogen helps to lower inflammation, so decreasing levels of estrogen during the menopausal transition are associated with increased levels of inflammation throughout your body.  This inflammation can add to the existing pain caused by old joint and muscle injuries, wear and tear, and just plain aging or it can trigger pain in joints that haven’t hurt before. This is a type of neuropathic pain and can become chronic.  [2]

[2] https://www.healthline.com/health/menopause/pain#changes

MYTH

Osteoporosis is a biological process of bone density loss and increased bone breakage. It is part of the natural aging process for both men and women. Strong bones depend on many factors including your genetics, how you grew during puberty, exercise levels, your diet, smoking, and alcohol consumption. Your bones are at peak strength and density around age 30.

MHT including estrogen is very effective at supporting bone density and strength, especially when combined with a healthy lifestyle. As well, strength training such as weight lifting or even standing instead of sitting, plus a good diet including calcium and vitamin D3 can help maintain bone strength.

Mid-life sees many hormone changes. Those plus decreased physical activity can contribute to osteoporosis, which can affect you in your early 50’s, causing low-impact bone breaks.

MYTH

MHT can benefit women with mild-to-moderate common symptoms such as 

• Vaginal weakness and dryness (vaginal atrophy)
• Urine leak
• Hot Flashes
• Osteopenia or weakened bones

Please talk to your healthcare provider about any of your health concerns. Many are manageable and some can be moderated with simple behavioral changes.

MYTH

Risk for colorectal cancer increases with age. Menopause transition and MHT/HRT themselves do not increase your risk for colorectal cancer. It is unclear right now whether MHT protects you against colorectal cancer. If you do not already, please start medical screening for CRC starting at age 50 as part of your overall self-care regimen.

MYTH

Data about the influence of MHT on stroke are mixed. MHT may increase the incidence of stroke, but this is nullified in women who exercise moderately. A stroke (ischemic stroke) is a clogged blood vessel blocking blood flow to the brain. Without blood flow and oxygen, brain tissue will die. Strokes can lead to serious losses of brain function. Strokes are the third leading cause of death in Canadian women and the risk for stroke increases with age.

The key to reducing the risk of stroke is a healthy lifestyle. The risk factors are:

1. Hypertension
2. Obesity
3. Smoking
4. Excessive alcohol
5. Lack of exercise
6. Diabetes
7. Migraine headaches [with visual aura]
8. Too little or too much sleep

Please discuss your personal risks for stroke when discussing MHT with your healthcare provider.

MYTH

MHT alone does not increase the risk of a heart attack. Heart attacks are the number two killer of women in Canada. Healthy perimenopausal women benefit from a protective effect from MHT and in fact have a lowered risk of heart attack.

Post- menopause, as a woman grows older, the risks of heart disease increase. Risks for MHT are age and life-style related.

The seven major risk factors for heart disease can all be modified, so a woman can adjust her lifestyle and reduce these risks. These risks are:

1. Smoking
2. Abnormal lipid profiles (seen from blood tests ordered by your doctor, these can include high blood levels of low-density lipoprotein (LDL) cholesterol or fats called triglycerides)
3. Hypertension
4. Abdominal obesity
5. Poor diet
6. Excess alcohol
7. Chronic stress

If you have any of these risk factors in your life, tell your healthcare provider when you are discussing hormone therapy.

MYTH

Hormone therapy for treatment of menopausal symptoms was thought to increase the risk of a woman’s chance of breast cancer, stroke and blood clots.  This evidence has been re-evaluated, and MHT using estrogen has been shown to be safe and effective. [6] [8] What is now known is:

• MHT remains the most effective treatment for vasomotor symptoms and genitourinary syndromes of menopause and has been shown to prevent bone loss and fracture. 
• The risks of MHT differ depending on the type of hormones, their dose, duration of use, route of administration, timing of initiation, and whether progestogen is used.
• Treatment should be individualized to identify the most appropriate MHT type, dose, formulation, route of administration, and duration of use.
• MHT must use the best available evidence to maximize the benefits and minimize the risks.
• MHT needs periodic reevaluation for the benefits and risks of continuing or discontinuing MHT.

There are both natural treatments and medical support for headaches and migraines.

A few natural methods of relief are:

• Using a cold cloth or an ice pack held against the painful area on your head or neck. You can wrap the ice pack in a towel to protect your skin
• Relaxation exercises to lower stress and anxiety
• Learn and practice biofeedback techniques you to monitor and understand how your body responds to stress

More on Self-care & Natural Remedies for Headaches & Migraines

If you have tried self-care and your headaches are still problematic, work with your doctor to find relief with medical alternatives. The following medications may be helpful:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Triptans.
• Gepants.
• Hormone therapy.
• Botox.

More on Therapy & Treatment for Headaches & Migraines

There are both natural treatments and medical support for headaches and migraines.

A few natural methods of relief are:

• Using a cold cloth or an ice pack held against the painful area on your head or neck. You can wrap the ice pack in a towel to protect your skin
• Relaxation exercises to lower stress and anxiety
• Learn and practice biofeedback techniques you to monitor and understand how your body responds to stress

More on Self-care & Natural Remedies for Headaches & Migraines

If you have tried self-care and your headaches are still problematic, work with your doctor to find relief with medical alternatives. The following medications may be helpful:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Triptans.
• Gepants.
• Hormone therapy.
• Botox.

More on Therapy & Treatment for Headaches & Migraines

Headaches cause pain in the head, face, or upper neck, and can vary in frequency and intensity. They are classified as either primary or secondary headaches. Primary headaches are caused by the activity of or issues with pain-sensitive structures within your head. Migraine and tension headaches are examples of primary headaches. Secondary headaches are a symptom of another issue or condition, such as an infection, stress, concussion, or just drinking too much the night before. [1]

Learn more here

There are many steps you can take at almost any age to help protect your skeletal system against osteoporosis.

• Eat a quality diet including adequate calcium and vitamin D. Aim for a daily minimum of about 800 mg Calcium and 2000 IU of Vitamin D3. Vitamin K2 is helpful as well.
• Exercise by doing weight-bearing activities such as brisk walking, crossfit, hiking, running, weight training, jump rope and brisk dance. Weight training twice a week will build both bone and muscle density and strength. Balance exercise can help prevent falls.
• Consult with a physiotherapist to develop a personalized bone-building recreational exercise routine.
• To help maintain bone strength, quit smoking and decrease alcohol and caffeine intake. Alcohol and caffeine both reduce bone calcification, the process by which bones are hardened.

NO!

Osteoporosis is not a direct symptom of the menopausal transition. However the reduction of estrogen and increase in follicle-stimulating hormone (FSH) during the menopausal transition can make osteopenia and osteoporosis worse. Post-menopausal women, and white and Asian women are at particular risk.

Risk factors are listed here

MYTH

Unfortunately, many individuals suffering from depression have learned how to keep their symptoms secret, often out of fear or shame of being labeled with a mental health condition. Depression is so common in our society that it is very likely you know at least one, if not more, individuals that are suffering. If you aren’t sure, ask. It can be hard for those who are suffering to talk openly about their struggles. 

MYTH

Discussing depression does not make it worse or keep you focused on feeling depressed. In fact, feeling isolated and alone in your depression can be very harmful and can make your depression worse. Talking to any supportive listener, be they a friend, family-member, or colleague, can be a huge help, especially if they have had or are having similar experiences. This can reinforce that you are not an awful or weak person, rather you are just struggling at the moment with a health crisis. Talking to a qualified and certified therapist or counselor can literally be a life-saver. 

It is true that antidepressants are used as a long-term treatment option for some people diagnosed with depression. Psychotherapy, which is often prescribed along with antidepressants, can help you learn strategies to cope with the challenges you are facing. As you get more skilled at coping, it is possible to wean yourself off of antidepressants with medical supervision. However, if your depression is a result of imbalances in your brain chemistry, you may keep taking antidepressants indefinitely. 

Consider that this is similar to taking high blood pressure medications. If you can control your high blood pressure with lifestyle adjustments then you may not need long-term medications for blood pressure management. If, however, your high blood pressure is caused by genetic or biological factors, you may need to stay on a long-term course of medication. 

MYTH

Genetics do play a role and a family history of depression does increase the likelihood of experiencing depression. However, genetics is not the only factor at play, and everyone, regardless of family history, can work to minimize their risk of depression with simple actions like ensuring high quality sleep, eating nutritious food, exercising, and avoiding drugs and alcohol. 

MYTH

Depression is a real and serious medical condition. It is not a choice or a sign of weakness. It will not be resolved by thinking happy thoughts alone. Changing your attitude can be helpful as part of a suite of interventions, but on its own, it is unlikely to resolve depression in the long-term. It is KEY to communicate how you feel to others and seek professional help. 

MYTH

Depression is generally treatable, and antidepressants are a common tool that is used for treatment. However, antidepressants work by changing the chemistry in your brain, so they will not help if the cause of your depression is not biologically based, and they often take weeks if not months to take effect. In some cases, multiple antidepressants must be tried before the one that works for you and your brain chemistry is found. Many healthcare providers will also prescribe psychotherapy in addition to antidepressants. 

MYTH

Depression is NOT just feeling sad and is not a character flaw Depression is  a complex disorder that can have social, psychological and biological causes. Do not think that you can just wish it away, or that it is normal to feel this low all the time. While human sadness is part of our condition, when it occurs frequently and/or in intense episodes, this is a real and serious medical problem. Talk to your healthcare provider about how you feel.

Depression has  complex root causes and can happen to any person, old or young, rich or poor, large and small. From the outside, you may seem to have “all you should need” and still be depressed. You may also have seemingly little, and have a high quality of life with balanced moods. 

MYTH

It is true that antidepressants are used as a long-term treatment option for some people diagnosed with anxiety. Psychotherapy, which is often prescribed along with antidepressants, can help you learn strategies to cope with any anxiety you are facing. As you get more skilled at coping, it is possible to wean yourself off of antidepressants used for treating anxiety. 

MYTH

Anxiety is a real and serious medical condition. It is not a choice, nor is it a sign of weakness. It will not be resolved by thinking calm, relaxed thoughts alone. Changing your attitude can be helpful as part of a suite of interventions, but on its own, it is unlikely to resolve anxiety in the long-term. It is KEY to seek professional help. 

YES

In time the anxiety will go away on its own, although you may continue to experience bouts of anxiety if you have worries in your life. Menopause anxiety is caused by the changes in your hormone levels as you enter into the menopausal transition. When your hormone levels stabilize after reaching menopause (when you haven’t had a period for one full year / 12 months) your anxiety should also stabilize and go away. 

Anxiety is unpleasant regardless of why it starts. Anxiety is characterized by feelings of worry, feeling restless and on-edge, having difficulty focusing, and being irritable. It is also common to have insomnia, feel physically tense, and experience fatigue. Anxiety that starts during the menopausal transition is usually generalized anxiety, and you will feel chronic anxiety, worry and tension, even when there is no cause for anxiety and nothing is wrong. If you are already experiencing an anxiety disorder, such as social anxiety or obsessive compulsive disorder, your symptoms may get worse. See your healthcare provider to find the best treatment(s) to manage your anxiety. 

Anxiety is anxiety, regardless of whether menopause triggers it, so symptoms of menopause anxiety are the same as those felt with non-menopause anxiety. Symptoms associated with anxiety are commonly felt in the chest or abdomen, and include: 

• Feeling restless, wound-up, or on-edge
• Being easily fatigued
• Having difficulty concentrating; mind going blank
• Being irritable
• Having muscle tension
• Difficulty controlling feelings of worry
• Presence of ‘self-soothing’ behaviours such as nail-chewing or handrubbing
• Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep [2]

Anxiety that starts during the menopausal transition will typically resolve itself once your hormones stabilize as you enter menopause. It is still important to seek help if your anxiety is strong because anxiety is treatable. There is no need to suffer for the length of your menopausal transition. 

When you have not had a period for one full year (12 months), you have officially entered menopause.

The most common reason for spotting after menopause is hormonal imbalance. This can be caused by a variety of factors, including changes in diet, stress levels, and medications. Other potential causes of spotting after menopause include uterine fibroids, endometriosis, and ovarian cysts. In rare cases, spotting after menopause may be a sign of cervical or endometrial cancer.

During perimenopause, the time before the period ceases,  it is normal for women to experience bleeding that is heavier than usual. This bleeding can last for a few days to a few weeks. In some cases, the bleeding may be so heavy that it interferes with a woman’s daily activities. If this occurs, it is important to see a doctor to determine the cause of the heavy bleeding.

The answer to this question is not entirely clear. There is some evidence that heavy bleeding may occur before menopause, but the research on this topic is still relatively limited. It’s possible that heavy bleeding may be a symptom of perimenopause, which is the transition period leading up to menopause. During perimenopause, hormone levels fluctuate and can cause changes in the menstrual cycle, including longer or shorter periods, or heavier or lighter bleeding.

The most common reason for spotting after menopause is hormonal imbalance. This can be caused by a variety of factors, including changes in diet, stress levels, and medications. Other potential causes of spotting after menopause include uterine fibroids, endometriosis, and ovarian cysts. In rare cases, spotting after menopause may be a sign of cervical or endometrial cancer.

You might be in menopause if you have any of the following symptoms: irregular periods, hot flashes, night sweats, sleep problems, vaginal dryness, or mood changes (and there are more). These symptoms can occur gradually or suddenly. If you think you might be in menopause, talk to your practitioner.

More on symptoms of the menopause transition

It’s a question that many women ask as they approach middle age.

Once a woman has gone 12 months without having a period, she is considered to be in menopause.

Perimenopause is the transition time before a woman is in menopause and in general begins in their mid 40s or 50s.

Perimenopause is the transition period leading up to menopause. It’s different for every woman, but usually starts in her 40s. For some women, perimenopause lasts a few years; for others, it can last up to 10 years. The symptoms of perimenopause are caused by changes in hormone levels. These changes can cause hot flashes, trouble sleeping, mood swings, and weight gain.

Menopause is the biological process, not a medical condition, that marks the end of a woman’s reproductive years. It’s diagnosed after 12 months without a menstrual period and can be confirmed with blood tests.

If you’re one of the many women experiencing symptoms of menopause, you may be wondering what relief is available. While there is no cure for menopause, there are treatments that can help relieve your symptoms.

Though these symptoms can be uncomfortable, there are solutions available. Some women find relief with over-the-counter treatments like lubricants and moisturizers. Some may need to consult with their doctor to discuss hormone therapy. Others find relief with nutritional therapy, movement therapy and mind body wellness therapy.

Menopause is a natural biological process that marks the end of a woman’s reproductive years. While most women experience menopause in their early 50s, the symptoms can last for years. For some women, menopause is a time of great transition and they feel completely comfortable with the changes. Others find the symptoms to be disruptive and long-lasting. The good news is that there are treatments available to help manage menopause symptoms.

Symptoms associated with the transition into menopause become noticeable in your mid-40s. This is typical, but some women start to experience symptoms in their 30s, while other women start noticing them in their 50s.  

The menopausal transition lasts, on average, for 7 years, but can last up to 14 years. Some women experience only one or two symptoms, while other women experience many. Not all symptoms happen at the same time, and not all symptoms will last for the entire time.

Menopause is different than perimenopause.  When you have not had a period for one full year (12 months), you have officially entered menopause.

The stage just before menopause has several names – perimenopause, the menopausal transition, or simply ‘the change’. When it starts and how long it lasts vary from woman to woman. During this transitional stage, your hormones begin to fluctuate, sometimes wildly.

The most common symptoms of perimenopause are hot flashes &  night sweats, anxiety, cognitive changes, metabolism & weight changes, mood changes & rage and insomnia & sleeping difficulties.

Learn more

There are dozens of changes and symptoms associated with menopause found in five major categories:

1. Vasomotor [Temperature]
2. Urogenital [Vagina and Urinary Tract]
3. Psychological [Mental Health]
4. Somo-Vegetative [Body]
5. Somo-Vegatative [Head]

Some of these are temporary whereas others can be permanent. Individual women often experience a range of symptoms from each category, varying from hot flashes and night sweats to anxiety and mood swings. Clinicians pair information about a woman’s symptoms with the date of the last menstrual period to determine whether a woman is likely to be in perimenopause, also known as the menopause transition.

Learn more

FALSE

It is true that Tai Chi is a gentle soft practice, with slow transitions between postures. However, Tai Chi is a form of martial art, and some styles of Tai Chi maintain martial art techniques including fast, almost explosive movements among the soft slow postures. When practiced properly under the guidance of a qualified teacher tai chi can be very physically demanding.

Absolutely not true. Like any healthcare provider, training is required. Although the specific details may vary, to be a registered acupuncture practitioner requires completion of an approved program of study, successful completion of an approved examination and a minimum number of hours (typically around 500) within the two years previous to application for registration. Always check the credentials of any healthcare professional before using their services to ensure that they are qualified and able to perform safe treatments. 

FALSE

Not true. Many acupuncture patients actually fall asleep during treatment because they are so deeply relaxed. The needles are very thin, and are nothing like the needles that are used to draw blood or give medications.

 FALSE

Ummm, no. Rattlesnake venom is a natural product but it isn’t safe for human consumption. Same with plutonium and boiling water – you shouldn’t put those on your skin if you are interested in safety. Hydrogen sulfide is natural but if you breathe it in, rotten eggs are the last thing you smell. Ever. Essential oils are highly concentrated substances that have the potential to be harmful, especially if used in large doses. Talk to your doctor or a qualified, properly-trained alternative healthcare professional before trying any new aromatherapy. Document any reactions you have after using essential oils as allergies to some essential oils are common. 

YES

Yes, meditation and mindfulness are easy quick ways to inject calm and peace into your busy day. But getting long-term benefits that last beyond the immediate time you are meditating does require practice. Regular long-term practice will provide the best results, such as maintaining a calm and peaceful mind throughout the day regardless of external stressors. The word ‘practice’ is intentional – like any other skill, meditation and mindfulness require an investment of time to fully develop and benefit from them. 

FALSE

Quiet is definitely helpful for meditation and mindfulness, especially if you are just beginning. However, quiet is not required. Mindfulness, where you increase your focus and awareness of the now, can happen anywhere – noticing the sensation of the steering wheel beneath your hands as you sit in a traffic jam is being mindful. Meditation is also easier to practice in quiet locations, but experienced meditators know that it is possible to overcome distractions. Gurudev Sri Sri Ravi Shankar, an Indian guru (spiritual teacher) notes “What you resist, persists!”, meaning that the more you struggle against noise and distractions, the more they will bother and interfere with your meditation. The approach to meditation in a noisy environment is to become aware of it, acknowledge it, and then return to a focus on your breath. As you practice this regularly, there will come a time when you are able to transcend the distractions and they will stop bothering you. 

FALSE

These two terms are often used interchangeably, but in fact mindfulness is just one of many types of meditation. Mindfulness meditation is a practice of focusing your attention on the present moment. If thoughts intrude (which they often will) they are noticed and released without judgement. The focus then turns back to the present moment. Mindfulness can also be a regular part of your daily life, where the key is to focus on what is happening in and around you. Eating, walking, and/or cleaning the house can all be done mindfully and this mindfulness interrupts the common tendency in all of us to dwell unnecessarily on challenges, stressful situations, and never-ending to-do lists.

NO

Not true! Practicing yoga is appropriate for all ages, shapes, and sizes. It is important to start your yoga practice in an appropriate class – so if you are recovering from an injury, suffering from perimenopausal body pain, or have any health issues, make sure you choose a gentle class rather than a hot, high-intensity yoga class that can cause injury. 

YES

While the point of yoga is not to achieve and hold contorted postures, the physical element of yoga was specifically developed to exhaust the body so that the mind can be clear and relaxed for meditation. While some types of yoga focus on restorative postures that are designed to relax and calm the body, if you want a workout, yoga can also get you sweating. It’s your choice – there are many types of yoga and some are very physically demanding. 

FALSE

Yoga is about mindful movement and focusing your attention on your breath as you perform various yoga postures. It’s an attitude of presence and self-acceptance, focusing more on ‘how’ than ‘what.’ Yoga poses are only one part of a larger practice that includes breathwork and meditation. A focus on doing, getting into, or holding yoga postures is not a part of the real yoga. No pain, no gain is the opposite of real yoga philosophy.

FALSE

Oh, please.

A national study of 5,045 older women [11] showed the following:

FALSE

No, there are many safe and effective non- prescription medications that can be used to lubricate your vagina. A vagina is a muscle, and it needs exercise.

FALSE

Vaginal healthy aging can be had by using non-prescription lubes, HT with estrogen, and regular exercise with masturbation and intercourse.

No.

Urine leakage can also be caused by damage done to the urethral sphincter during childbirth, as a complication of obesity and as a side-effect of urological surgeries such as a hysterectomy.

YES

Kegel exercises, done routinely, help with stress incontinence in most women. It is helpful to do Kegel contractions when exercising, walking, stretching or during yoga.

MYSTERY

Research has shown that declining levels of estrogen are associated with the development of peripheral neuropathy. [2] How declining estrogen levels actually cause the nerve damage of peripheral neuropathy is an area of concern that needs further research.

FALSE

Neuropathy symptoms can vary dramatically, depending on the cause and the stage of neuropathy. The peripheral nerves involved will determine where your symptoms occur (neuropathy of your sensory nerves can affect what you feel; neuropathy of your motor nerves can affect your balance or your grip; neuropathy of your autonomic nerves can be extremely dangerous by affecting your heart or breathing rates. As well, early neuropathy symptoms are usually experienced as mild numbness and tingling, while neuropathy at later stages can be experienced as sharp pains, loss of balance, or significant muscle weakness.

FALSE

Research studies have shown that peripheral nerves can be healed after they have been damaged. The process is slow and depends on the severity of the damage and the time that has passed since the damage. If decreased estrogen during your menopausal transition is the cause of your peripheral neuropathy, hormone therapy may stop your symptoms. Working with a physical or occupational therapist can also be helpful. Talk to your healthcare provider to find the best treatment approach for your individual situation.

FALSE

While peripheral neuropathy is common in diabetic patients, there are over 100 types of peripheral neuropathy all of which have their own cause other than diabetes. Other causes of peripheral neuropathy include decreased levels of estrogen, chemotherapy, B-vitamin deficiency, and side effects associated with commonly prescribed medications.

MYSTERY

Insomnia is a very common condition in modern life and is caused by environmental, social and biological factors. Research is actively trying to untangle the complex outcomes of these interactions.

FALSE

TV may be boring, but bright light and blue light can disrupt melatonin release and biological clocks.

FALSE

No, insomnia is common, and as a result there are many helpful therapies and self-care actions available to address it.

FALSE

At first alcohol is relaxing, but it actually interferes with the brain and body’s ability to sleep deeply and for long periods.

No. Absolutely not.

Your skin is not your muscles – you don’t want to feel the burn. If your skin burns, stings or tingles when you use a product it means your skin is being irritated. Stinging and burning are also indicators that the pH of your skin is being altered and your natural oils are being stripped off of the surface of the epidermis. These can all lead to more acne, blemishes, dryness or wrinkles. Be kind to your skin and use products that make it feel good.

NOT TRUE at all

If you care about both your skin and your wallet, carefully read the list of ingredients first and notice the fancy packaging second. The simplest and cheapest precautions are often as, or even more, effective than the more expensive products. Using inexpensive sunscreen and moisturizer (after confirming the ingredients) will have the same long-term results as more expensive products. The key is to be consistent with your skin care and to start as early in life as possible. No amount of expensive or fancy treatments started after your appearance starts to age will give you better results than starting early and sticking with it.

NOT TRUE

Genetics plays a role in how you age and when your age starts to show, but like most other factors in life, there is also a large role played by your behaviour and your environment. Your natural aging process will be affected by your skin care routine and by the amount of exposure you have to sun and UV light. Other environmental factors, such as cigarette smoke, pollution, heavy drinking or chronic insomnia, can also speed up the appearance of aging.

FALSE

Wrinkles are usually the first thing that people notice as they age, but there are other signs that trained dermatologists or skin care technicians can see, including skin tone, fine lines, colour changes and changes in texture. It is never too early to start a good skin care routine that will delay the signs of aging for as long as possible.

FALSE

Research suggests that prolonged sun exposure does not increase levels of vitamin D because the body can only absorb a limited amount of vitamin D at a time. Prolonged sun exposure will, however, increase the risk of skin cancer and premature aging. Most people need about 10-20 minutes of sunlight a day to meet their vitamin D requirements. This varies slightly based on the lightness or darkness of your skin tone. You should get more than enough sun exposure walking to your corner store. If you think you could be at risk of a vitamin D deficiency speak to your healthcare provider.

NOPE

It sounds like SPF 50 is way stronger than SPF 30 but the truth is that SPF 30 sunscreens filter about 96.7% of UV radiation while SPF 50 sunscreens filter 98% of UV radiation. [17] Your sunscreen should be a minimum of SPF 30, and remember to reapply it every two hours, after swimming, sweating, or towel drying.

YES

Darker skin tones are still susceptible to cancer because UVA and UVB rays still penetrate the epidermis to the dermis. Regardless of skin type, exposure to UV radiation from the sun and other artificial sources can cause skin to be permanently damaged.

Maybe

Yes, unless the cosmetic product is labeled SPF30 or higher, is also a broad-spectrum sunblock, and you are only out for a short period of time in the sun. You will need to wear additional sunscreen under your makeup if you’re going to be in the sun for an extended period. For longer periods of time in the sun, use a separate sunscreen and reapply it every two hours. Look for the label – most cosmetics offer no sun protection whatsoever.

Not at all.

Having darker skin from a fake tan does not block UVA or UVB rays. To do this you need to use a proper broad-spectrum sunscreen. Some fake tanning products are rated with an SPF (sun protection factor), so if the SPF is above a 30 and if the product is certified broad-spectrum, you may be fine for limited exposure right after you apply it. Remember that all sunscreens need to be reapplied every few hours and after getting wet so don’t rely on your fake tan with sunscreen for long-term protection beyond what you would get with a regular sunscreen.

Not true at all.

You can get sun damage on windy, cloudy and cool days because sun damage is caused by ultraviolet (UV) light radiation, not temperature. UV radiation penetrates cloud cover and remember it is a light wave – it doesn’t get blown around. Sun damage is also possible on cloudy days, as UV radiation can penetrate some clouds, and may even be more intense due to reflection off the clouds. Most weather apps have a UV forecast that can indicate the true level of UVA and UVB rays on any given day so you can check and this will remind you to put on a broad-spectrum sunscreen. 

Nope.

The thickness of your hair is determined by the density of your hair follicles in your skin. This is absolutely not affected by shaving or cutting your hair short. 

NOT TRUE

Stress can cause temporary hair loss, called telogen effluvium, but learning how to cope with and manage your stress will result in your hair returning to its normal thickness. 

Not true.

Chemicals can damage your hair and it is possible that your hair could break or be weakened, but shampooing, even vigorously, and normal hair treatments are not going to affect the hair follicle and cause the actual hair shaft to detach from the blood supply, die and fall out. 

MYTH

While the changes happening to your body during the menopausal transition can impact a woman’s sexual health and sexuality, there are many treatment options available. Talk to your healthcare provider to see if you need any medical interventions such as a prescription for hormone therapy that can help with changes like vaginal dryness.

Oh yes they do!

A national study of 5,045 older women [11] showed the following:

MYTH

While variable hormones during the menopausal transition can impact sexuality, there are many effective treatments that can restore sexual function. These include hormone therapy, vaginal lubricants, sexual aids, and counselling or therapy. Contrary to this myth, many women experience an increase in desire. This could be hormonal, but is also influenced by factors such as lowered stress and enjoying the privacy that comes when children move out of the house.

MYTH

Unfortunately, this is not true. While gum disease can definitely cause bad breath, it is not the only cause by far. If your bad breath or a bad taste in your mouth doesn’t go away, talk to your dentist or your healthcare provider to see what the cause could be.

MYTH

Gum disease is painless so there aren’t any obvious indicators that you are experiencing gum disease. Your dentist can help determine if you are at risk. If your gums are red and sore and / or bleed easily you are at an early stage of gum disease and the condition can be reversed with the help of proper dental care. 

MYTH

No, unfortunately gum disease is very common. The US Centers for Disease Control and Prevention states that 50% of adults over the age of 30 have some form of gum disease. You can help keep your gums healthy by practicing good dental hygiene and brushing and flossing regularly to remove the buildup of plaque on your teeth.

While the obvious answer is found in gender, age and racial inequity, the study of mid-life women’s sexual and reproductive health has historically been less profitable than fertility. Thankfully the “menopause market” is on the rise, which will hopefully drive more dollars into the evidence-based scientific research that is so badly needed to drive more safe, effective and personalized treatments for menopausal women. 

MYSTERY  

Obesity research is starting to find some of these answers, but frustratingly at the moment it remains a mystery.

MYTH

Healthy weights can be achieved and maintained. While hormones affect metabolism and fat deposition, achieving a healthy weight and comfort with your changing body is always possible. 

MYTH

Absolutely not – as the science shows, fat is complex and influenced by multiple factors including female hormones, and metabolism. Will power can help you make positive choices, but losing weight occurs over the long term, so behavioural changes around food and movement are very important to stoke your metabolism. 

MYTH

Hormone therapy with estrogen, combined with regular movement, good nutrition, and good sleep can help women decrease their weight.

MYTH

Big stressors such as moving, starting a new job, or seeing your family over the holidays can definitely have an impact. However, the everyday stressors like traffic jams, running late to pick up the kids from daycare, or misplacing your keys are the most likely triggers for tension headaches. Not only are these stressful on their own, they can also cause you to physically tense up or clench and tighten your jaw. These in turn can trigger tension headaches or make them much more likely.

FALSE

Nope. Not true.

There are multiple treatment options available. While medications are often effective and available, they can become part of the problem if they are used too frequently.

Experiment with at-home treatments such as meditation and mindfulness practices, or dietary detox (eliminating different food groups and seeing if there is any change in your condition when you, for example, stop eating dairy or soy products). Talk to your healthcare provider about all of your options. 

While this is true to a certain extent, if you suffer from frequent migraines and you take medication for them, you are at risk of a condition called medication-overuse headaches. Talk to your healthcare provider about finding alternative treatments if you suffer from frequent headaches or migraines and use medications to con

MYTH

Caffeine can trigger headaches, but it can also relieve them. Caffeine is a vasoconstrictor that causes blood vessels to narrow and restrict the flow of blood. This can help reduce headache pain. When caffeine is combined with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, studies have shown that the pain relief is boosted by up to 40%. 

Having a cup of coffee when you feel a headache coming on may be helpful, but remember, too much caffeine, or rather the withdrawal of caffeine, can also cause headaches. If you have been drinking a lot of caffeine and you stop or slow down your consumption, your body can go into withdrawal and you can get a headache as a result. If you are planning on reducing your caffeine intake, remember to do it slowly!

FALSE

Headaches and migraines are often separated from each other based on the presence of an aura before the pain starts. The aura is usually experienced as visual disturbances or hallucinations such as flashes of light. In fact, less than one third of migraines have a distinct aura stage.

FALSE

A migraine involves more than a typical headache. In fact, headaches are often one of many symptoms of migraine. These other symptoms can include sensitivity to light and noise, nausea, weakness, and vision problems all of which can be as disabling as the headache pain.

False false false.

Good nutrition and balanced mineral and vitamin intake is very important to your overall health. Both supplements and moderate cleanses (such as detox or juice cleanses) can be helpful in certain conditions and when supervised by your healthcare provider. But fatigue is not just a nutritional issue. Good nutrition will support an energetic lifestyle, but good high-quality sleep on a regular basis is the key to managing fatigue. 

FALSE

Sleep is not money – you can’t save it or borrow it or keep some aside for a rainy day.
You can’t tell if someone is fatigued There are symptoms that may indicate a worker is fatigued, such as short term memory problems, an inability to concentrate, impaired decision-making, slow reflexes and withdrawal from interpersonal communication.

NO

Long-term sleep deprivation, which would occur if you were only sleeping five or six hours a night, can have serious consequences for your physical and mental health. Most people require a minimum of seven to nine hours of sleep per night.

FALSE

Feeling fatigue is a physical experience – you can’t just decide to not experience it. The best approach to fatigue is to ensure you are getting enough high quality sleep. Remember that insufficient or poor quality sleep can happen for many different reasons. Practice self-care, read the suggestions above in the self-care section or those in the Sleeping Difficulties document [link to Sleeping Difficulties] for helpful suggestions. 

FALSE

There are many different problems that can result in the feeling of vertigo. The inner ear is the most common, but other issues including medication side effects, stress, hormonal changes, or high blood pressure can also cause vertigo. [8] 

MYTH

Not true. Acrophobia is the technical name for having a fear of heights. It can happen if you are up a ladder or look out of a window in a tall building, and it can also be a debilitating disorder if you have serious acrophobia. Acrophobics may have the sensation of vertigo when they are having a stress response to being high up, but vertigo can come from many different causes.[8] 

FALSE

Vertigo has multiple other symptoms that usually happen at the same time as the sensation of spinning. These include nausea, vomiting, sweating, headache, changes in your hearing, tinnitus, loss of your balance and the sensation that you are being pulled sideways. [8] 

MYTH

Not true.  The terms vertigo and dizziness are often used interchangeably, but their symptoms and their causes are different. Typically dizziness makes you feel like your head is spinning, and vertigo makes you feel like the world is spinning around you or the floor beneath your feet is tilting. [8] 

MYSTERY

While the obvious answer is found in gender, age and racial inequity, the study of mid-life women’s sexual and reproductive health has historically been less profitable than studying fertility. Thankfully the “menopause market” is on the rise, which will hopefully drive more dollars into the evidence-based scientific research that is so badly needed to develop more safe, effective and personalized treatments for menopausal women.

FALSE

Unfortunately, women experiencing the menopausal transition continue to be excluded from the workforce where they feel embarrassed and isolated by their untreated symptoms. Slowly this is changing as employers and insurance companies start to realize that leaving the health concerns of this enormous group of workers unaddressed is costly.

MYSTERY

Sometimes yes. Sometimes no. Dry mouth (xerostomia), tingling in the mouth (paraesthesia), taste disturbances (called dysgeusia), and burning mouth and/or tongue (glossodynia) can occur at the same time or can occur individually.

MYSTERY

There is no clear answer to this question. It is likely that hormone fluctuations are involved because the problem happens most frequently in peri- and post-menopausal women but there have been no conclusive studies that support this hypothesis. To get a diagnosis of primary Burning Mouth Syndrome all other factors must be ruled out. The label of ‘primary’ means that no cause can be found.

Mystery

Medical research has shown that decreasing estrogen and a steep rise in follicle stimulating hormone (FSH) during menopausal transition contribute to bone loss.

Mystery 

New therapies are under development for managing the decline in follicle-stimulating hormone (FSH) during the menopausal transition. 

FALSE

Many women maintain adequate bone strength throughout their lives. Osteoporosis is a result of many life history factors including genes, puberty, diet, smoking, caffeine intake and physical activity. 

MYTH

We are absolutely done with this thinking at Herstasis. Pain is a sign that there is a problem and the first step is to talk to your health-care provider. If they don’t treat your pain with compassion and empathy, find another health-care provider. Together you can come up with a plan to identify the source of your pain and then you can determine the best course of action.

MYTH

No. No. No. No. Pain is a sign that something is wrong, listen to your body. Pain can be treated, but there is no way to start treatment if you do not acknowledge the pain in the first place and seek help. Talk to your health care provider about your pain, track it over time to see if it is coupled with any other symptoms, and start a treatment plan. There are many healthy ways to manage chronic pain including professional counseling, support group meetings, mindfulness training and breathing exercises, meditation, and the use of various medical therapies, devices and techniques.

MYTH

Not True! Changes in estrogen levels can impact the levels of inflammation throughout the body, which can then increase pain in multiple parts of the body. But pain is not normal, it is a signal that something is wrong. Talk to your healthcare provider about any changes to the levels of pain you are experiencing. If the underlying cause can be identified then treating the source of the pain is possible. Even if there is no clear cause, such as with fibromyalgia, your healthcare provider can help you find ways to manage the pain. Practicing self-care as outlined in the above material can also make a big difference. 

MYSTERY

Research supports the fact there is a gender difference in the way pain systems function. Studies have found that there is a higher density of nerves in women that may cause a greater sensitivity to pain. The pain itself may be at a similar level but the perception of pain is different, with women perceiving more pain than men for similar stimuli. [12]

A fascinating study on pain and sex hormones looked at a unique study group – individuals undergoing sex-change procedures. One research trial showed that 30% of men who started taking female hormones began experiencing chronic pain during their treatment. When women started taking testosterone as part of their sex-change transition, more than half reported a reduction in their chronic pain. [8] The underlying processes around how sex hormones impact pain tolerance are poorly understood at the moment. Researchers propose that testosterone somehow reduces or blocks the pain signaling pathways in the central nervous system. Conversely, estrogen reverses this and stops any blockage of pain signals so pain sensitivity appears to increase. [8] 

FALSE

This is not true. Sensing pain is subjective so it is highly variable amongst individuals. There is also a clear difference between how men and and women experience pain. Recent research has shown that male and female [mice!] differ in the neural pathways to sensing pain. Male mice that lack testosterone experience the ‘female’ path, and females that lack T cells (special cells involved in the usual female pain transmission path) or are pregnant switch to the pathway seen in male mice. More research is underway to understand this better. [11] 

NOPE, not true at all.

The blood that leaves your body during menstruation isn’t toxic, and it isn’t ‘bad’ in any way. Rather it is a normal, healthy result of your menstrual cycle. Menstrual blood will not interfere with your sexuality and it does not mean you are unclean in any way. 

FALSE

Birth control pills are often used to manage menstrual blood flow and are commonly prescribed for heavy bleeding. Older versions of birth control pills did have high doses of estrogen, which increased the risk of blood clots in women over 35, however today’s birth control pills use much lower doses of estrogen and do not carry the same risks. In fact, today’s birth control pills are known to have benefits that include a lower risk of ovarian and endometrial cancer. Birth control pills are not recommended for women over 35 who smoke, have high blood pressure, or have a history of heart disease.

YES

There are several treatment options available, some of which, like a hormonal IUD, can be used to treat heavy periods for up to five years. Talk to your healthcare provider to find the best solution for you.  

YES

Heavy bleeding and/or long menstrual periods can lead to health issues including iron deficiency anemia (IDA). As well, heavy bleeding can have a major negative impact on a woman’s quality of life because it can interfere with daily activities.

NO

Not true. Heavy bleeding during the menopausal transition is linked to obesity and fibroid tumours. If you experience heavy bleeding and are not in the menopausal transition, talk to your healthcare provider to rule out any serious health issues.

FALSE

Heavy periods that involve losing more than 80mL of blood (5.5 tablespoons) are not normal. This condition is called menorrhagia and current research suggests they are not totally hormonally driven. Rather they are also linked to obesity and/or the presence of fibroids (fibroid tumours). [5] 

FALSE

Depression and anxiety have complex root causes and can happen to any person, old or young, rich or poor, large and small. From the outside, you may seem to have “all you need” and still be depressed or anxious. You may also have seemingly little, and have a high quality of life with balanced moods.

NO

Depression is NOT just feeling sad and is not a character flaw. Depression is  a complex disorder that can have social, psychological and biological causes. Do not think that you can just wish it away, or that it is normal to feel this low all the time. While human sadness is part of our condition, when it occurs frequently and/or in intense episodes, this is a real and serious medical problem. Talk to your healthcare provider about how you feel.

MYTH

Stress is part of life and can be very hard, if not impossible, to avoid. It is important to seek out help to learn effective coping strategies for stressful situations. This is especially important if you are aware that certain situations (like interpersonal conflict) can trigger your anxiety. Finding coping strategies that work is possible and using them successfully can have broader positive impacts as you successfully manage stressful situations. 

FALSE

Discussing depression does not make it worse or keep you focused on feeling depressed. In fact, feeling isolated and alone in your depression can be very harmful and can make your depression worse. Talking to any supportive listener, be they a friend, family-member, or colleague, can be a huge help, especially if they have had or are having similar experiences. This can reinforce that you are not an awful or weak person, rather you are just struggling at the moment with a health crisis. Talking to a qualified and certified therapist or counselor can literally be a life-saver.  

FALSE

It is true that antidepressants are used as a long-term treatment option for some people diagnosed with depression. Psychotherapy, which is often prescribed along with antidepressants, can help you learn strategies to cope with any challenges you are facing. As you get more skilled at coping, it is possible to wean yourself off of antidepressants. However, if your depression is a result of imbalances in your brain chemistry, you may keep taking antidepressants indefinitely. Consider that this is similar to taking high blood pressure medications. If you can control your high blood pressure with lifestyle adjustments then you may not need long-term medications for blood pressure management. If, however, your high blood pressure is caused by genetic or biological factors, you may need to stay on a long-term course of medication. 

FALSE

Genetics do play a role and a family history of depression does increase the likelihood of experiencing depression. However, genetics is not the only factor at play, and everyone, regardless of family history, can work to minimize their risk of depression with simple actions like ensuring high quality sleep and avoiding drugs and alcohol. 

FALSE

Depression is a real and serious medical condition.  It is not a choice, nor is it a sign of weakness. It will not be resolved by thinking happy thoughts alone. Changing your attitude can be helpful as part of a suite of interventions, but on its own, it is unlikely to resolve depression in the long-term. It is KEY to seek professional help. 

MYTH

Depression is generally treatable, and antidepressants are a common tool that is used for treatment. However, antidepressants work by changing the chemistry in your brain, so they will not help if the cause of your depression is not biologically based, and they often take weeks if not months to take effect. In some cases, multiple antidepressants must be tried before the one that works for you and your brain chemistry is found. Many healthcare providers will also prescribe psychotherapy in addition to antidepressants.

YES

Anxiety is not just feeling worried and it is not a character flaw. They are complex disorders that have social, psychological and biological causes. Do not think that you can just think them away, or that they are normal. Help is available so talk to your healthcare provider. While sadness, stress, anxiety, and worry are normal and common, when they occur frequently and/or in intense episodes, this is a real and serious medical problem. 

FALSE

As long as the microorganisms stay at stable levels, even potentially harmful ones like E. coli can live without causing harm. The microbiome is exactly that – a small separate ecological community that exists in isolation in your gut. As long as it is in the correct balance for your own individual needs even deadly bacteria can live there and cause no problems. 

FALSE

Your diet supplies nutrients that support or oppose the presence of particular microorganisms. Fibre (also known as roughage), the edible parts of plants that are resistant to digestion, is definitely important for promoting ‘good’ microorganisms, but sugars, fats, and proteins have all been shown to impact the microbiome in various, not always positive, ways. Sugar, or fructose, for example, prevents Bacteroides thetaiotaomicron from increasing in number in the gut. This can cause issues because Bacteroides thetaiotaomicron ferments fibre from fruits, vegetables and beans, all of which keep the gut healthy. Too much protein can lead to the overgrowth of bacteria because protein is rich in nitrogen which encourages the growth of bacteria. [16]

^{[16] Townsend GE, Han WW, Schwalm ND, Raghavan V, Barry NA, Goodman AL, et al. Dietary sugar silences a colonization factor in a mammalian gut symbiont. Proc Natl Acad Sci USA. 2019;116(1):233–8. https://doi.org/10.1073/pnas.1813780115.}

MYSTERY

Current studies – on humans and on animals – support the hypothesis that estrogen is involved with the experience of multiple abdominal symptoms and that it also provides protection from some serious abdominal diseases such as cancers and ulcers. Hopefully more research is underway to get a clearer idea of how estrogen is involved and what treatments are needed, if any. [15]

^{[15] Nachtigall, Lila E. MD, NCMP1; Nachtigall, Lisa MD2 Menopause and the gastrointestinal system: our gut feelings, Menopause: May 2019 – Volume 26 – Issue 5 – p 459-460
doi: 10.1097/GME.0000000000001316}

FALSE

Nope, this won’t work and is a terrible idea! Once your immune system is sensitized to an allergen, you will keep having allergic reactions when you are exposed to that allergen. Allergy shots, or immunotherapy, do desensitize you to allergens, but this must be done under the care of an allergy specialist who will control the quantity, quality and time intervals of these shots. Talk to your healthcare provider for information if you think this may be an approach you are interested in. 

FALSE

Some allergic reactions can be deadly. An anaphylactic reaction happens when a very large amount of histamine is released into your system at once causing a massive inflammatory reaction. Symptoms include difficulty breathing, wheezing, stomach pain and cramps, diarrhea, anxiety, swelling of the feet, hands, lips, eyes, and possible loss of consciousness. Death often occurs when airways swell shut. Portable epinephrine injectors, (one common brand is called the EpiPen) are designed to auto inject a hormone called epinephrine, which works rapidly and stimulates the heart, raises blood pressure and reduces swelling in the throat, lips, and face. In Canada, EpiPens are available with or without a prescription. Ask your healthcare provider for advice on whether you should have one available. 

NO

If you know you will be coming into contact with a known allergen (visiting your friend who has a dog that you react to, for example), take your allergy medication (often an over-the-counter antihistamine) before you go. This can actually prevent any allergic reaction at all. 

FALSE

Absolutely not true, as most allergy sufferers can tell you. Some individuals seem to have more sensitive reactions than others and can have multiple allergies to multiple different allergens. Not all of these allergies will occur at the same time, nor will they all last the same amount of time. 

FALSE

Some allergies do, in fact, stick around for your whole life. The good news though, is that many allergies fade away as time passes. It all depends on the allergen and your individual system and sensitivities. 

FALSE

Developing allergies in adulthood is relatively common, and in fact nearly half of adults with food allergies had those allergies start in adulthood. While it is very common for adult-onset allergies to happen in your 20s and 30s, perimenopause is a time when many women start to suffer new allergies or have increasingly problematic symptoms to existing allergies. This is caused by the interactions of estrogen and progesterone with the immune system, because estrogen and progesterone bind to the parts of the immune system that trigger allergic reactions.

FALSE

Heavy smokers and drinkers, and women with nutrient deficiencies may experience hot flashes.

MYSTERY

As scientists unravel the science of hot flashes, they are also using this information to develop new treatments.

MYSTERY

Medical research isn’t clear on how hot flashes are triggered, but unstable and decreasing estrogen levels, plus the chemical messages of inflammation, may upset the body’s “thermostat” in the brain.

FALSE

However, they can trigger persistent insomnia which should be treated since chronic insomnia is dangerous.

No. There is a great deal of variability in the types and severity of symptoms. Genetics may play a role, so if possible, looking at your family history can help set your expectations for your own symptoms.

_{1. Dennerstein L, Dudley EC, Hopper JL, et al. A prospective population-based study of menopausal symptoms. Obstet Gynecol. 2000; 96:351–358. [PubMed: 10960625]}

Menopause is recognized to have happened after one year (12 months) without a period. You can also ask your healthcare provider to measure the blood levels of Follicle Stimulating Hormone (FSH) that rise during perimenopause and stay elevated during menopause.

_{1.http://www.menopause.org 2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.}

Genetic factors play a role in the timing of this transition, so if you are able, look to your family history to set expectations. Lifestyle quality and your general health will also contribute to the timing. However, there is a great deal of variability amongst women so it is impossible to predict with complete accuracy.

Make sure you have a supportive and knowledgeable healthcare provider who will give you annual health screenings who is pro- active about your concerns. Physiotherapists, psychologists, trained counselors, and nutrition experts can also help you manage your physical and emotional symptoms. http://www.menopause.org is a website that can help you connect with well- trained experts in perimenopause symptoms.

_{1. http://www.menopause.org}

_{2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.}

_{3. Santoro_2016_Perimenopause: From Research to Practice}

_{4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms}

_{5. Dasai and Brinton_2019 Autoimmune disease in women: endocrine transition and disease across lifespan}

Like other stages of life, eating a balanced nutritious diet, getting adequate high quality sleep, exercising regularly and maintaining a healthy body weight are key elements to good health. As well, share your experiences with family, friends and co-workers – not only does this normalize what you are experiencing and keep you from being isolated and alone, it will give your support system the information they need to assist you. Keep track of your symptoms and share these with your health care team. Take action where you can and stay positive.

_{1. http://www.menopause.org}

_{2. Melmed et al.Williams Textbook of Endocriology 14 th edition.}

_{3. Santoro_2016_Perimenopause: From Research to Practice}

_{4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms}

_{5. Dasai and Brinton_2019 Autoimmune disease in women: endocrine transition and disease across lifespan}

Menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT), is generally safe if you work together with a qualified healthcare provider. MHT is known to help many women with hot flashes, vaginal dryness, and keeping bones strong among other symptoms.

_{1. http://www.menopause.org}

_{2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.}

_{3. Santoro_2016_Perimenopause: From Research to Practice}

_{4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms}

_{5. Dasai and Brinton_2019 Autoimmune disease in women: endocrine transition and disease across lifespan}

For most women, transition symptoms will likely fade away within one or two years of menopause. You might also still experience insomnia, memory challenges and depression. Every woman is a little different.

_{1. http://www.menopause.org}

_{2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.}

_{3. Santoro_2016_Perimenopause: From Research to Practice}

_{4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms}

_{5. Dasai and Brinton_2019 Autoimmune disease in women: endocrine transition and disease across lifespan}

Some women gain adipose (fat tissue) around the middle even though there is no change in diet or lifestyle. You may experience bloating in your digestive system. If you have an autoimmune disease, it may become harder to manage. Migraines, depression and breakthrough bleeding are also associated with perimenopause.

_{1. http://www.menopause.org}

_{2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.}

_{3. Santoro_2016_Perimenopause: From Research to Practice}

_{4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms}

_{5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging}

Many women experience hot flashes, which are sudden surges of blood rushing to the surface of your face and torso. Other common symptoms include vaginal dryness, stress urinary incontinence (release of urine when you lift or sneeze), deep fatigue, insomnia, rapid mood swings and temporary forgetfulness.

_{1.http://www.menopause.org}

_{2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.}

_{3.Santoro_2016_Perimenopause: From Research to Practice}

_{4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms}

Your body enters into the late reproductive stage when it begins phasing out reproduction around age 35- 40. It may be harder to get pregnant at this stage of life. You may also experience an early or “premature” perimenopause at this time.

_{1.http://www.menopause.org}

_{2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.}

_{3.Santoro_2016_Perimenopause: From Research to Practice}

_{4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms}

_{5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging}

Your reproductive hormones are the main hormones changing their levels. These include estrogen and progesterone (from your ovaries), and luteinizing hormone (LH) and follicle stimulating hormone (FSH) from your hypothalamus located in your brain. During perimenopause, estrogen levels decrease overall, but might vary between very high or very low levels. These hormonal swings may account for mood disturbances (mood swings) and hot flashes.

_{1.http://www.menopause.org}

_{2. Melmed et al.Williams Textbook of Endocrinology 14th edition.}

_{3.Santoro_2016_Perimenopause: From Research to Practice}

_{4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms}

_{5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging}

Perimenopause, or the menopause transition, is a gradual, natural transition in your reproductive system that leads to menopause. It usually happens over 7-10 years and often starts around the age of 40. During perimenopause you will experience shorter and more irregular periods. The majority of women experience some troubling physical and mental symptoms.

_{1.http://www.menopause.org}

_{2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.}

_{3.Santoro_2016_Perimenopause: From Research to Practice}

_{4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms}

_{5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging}

Menopause is the day you have the last period of your life, which marks the release of your last ovarian follicle. Most of the troublesome experiences happen earlier during the perimenopause transition.

_{1.http://www.menopause.org}

_{2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.}

_{3.Santoro_2016_Perimenopause: From Research to Practice}

_{4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms}

_{5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging}

Yes, this is a normal symptom.

As estrogen declines during the perimenopausal transition, inflammation in your system develops because estrogen modulates your immune system and the biochemical signals that cause inflammation. You may notice you are developing osteoarthritis in some of your joints, and old joint injuries may begin to hurt and become stiff. As well, some women may experience an increase in their auto-immune disease symptoms.

To date, it isn’t known whether standard HT with estrogen is helpful for joint pain and inflammation. However it is known that joint inflammation can be reduced by regular moderate exercise including modified strength training. Low- impact exercises such as swimming and cycling are excellent at reducing pain and inflammation, promoting high quality sleep and they won’t damage your spine, knees and hips.

Episodes of rage and anxiety are normal. They may be intense but usually pass quickly. Changes in mood are not very well understood so treatment options are currently limited.

If you are concerned about your rage, seek help from your healthcare provider and/or trained counsellors/psychologists. As well, talking openly about this challenge with family and friends can help them understand what is happening and allow them to support you in ways that are meaningful to you.

Regular cannabis use by mid- life women in North America is fairly new and there is not much data on the safety and effectiveness of cannabis with respect to menopausal symptoms. Make sure your care provider knows about your cannabis consumption, particularly if you are using prescription medications.

Hot flashes can be addressed in many ways but it’s best to collaborate with your care provider to find a therapy that works for you. Menopausal hormone therapy (MHT) can be effective at reducing the frequency and intensity of hot flashes for many women. Antidepressants, meditation and relaxation techniques work also well as they lower stress hormones. Ensuring you are eating a well-balanced nutritious diet can also help.

A Stress urine leakage or stress urinary incontinence (UI) occurs when the pressure in your bladder is stronger than your urethra, the tube that empties your bladder. You may pee suddenly when lifting, jumping, laughing or sneezing. Stress UI happens during perimenopause and post-menopause when the muscles that keep your urethra closed weaken due to lack of hormonal support.

You can help strengthen your pelvic floor muscles with Kegel exercises – see a trained physiotherapist to get training on the correct set of exercises for you. HT with estrogen applied topically (in creams or tablets) within the vagina is effective for both dry vaginal pain and urinary incontinence. The outer third of the urethra is estrogen-sensitive. When the estrogen cream is applied to the vagina it can increase blood supply to the urethra and nerve function which can help strengthen the muscle.

It might be also advised to stay away from caffeinated drinks because caffeine is a bladder irritant.

You should request a bone density exam by age 65 in order to test for osteoporosis (fragile bones). If you are at risk for low- impact fractures (because of family history) or you have had a low- impact fracture, request this exam by age 50. Low impact fractures commonly occur from falls and result in breaking a wrist or fracturing a vertebrae or hip bone). These types of fractures indicate you may be developing osteoporosis. Losing height by 1.5 inches or more also suggests that you may have some osteoporosis in your spine.

Women who are low-normal or below normal weight, who smoke, drink alcohol, and have low rates of exercise are at higher risk for osteoporosis in post- menopausal life.

This isn’t necessarily due to menopause! During the aging process, the lens of your eye undergoes natural changes that may make it harder to adjust your focus. However, decreasing estrogen in your blood can disrupt tear and oil secretions needed for lubricating your eyes, which can make vision blurry or dry your eyes. Your optometrist or your pharmacist can help with therapies for these symptoms.

It is suggested that women see a healthcare provider specifically about menopausal transition when you start to notice that your periods are getting irregular or you start to experience symptoms.

Natural menopause happens when your ovaries develop and release their last follicle and egg and stop producing estrogen. Medically induced, or treatment induced, menopause happens when there is surgical removal of both ovaries (oophorectomy). Medical menopause occurs also when a severe medical issue like breast or uterine cancer has been treated or managed with chemotherapy, radiation therapy, and/or hormonal therapy.

A hysterectomy, which is the removal of the uterus, does not necessarily mean menopause – it depends if one or both ovaries were removed at the same time. However, women who undergo a hysterectomy to treat fibroids or excessive bleeding have a nearly two-fold increased risk for developing menopause early.

Yes! Until you have had 12 consecutive months without a period, use contraception if you don’t intend to get pregnant.

Note that women who become pregnant after age 35 have an higher risk of miscarriage, and more than half of all pregnancies after age 45 end in miscarriage.

_{American Society for Reproductive Medicine}

Mood swings are normal. They can be mild, very strong and disorienting or even make you feel giddy or reckless. Episodes of rage and anxiety may be intense but usually pass quickly. Mood swings are not very well understood so treatment options are currently limited.

If you are concerned about your mood swings, seek help from your healthcare provider and/or trained counsellors/psychologists. As well, talking openly about this challenge with family and friends can help them understand what is happening and allow them to support you in ways that are meaningful to you.

Two things happen to women mid-life: their biological metabolism slows down and hormone levels change, both of which can lead to an increase in weight gain. Two hormones in particular are known to affect weight gain: estrogen (that declines), and follicle stimulating hormone (FSH) (that increases).

As well, women often decrease their exercise and movement levels, may eat more and drink more alcohol, and their quality of sleep decreases. All of these factors combined can cause weight gain, particularly around the middle – called central adiposity. Weight gain is not inevitable – simple actions such as walking 30 minutes daily and paying extra attention to healthy nutrition can help manage this impact.

This life stage usually lasts 7- 10 years. If you have a high BMI, you may have a longer Menopausal transition.

Bio- identical hormones are reproductive steroid hormones, such as estrogen or progesterone, used in menopausal hormone therapy (MHT). The term “bio-identical” means the hormones in the MHT product are chemically identical to those your body produces.

Bio-identical hormones can be easily recognized and used by our bodies so the effects are more consistent with our natural biochemistry. As well there is a smaller risk of unpredictable side effects than with synthetic or non-bio-identical hormones.

There are FDA approved bio-identical hormones that are safe and effective, but there is no evidence to date that bio-identical hormones are more effective or safer than synthetic hormones. There are also FDA approved natural hormones that are derived from plants.

There are options to help reduce or manage some symptoms. The primary tool is called menopausal hormone therapy (MHT), also called hormone replacement therapy (HRT), menopausal hormone therapy (MHT), hormone replacement therapy (HRT) or hormone management therapy (HMT). MHT is helpful for decreasing hot flashes, improving the health of your vagina and urinary systems, and supporting your muscle and bone health and strength.

Unfortunately, other symptoms may not respond as well to MHT. Physiotherapy can help with physical pain and psychological counseling and therapy can help with emotional troubles. Lifestyle changes to promote quality sleep, good nutrition, and exercise are important and known to decrease menopausal transition symptoms.

No, about 20% of women have mild or no symptoms, or don’t seek medical care. About 40% of women have mild to moderate symptoms and seek medical care. Another 20 % have intense symptoms and need medical care.

Generally, women who have a high BMI and chronic stress in their lives tend to have more menopausal symptoms and those symptoms last for longer periods of time. Genetics may also impact your perimenopausal symptoms. There is a good correlation between the length and intensity of your menopausal transition and your mother’s menopausal transition.

No! Menopause is the life stage after the reproductive years. It is marked by the end of a woman’s menstrual cycles and is recognized when a woman hasn’t had a period for 12 months.

No! Perimenopause, also known as the menopause transition, is not a disease or a hormone deficiency disorder. All women go through this transition phase later in life (although the timing of onset does vary) and many have similar symptoms.

With medical support and the appropriate treatments many unpleasant and quality of life-impacting ‘symptoms’ can be managed. Talk to your health care provider if you are bothered by the changes you are experiencing.