it’s not ‘just menopause’: what menopause really is and how it impacts every woman
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what is menopause? it's more complicated than you think.
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every woman will eventually deal with menopause. it’s a biological process that is unavoidable. but how much do women actually know about what it is, what they’re in store for when they start to go through the transition and the effects that it can have on overall health?
according to research, an astounding 90 per cent have never been taught anything about it in their lifetimes, leaving the majority to go into it blindfolded.
what is menopause, and why does it happen?
the definition of menopause is “the end of periods,” but what exactly is going on in the body that drives this halt in menstruation?
a period called perimenopause.
“it’s actually a transition in a whole process whereby your ovaries stop producing estrogen as reliably. they stop ovulating, but that doesn’t stop overnight. it’s sort of a sputtering process where the ovaries have a decline in estrogen production, sometimes over a period of 10 years,” said dr. iliana lega, an endocrinologist at women’s college hospital and university of toronto.
dr. nese yuksel, a women’s health specialist and co-founder of effica health, notes that the ovaries stop responding to other hormones that also play a role in ovulation: follicle-stimulating hormone (fsh) and the luteinizing hormone.
“fsh stimulates follicles and makes follicles develop into a dominant follicle, and then luteinizing hormone comes along and causes ovulation to happen. but now, the ovaries are not responding to that anymore,” she said.
during this time, the body undergoes a process known as atresia, where eggs stop functioning in the ovaries, which also fail to respond to hormones as effectively as they did in earlier years.
essentially, this perimenopausal transition leading up to menopause is where the symptoms begin to peak because the entire production line begins to shut down, causing women to become increasingly aware of the changes going on within their bodies. so, menopause is more of a result of this perimenopausal transition, and not the driver.
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symptoms of perimenopause
the most common symptoms, hot flashes and night sweats, are well known among women. but the hormonal changes that go on within the body during perimenopause don’t stop there. there are over 30 different symptoms that can arise when a woman begins this transition, some of which can severely affect quality of life if not treated.
“the symptoms can happen even before menstrual cycle changes begin,” said dr. yuksel.
menopause can do a number on the body, and these symptoms can range from person to person. recent research into the transitional period has found that aside from hot flashes and night sweats, a person may experience:
- insomnia and sleep problems
- vagina dryness leading to pain during intercourse
- reduced libido or desire to engage in sexual activity
- changes in mood, including increased anxiety, irritability, or tension
- difficulty with memory, concentration and finding words
- thinning hair
- dry skin
- weight gain, often in the stomach area
- headaches or migraines
- muscle and joint aches
- racing heartbeat or heart palpitations
- issues with bladder health, such as urgency and incontinence
- increased risk of developing urinary tract infections (utis)
- gastrointestinal upset, such as heartburn
- teeth and gum sensitivity
- typical symptoms of premenstrual syndrome (pms)
- tingling in the hands or bottoms of the feet
- dry eyes
- panic attacks
“some women will have symptoms during that time and then the periods will change much later, but they may not have any changes, while others might have just really menstrual cycle changes and no symptoms or a combination of both,” said dr. yuksel. “it’s really varied, and that’s the biggest thing about perimenopause, it’s so varied for the individual.”
these symptoms don’t just develop until menopause occurs, either. the time it takes for the transitional period to end, as well as its aftereffects, can vary significantly in women.
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“it seems, on average, symptoms start appearing around four years prior to menopause. but for some women, it can range as long as 10 years prior to menopause,” said dr. lega, noting that depending on when symptoms start, a person can experience symptoms for years beyond their last menstrual period.
“it’s all over the place,” echoed dr. yuksel.
while some symptoms can improve over time, others, such as vaginal dryness, painful intercourse, or bladder issues, could continue to worsen after menopause.
treating menopause
many women are unaware that there are therapies and treatments available for perimenopausal symptoms. they don’t have to live with them until the transitional period is over, but because of this lack of knowledge in the area, many fail to even seek out treatment.
according to dr. lega, they assume they have to “deal with it,” but that’s not the case.
there are several potential treatments, many of which are geared toward the symptoms a person is experiencing, including:
- hormonal therapy
- non-hormonal prescription medications, such as gabapentin, fezolinetant or antidepressants
- lifestyle changes, such as diet, exercise and mindfulness
- complementary therapies, including cognitive behavioural therapy
newer research into perimenopause and its symptoms is also paving the way for the development of more treatments, giving women even more options for care. one, fezolinetant, is particularly focused on vasomotor symptoms, such as hot flashes and night sweats.
still, hormonal therapy remains the first-line approach because it addresses the loss of estrogen that drives these symptoms in the first place, and it can often be enough for many women. that said, it’s often only prescribed to treat vasomotor symptoms, which in many cases causes a positive ripple effect on other afflictions.
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“because a lot of women may have night sweats, which really disturb their sleep, treating their night sweats with the hormone therapy really improves their sleep, so it’s almost a treatment of their sleep. once you have better sleep, often your mood improves too, as can other aspects of your cognitive function, like your brain fog,” said dr. lega.
common misconceptions surrounding menopause
one common misconception is that menopause is a thing that just happens, but it’s not. it’s a progressive period of transition that can last for years, holding women hostage to their own biology.
another is that the stoppage of periods is the most important sign. because, typically speaking, by the time the periods stop, women have already been dealing with perimenopausal symptoms for an average of four years.
“women can have symptoms even without period changes,” said dr. yuksel. “the biggest misconception is that you need to start having period changes, and that’s not the case for perimenopause.”
treatment is also a point of misunderstanding in perimenopause and menopause, mainly due to a lack of information regarding the safety of hormone therapy amid decades-old research stating it was unsafe.
“that’s absolutely a myth,” said dr. lega. “in fact, different types of hormone therapy are extremely effective at helping control a lot of the symptoms, including bleeding.”
dr. lega notes that because of the misinformation regarding hormone therapy, many women forgo even going to the doctor to seek help for these troublesome symptoms because they believe that there’s nothing that can be done.
“as long as they’re bleeding, they’re like, ‘oh. there’s nothing that we can do about it because i’m just perimenopausal,’” she said.
the long-term effects of perimenopause and menopause
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because of the changes going on with hormone levels in the body during perimenopause, women are subject to the long-term impacts that can severely affect their overall health.
“estrogen is really important for maintaining bone health, so after you go through menopause, because you lose that estrogen, you also lose up to 10 per cent of your bone mass,” said dr. lega. “that’s why older women are more at risk of osteoporosis, which is weakening of the bones.”
she also notes that the loss of estrogen can cause blood pressure and blood glucose levels to “creep up”, as well as driving worsened cholesterol panels, migration of fat to the belly area and an increased risk of cardiovascular disease. the risk of muscle mass loss, joint pain and frailty is also increased.
“all these things happen independent of aging, meaning that when you go through menopause, all these things worsen far faster,” said dr. lega.
however, there are things women can do to offset these long-term effects, and the earlier they get started, the better.
“we’re talking about exercise, strength training, being mindful of what you’re eating in terms of eating protein and fibre, avoiding the bad stuff, avoiding alcohol,” said dr. lega. “all the life’s healthy lifestyle factors should really be optimized during this period.”
while it may seem like quality of life can severely diminish during perimenopause, it doesn’t have to because of the interventions available, especially with more education surrounding what perimenopause and menopause are, and the options women have to deal with it.
“they don’t have to suffer in silence,” said dr. yuksel. “they should talk to their family physician or their primary care provider, nurse practitioner or whoever they have and start that conversation going about what they may be experiencing.”
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dr. lega and dr. yuksel are scheduled to speak at women’s health collective canada’s vital talks panel, “elevating the standard of menopause care,” on oct. 29, 2025. the panel will discuss the evolution of menopause understanding, including symptom recognition, navigating care and modern treatment options.
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