Menopause in Depth

Lesson 1

My name is Dr. Gregory Davies and I'm an obstetrician gynecologist. I'm certified both in Canada and the United States and for the last 23 years I've been a professor of obstetrics and gynecology at Queen's University and I'm also the owner of Avantia Medical Imaging and Restorative Health in Ottawa.

In our first video, we're going to be talking about menopause; when it happens, how it affects your body, the symptoms that you might have related to menopause, and some symptoms that you might have that you don't even know that they're related to menopause.

Pre-menopause? Post-menopause? What's the difference?

There are some terms that get thrown around related to menopause such as pre-menopause, post-menopause, peri-menopause, so let me help explain what those terms mean. Menopause is the definition of when you've stopped having periods for at least 12 months. However, before that happens, pre-menopause, many women will experience changes in the regularity of their periods.

So instead of having a period every month, it's now two months or three months or then two months close together and then three months apart. And so it can change a lot specifically, and commonly, in women's forties.

The peri-menopause is that time before and initially after menopause where we have some changes in the regularity of periods, then the periods stop. And then shortly thereafter women will start having some of those common symptoms associated with menopause, such as hot flashes. Many times the cessation of periods as well as the initiation of hot flashes is the clue to women that in fact they've now entered menopause.

Post-menopause is that time in the remainder of a woman's life, after they've stopped having periods, and they have begun having the symptoms of menopause.

What is menopause, exactly?

So menopause is a normal change in a woman's life. The average age of menopause is approximately 51 years old. And that's when the reproductive years stop. Up until that time, women are having menses with their menstrual period comes ovulation during that cycle when they could become pregnant. But it is the body's natural change that at approximately around the age of 50, 51 that women are no longer reproductive. And so their periods stop and the ovulation stops and their chance of getting pregnant goes to zero.

Is medically induced menopause the same as natural menopause?

Some women will need to have their ovaries removed as a treatment for a medical condition. For example, breast cancer. So these are commonly younger women say in their thirties or forties when their ovaries removed, they will go through the same symptoms of menopause such as hot flashes or dry vagina that a woman who goes through menopause naturally will have, just like the women who are naturally going through menopause at 50, 51, 52 those women who are younger and have their ovaries removed, will have the same symptoms.

What changes are happening to my body during menopause?

The major change that's happening inside your body when you go through menopause is that part of your brain that sends the signal to your ovaries to produce estrogen, stops sending that signal. And so the ovaries are no longer producing estrogen and it's that significant lack of estrogen production that leads to the symptoms of menopause.

Is menopause preventable or can it be slowed down?

There's no way to slow the onset of menopause, but there are some treatments to treat the symptoms of menopause. For certain, one doesn't need to put up with the symptoms of menopause. They are easily treated. Taking estrogens, whether it's by mouth or by patch or using a vaginal cream or suppository, are ways of replacing the estrogen that your body was producing naturally.

What are hot flashes and what do they feel like?

When a woman is experiencing a hot flash, they'll get a dramatic sense of warmth inside their body. They may have sweating, they may need to remove their sweater, even if they're in a cold room and it can last for not just minutes, but half an hour or even longer and go away for short period of time, but then come back and women can get a series of waves of hot flashes that can be really disturbing, both physically and emotionally.

What are the early signs of menopause?

Usually within two or three years of menopause, women will start to notice some other changes to their body related to this dramatic drop in estrogen. It can be things like dry skin in their face or difficulty with lubrication for intercourse or changes in their bladder function such as stress incontinence or that sense of urgency that you've got to go to the bathroom right away. Other things that women may notice is problems with sleep or changes in their mood. Things like depression, anxiety, some women will notice an increase in urinary tract infections.

What are the genitourinary symptoms of menopause?

The genitourinary symptoms of menopause, which is a new term that in the medical literature we've been using for the last five to 10 years or so, they describe those symptoms related to menopause that may not happen immediately after menopause, but within two to four years, women will begin to notice those symptoms. They are things like dry vagina, abnormal lubrication despite normal stimulation, problems with bladder. So, common things would be stress incontinence or urge incontinence - that sense that you've got to go to the bathroom right away even if your bladder is not full.

Are these symptoms normal?

When we talk about the genitourinary symptoms of menopause, it's really important to understand these are super common symptoms. At least 50% of women will experience the genitourinary symptoms of menopause, such as dry vagina with intercourse. They don't have to be acceptable. There's definitely treatments that can help. But they are very, very common.

What are other health risks I should be aware of, before or after menopause?

When women go through that transition of menopause, not only does it create some symptoms like hot flashes and such, but there are other impacts to their body because of this dramatic lack of estrogen. Things like bone health. Lots of women are familiar with this concept of osteoporosis. And osteoporosis is a normal body change for both men and women as they get older. But when the estrogen levels are dramatically low after menopause, it can accelerate the rate of osteoporosis, especially in women who are thinner.

So women need to keep an eye on their bone health, work with their family doctors, have their bone health evaluated. And for those women who are developing osteoporosis, there are easy treatments that can be effective for that. Another effect of a lack of estrogen after a period of time is a risk of cardiovascular disease. Women's heart health catches up to men's heart health from the point of view of risk for things like heart attack by about the age of 65 because of this lack of estrogen. And so women need to lead a healthy lifestyle, eat in a healthy way, exercise regularly, certainly avoid smoking, to try and reduce that cardiovascular risk.

Can menopause affect my intimate relationships?

One of the symptoms that is very common for women after they go through menopause and they start having, for example, dry vagina, it starts affecting everything else. So it starts affecting their interest in sex because if they know sex is going to hurt, then they're going to avoid it. That can have impact on their relationship. The other thing that happens is because of lack of estrogen, the things that they used to take for granted such as orgasm become harder to achieve and this can all be fixed by either replacing estrogen or using this new treatment, MonaLisa Touch, that we're going to talk about in one of our other videos.

In what other ways can menopause affect my life?

There's a lot happening in a woman's life when she's going through menopause. Not only do we have these physical symptoms, many of which can affect sleep. Things like having hot flashes in the middle of the night or having itchy vulva related to lack of estrogen. Once your sleep gets disturbed, that affects a lot of the things that are happening in the day. If your sexual health is not the way it used to be and it's causing conflict within your relationship, that can be another issue that women are having to manage in addition to their physical symptoms. And this is a time in a woman's life where many times their children are grown up, they're leaving the house, their role around the house and what's happening to the dynamic in their household is changing. And so a lot of women describe this time as being tumultuous. There's just a lot of things going on at the same time, whether it's changes in their physical symptoms, changes in their relationship, what's happening around the household, what's happening at work, and all of these things can be impacted by the symptoms that they're having during menopause.

What emotional impact can menopause have?

Many of my patients, when we're chatting about their symptoms of menopause and how it's affecting their life will tell me that it has a strain on their relationship, their sexual relationship with their partner. And they don't realize that this is just such a common thing. And almost every couple goes through these kinds of dynamics during the time of menopause trying to find solutions for issues like dry vagina or issues like constant urgency to go to the bathroom. They're worried that they feel isolated or alone - that nobody else is going through this. And I can definitely assure you that this is just super common. And the nice thing is that there are some solutions that can make things better. It doesn't have to be this way.

I'm active and busy. Will menopause slow me down?

The women that I meet who come to my clinic, they're busy, they're active, they're working, they're exercising, they're living life to the fullest. And they're frustrated with the fact that these genitourinary symptoms of menopause and other symptoms like hot flashes are getting in the way of their dynamic lives. They're looking for solutions, they're looking to get rid of the symptoms and get their life back to where it was, get things back on track. And the nice thing about it is we actually have some solutions now where we can either replace estrogen or treat the vagina and vulva with MonaLisa Touch.

Should I be talking to my doctor about menopause?

As a woman goes through menopause, it's important to have an ongoing conversation with your healthcare provider, whether that's your family physician, nurse practitioner, gynecologist about the whole package. And the whole package includes, for example, treatment of things like hot flashes, but it also includes treatment and evaluation of risk for osteoporosis or cardiovascular disease, risk of things like heart attack.

And just as important is in focusing on things like sexual health, what's happening in the relationship, what's happening because of the lack of normal lubrication, what's happening with your bladder. Are you at increased risk for things like stress incontinence or urge incontinence, that sense that you've got to go to the bathroom right away. As you go through this process, understand that you're not alone, that this is happening to everybody else who's going through this same change in life and have that ongoing conversation. There's lots of information and there's lots of great treatment.

What inspires you to focus on helping menopausal women?

As a physician, there have been lots of opportunities for me to learn and become a better physician, with changes in our own family's life. Whether it's having newborns, or going through the teenage years with children. The most recent change in our family has been watching and learning from my wife's experience going through menopause. She had all of the typical symptoms. She's a vibrant, busy, wonderful, active person. And when menopause came she was just so surprised about how it got in the way of all the things that she loved to do, whether it was related to hot flashes and disturbance of sleep or whether it was related to intimacy and lack of lubrication. It's been a really great learning opportunity for me as a physician to learn from this experience. And having gone through this experience with my wife and having seen the dramatic change in her genitourinary symptoms of menopause after the treatments, it became very important for me to share that with others.

What's Next?

In our next video, we're going to be talking about how we can treat these symptoms and try and keep your quality of life as high as you want it to be and keep you active and getting through this menopause thing, not as a problem, but as an issue that's full of solutions.