Menopause: part of our journey of physical, mental and spiritual health

A message from Dr. Unjali Malhotra, FNHA Medical Officer, Women's Health

As a women's health specialist, I always enjoy meeting up with colleagues who have the same goal – to share the latest and greatest information about how women can live and age in our best health! I recently spent a wonderful week at the International Menopause Society meeting as a Canadian delegate, and want to share with you some of what we discussed about menopause.

Most of us know that menopause is a transition for women and marks a time of change, but at this meeting we discussed how we could also see it as representative of a lifelong journey of physical, mental and spiritual health. Part of what makes and keeps us healthy overall, including during menopause, is accessing safe and effective health care, which is something the FNHA is advocating for and working on; our genetics, which we should try to be aware of and work with; our environment, which we can do our part to improve, where possible; and healthy behaviours, including those encouraged by the FNHA in our four wellness streams, which we should all strive to practise.

Let's support each other in making these behaviours into habits that will give us all better health! Let's cook real food at home, walk together, and support each other in getting screening and quitting smoking. Following are some specific strategies and tips for dealing with the symptoms of menopause that I hope you will find helpful.

Hot flashes: The classic symptom of menopause is the dreaded hot flash. Strategies for coping include dressing in layers so as to be able to adjust your body temperature as needed, avoiding triggers like alcohol, maintaining a healthy body weight, and keeping iced/cool drinks on hand. You could also speak to your employer about a comfortable working temperature and flexible start times at work, as night sweats can disrupt sleep. And you can consider hormone therapy if you're within 10 years of your last menstrual period, under 60 years old, and have no condition that such therapy could worsen (this last would be determined by your healthcare provider).

Mental health: For some women, menopause is considered a "window of vulnerability" or "window of risk"; at this time of life, women can experience mood changes such as depression and anxiety.  For some, these changes could result in a significantly impaired ability to function well and a poorer quality of life. Those who have endured mental health challenges in the past, including post-partum depression and pre-menstrual syndrome (PMS), are at the greatest risk. Other triggers can be a stressful life event at the time of the menopausal transition or accumulative lifelong stresses. Mental health supports during this time include getting connected in a community or support group, undertaking cognitive behaviour therapy, practising mindfulness, and speaking to a healthcare provider you trust.

Bone health: Estrogen changes during this transition can impact bone strength. Bone strength and fracture prevention should both be lifelong considerations, as strong bones are so very important for our overall health. Things you can do to prevent fractures over your lifetime include consuming calcium-rich foods and Vitamin D (especially if you live in a cloudy city), and taking safe exercise.

Breast health: Breast cancer increases with age. At age 50, one in 43 women will get it; at 60, one in 29; and at 70, 1 in 26. Safe exercise, healthy eating and limiting alcohol intake can reduce breast cancer risk.  Risk factors for breast cancer include obesity and an alcohol intake of more than three drinks per week.  Currently, the most effective way to screen for breast cancer in BC is mammography; if an abnormality is found early, this can prevent a worse outcome. Nurturing your spirit and decreasing commercial tobacco will also positively impact overall health and wellness. For more information, you can visit these websites.  

Cardiovascular health: Hormonal changes in menopause are a complex influencer on cardiovascular health in women. Although almost 80% of premature heart disease and stroke is preventable, heart disease is the leading cause of premature death for women in Canada, and the rate of heart disease in Indigenous women is rising. According to the Heart & Stroke Foundation's report on women's heart health, heart disease is responsible for significantly more deaths in Indigenous women compared to non-Indigenous women. What's more, Indigenous women have been shown to die from heart disease at a younger age compared to non-Indigenous women.

An important thing about prevention of cardiovascular disease is early awareness. The First Nations Health Authority recommends that Indigenous people in BC follow the four wellness streams, which align with the four pillars of cardiac prevention: 1) maintaining a healthy body weight, 2) eating a healthy diet rich in vegetables, 3) exercising regularly, and 4) not smoking commercial tobacco. It has been shown that introducing all of these over four years can reduce the likelihood of a cardiac event by 40%. If done over decades, it can reduce the chance of an event by almost 90%.

Lifestyle interventions are key to prevention in many. Ways to reduce cardiac events include eating traditional diets, avoiding high-sugar foods and processed foods, exercising regularly, ensuring good sleep patterns, controlling stress as much as possible, and speaking to your healthcare professional about individual risk. This is all the more important if you are diabetic, which increases risk.

What else can you do? Talk with your healthcare provider about family members' health issues and what health steps you're taking to keep yourself healthy. And get your blood pressure checked! For more information about cardiovascular health, click here.

Gynecological health: Annoying issues can develop in the pelvis over time, but really at any age. Hormonal changes can result in bladder leakage, pain with sex, vaginal discomfort, and frequent urinary tract or yeast infections. Talk to your healthcare provider about managing these with one of the easy and safe treatments available, including lubricants or creams.  

Weight control: As we age, our metabolism changes. We may find that we are a little squishy in places we were not before, and that is harder to maintain a healthy body weight. There are so many different diets, and it can be so very confusing! Keep in mind the most important factors that are common threads in all diets: 1) avoiding processed food, and 2) decreasing sugar. Add to that safe activity, which benefits not physical but mental health!

Screening and prevention: To keep yourself healthy at this time of change, one thing to consider is prevention by screening and vaccines, such as the shingles vaccine.

Bleeding: Irregular bleeding, especially more frequent or heavier vaginal bleeding, is something that should be investigated as it can be a sign of abnormalities in the pelvis and/or body. Many women will encounter unwanted bleeding changes and may feel it is a normal part of the menopausal transition, however, please don't suffer unnecessarily! As women, we can at times grin and bear suffering. But I encourage you not to do this. Please be seen, be heard, and know that if something seems that it is not right, it warrants a check-up to figure it out!

Special Thanks: Dr Nandan Anavekar, Mayo Clinic; Dr Stephen Kopecky, Professor of Medicine, Department of Cardiovascular Diseases, Mayo Clinic