My name is Dr. Shafeena Premji.
I am a family physician with a special interest in women's health.
I have a clinic which opened five years ago, Mahogany Medical Clinic
where we provide menopausal care for women in Alberta.
I also am a board member of the Canadian Menopause Society
Menopausal hormone therapy is a safe option
for any woman in the perimenopause or in the menopause.
The Society of Obstetricians and Gynecologists of Canada
and the Canadian Menopause Society have released guidelines in 2021.
The guidelines recommend that any woman who is under the age of 60
or within ten years of their menopause are considered safe candidates
for hormone therapy.
Now, there are also a subset of women those who are under the age of 40
in premature menopause or those who are under the age of 45.
In early menopause, for these women, menopausal hormone
therapy is actually recommended for the prevention of osteoporosis,
cardiovascular disease and genital urinary syndrome of menopause.
The most common side
effects that women will tell us about are unscheduled vaginal bleeding,
which is usually only for the first 3 to 6 months from the onset of therapy.
We also see women talk and complain about some breast tenderness,
headaches, as well as fluid retention.
For those women who are also taking progesterone, oftentimes
we will see some mood fluctuations and sometimes they also
will complain of some drowsiness.
Is hormone therapy safe?
Well, there are a subset of women who.
Hormone therapy is contraindicated.
If you are a woman with a personal history of breast cancer,
if you have ever had a stroke, if you have a history of a clot
in your lungs or in the deep veins of your legs.
If there is any history of active liver disease, these are patients
who are contraindicated to hormone therapy and we do have offer it.
We do have options for non hormonal therapies as well.
Brain fog, lack of concentration and body aches
are most definitely symptoms of perimenopause and menopause.
Fortunately, when we specifically look at brain fog,
we know that it is considered a transient symptom.
In terms of how to manage this, it is a multifaceted approach.
So first of all, we recommend that you visit your health care provider
to assess and treat modifiable risk factors.
So things such as diabetes, high cholesterol and high blood pressure.
We also recommend that women consider stopping smoking
and also consider limiting their alcohol intake.
We recommend regular Exercise 150 minutes per week.
And finally, for those women who are looking for something else to do.
We recommend really trying to engage with the community socially
and challenging themselves.
That would mean including
potentially learning a new language or learning a new skill.
Although entering at a local community center.
So the question you have to ask yourself is when a hysterectomy is done,
are there ovaries left in place or are they removed?
If you have a hysterectomy and your ovaries are left in place,
this is not menopause.
This is actually just a cessation or a stopping of your menstrual periods.
If a woman has a hysterectomy and both her ovaries are removed
for various medical reasons, then this is considered
surgical menopause.
If we go back to 2002, when the Women's Health
Initiative report was released, it really put a big fear
of hormone therapy, both for women and for health care providers.
When the data was reevaluated, what we realized, what that was, that
the data had not been extrapolated and differentiated based on a woman's age.
And so when we reviewed the data now, we realized that
the data was incorrectly published initially.
What is exciting to know is that over the last ten years, there has been so much
time, energy and research into the care of the menopausal women.
As a board director, the Canadian Menopause Society, we work with
health care professionals across the country to help educate
and provide more information on how to care for these women.
In addition, over the last five years, we've had four Health Canada approved
products which have been released and are now available on the market
to help women with these symptoms.
So although, you know, this area has been considered,
we are coming a long way.
A lot of women, unfortunately, do also complain about weight gain in menopause.
And we do know that to weaken is not considered
abnormal or unusual for women in menopause.
In general, women will gain around 2.5 kilograms after they go through
this transition in life.
We know that there is a change in the fact distribution
and this is genetically and biologically determined.
We do recommend several lifestyle changes.
So for example, we recommend that women focus on decreasing
simple carbohydrates, decreasing portion sizes.
We also recommend regular physical activity, 150 minutes
per week, and particularly 2 to 3 times a week of muscle
weight lifting, because we know that when we lift
weights and move and burn calories by using our muscles,
it is a better and more efficient way of burning calories.
We also recommend a mediterranean diet.
And in addition, we also suggest that women really focus
on their sleep because we know that women who do not sleep well do tend to gain
weight more.
For women who cannot take hormone therapy, this is a very difficult,
challenging time for them.
Very fortunately, we do have medications which are non-hormonal therapies
to help women manage their vasomotor symptoms and night sweats.
So first line, first of all, we do have an anti depressant,
so B ss our eyes and and our eyes do have some effect on hot flushes.
We also have a medication called gabapentin.
Gabapentin is an anti-seizure medication or a medication
we use for neuropathic pain.
This medication has shown to improve hot flashes for women.
We have a very old blood pressure pill called clonidine,
and finally there's a medication which is been used for urinary symptoms.
It's called Oxybutynin.
And in the recent recent studies there has been some evidence
for their benefit as well for these symptoms.
How do we diagnose perimenopause and or menopause?
There is really no single test that can confirm this diagnosis.
This is a clinical diagnosis.
We as a expert panel
of the Menopause Society and the SGC do not recommend
any expensive salivary gland testing or any specific hormone testing.
As we know, as women go through the menopause transition,
there are constant fluctuations in their hormonal levels.
So really, if we were to do any kind of hormone testing,
it would really just be looking at a single point in time.
We therefore do not support any kind of formal testing.
And what we do recommend,
however, sometimes is a screening for thyroid dysfunction,
because many women in this age do experience thyroid disease.
As a family physician myself, we are your health advocates.
We support and recommend health prevention and health promotion.
The challenge really lies in the medical school curriculum.
We don't have any formal training in menopausal care and care of the women
in the menopausal transition, in our medical training and residency
programs also have very limited, if any, training at all.
The other challenge also lies in the fact that many centers across the country
don't have a formal multidisciplinary menopause clinic,
so that in combination with the continued fear about prescribing
and how to prescribe and what to prescribe is really what leads women
to feel that their symptoms and their concerns are being dismissed.
As a member of the Canadian Menopause Society and a board member,
we as a team of health care providers and professionals are working
really hard to close the gap of knowledge.
We have a website.
We've got lots of information about how to access
Health
Canada approved therapies and what the most updated guidelines are.
So we are working hard and hopefully over the coming years our colleagues
will feel more supported and will be able to provide better care for you.
As a woman going through this challenging time in your life.
Some of the questions you want to ask would be,
Are you providing menopausal care, which is in line with the Society
of Obstetricians and Gynecologists of Canada guidelines?
Do you potentially have a NAMS certification?
So a North American menopause society menopause certification,
which is an examination that many menopause practitioners will write?
And do you also prescribe therapies which are Health Canada approved?
These are excellent questions you want to be asking your menopause specialist.