Fifty per cent of Canadians will experience menopause, yet many feel poorly informed and unprepared for the changes they experience.
Menopause symptoms can be bothersome, and can affect your quality of life, relationships, and work.
Perimenopause is the time leading up to menopause when your hormone levels, especially estrogen and progesterone, begin to change. You will still have periods, but they will become irregular.
When it happens:
- Usually starts in your 40s (sometimes late 30s)
- Can last a few months, or up to 8–10 years
- Ends when you have gone one year without a period
Common symptoms
On average, symptoms last 7.4 years from start to finish, and peak around the same time that periods stop. Eighty per cent of people will experience symptoms, but about 20% will have little to no symptoms.
Perimenopause signs and symptoms:
- Irregular periods (longer, shorter, heavier or lighter than usual). This is the most common symptom of perimenopause
- Hot flashes - a sudden rush of heat in the upper body, often in the face, neck and chest. Night sweats are hot flashes that occur at night and can disturb your sleep
- Trouble sleeping or waking up frequently throughout the night
- Mood swings or anxiety
- Brain fog - a feeling of mental slowness that is different than before, where it becomes harder to think, concentrate, remember things, or stay focused
- Vaginal dryness
- Changes in sexual drive - this can mean wanting sex less often, more often, or differently than before
Changes in your body
- Your ovaries gradually produce less of the hormone estrogen
- Your hormone levels may fluctuate unpredictably causing symptoms
- Ovulation becomes irregular; your ovaries may not release an egg every month, or you may ovulate twice in the same month
When to seek care
- Your periods are less than three weeks apart, last more than seven days or are very heavy
- You notice changes in your period or experience perimenopausal symptoms before age 40. This can be a sign of premature ovarian insufficiency (POI).*
- Your symptoms interfere with your daily life
* POI is the premature loss of eggs and their surrounding cells in the ovaries. It affects up to 2 % of the population.
Menopause is the term used to mark a specific point in time—once you have gone 12 months in a row without a period. It happens around age 51, but it varies from person to person.
Common menopause symptoms
Many menopause symptoms are the same as those of perimenopause. For some people, symptoms improve on their own. For others, symptoms continue and may need treatment.
Changes to your body
Your ovaries make the hormone estrogen. As you approach menopause estrogen levels decrease. When you reach menopause, your ovaries make so little estrogen that they stop releasing eggs and your period stops.
Menopause can be:
- Spontaneous: your ovaries stopped making eggs due to aging
- Induced: you had your ovaries removed, had a medical treatment like chemotherapy or another outside cause
Your estrogen and progesterone levels will be consistently low. Your testosterone levels will not change with spontaneous menopause but will decline gradually with age.
You may not be able to tell when menopause occurs if you:
- Are using hormonal birth control, or other medication which stops ovulation
- Do not have a uterus, and so do not have a monthly period
After reaching menopause, you enter postmenopause.
Symptoms and body changes
Hormone levels (estrogen and progesterone) stay consistently low. Most menopause symptoms, such as hot flashes, lessen over time, but for some people, symptoms may persist for years.
The following symptoms can worsen over time:
- Vaginal dryness
- Painful sex
- Frequent need to pee
- Repeated urinary tract infections
This is known as genitourinary syndrome of menopause or GSM.
Health considerations
Because estrogen plays a protective role in the body, lower levels of estrogen can increase your risk of:
- Bone loss (osteoporosis)
- Heart disease
- Genitourinary symptoms (for example, vaginal dryness, urinary changes)
- Changes in skin, hair, and metabolism
When to get care
- Your periods stop before age 45
- You have any chest pains, new headaches or other non-typical symptoms
- Symptoms affect your daily life
- You have any new symptom that you are not certain is due to menopause
Treating menopause symptoms
Some changes that happen around menopause, such as thinning hair, or weight gain, are mostly due to aging. Treatments for menopause symptoms mostly focus on relieving the symptoms until they eventually pass.
Some treatment options include menopause hormone therapy (MHT) and non-hormonal treatments such as lifestyle changes.
Menopausal hormone therapy (MHT) uses hormones to help relieve symptoms and prevent some of the long-term health effects of low estrogen. The hormones used are usually estrogen, sometimes combined with progesterone.
MHT works by supplementing estrogen (and progesterone if you have a uterus). This helps stabilize your body’s hormone levels, reducing symptoms like hot flashes and vaginal dryness. It also supports bone health.
Some people have few or no symptoms of menopause. Some choose MHT for relief of symptoms such as hot flashes, or for bone protection, but others manage menopause symptoms with non-hormonal treatments or lifestyle changes.
Testing your hormone levels
For most people, hormone testing is not needed. Your healthcare provider can usually make a diagnosis based on your age, menstrual cycle, and symptoms.
Because hormone levels can fluctuate during perimenopause, a single blood test does not provide an accurate picture. Routine testing of hormone levels is not needed to determine the appropriate dose of MHT.
Treatment is guided by your symptoms, your treatment goals, and your general health.
Dosage and duration
Most people only use MHT for a few years, although some may benefit from longer use.
If recommended, MHT is usually prescribed at a dose that controls menopausal symptoms. It is reviewed every year, or more often if needed, to make sure it is still the right treatment.
Safety
MHT is safest when started within 10 years after menopause (final menstrual period) OR before age 60.
For some people, the risks of taking MHT may outweigh the benefits. This includes people with:
- Estrogen-dependant cancers (breast, ovarian and endometrial)
- Heart disease or a history of blood clots
Talk to your provider about any risks, and to determine if MHT is appropriate for you.
Hormone therapy and breast cancer Some types of MHT (especially combined estrogen-progestogen therapy) are associated with a small increased risk of breast cancer with long-term use.
Estrogen-only therapy is associated with little or no increased risk of breast cancer.
Hormone therapy and heart attacks
Starting MHT in healthy patients before age 60 or within 10 years of menopause does not appear to increase heart disease risk. Starting MHT later than this may increase risk.
Hormone therapy and strokes
MHT, especially oral estrogen, may slightly increase the risk of stroke and blood clots, but the absolute risk for most people is low.
If you cannot or choose not to use MHT, there are many Health Canada approved alternative medications that are also safe and effective. These include medications such as oxybutynin, gabapentin and some antidepressants. They act on the part of the brain that causes hot flashes.
Many natural and herbal therapies
are not recommended as they do not work any better than placebo.
Alternative therapies
Complementary or “alternative” therapies are non-prescription approaches which some people use to manage menopause symptoms, either on their own or combined with medical treatment.
Lifestyle approaches
Regular exercise, a balanced diet, good sleep habits, and stress reduction activities (e.g. yoga, mindfulness) can help improve overall wellbeing and may reduce symptoms such as mood changes, joint aches and pains, and sleep disturbance, in some people.
Cognitive behavioural therapy (CBT)
CBT is a structured, evidence-based therapy that can help manage hot flashes, night sweats, anxiety, and sleep problems by changing thought patterns and coping strategies. This is the most recommended non-medical therapy for menopausal symptoms.
Herbal remedies
Products like black cohosh, red clover, soy (phytoestrogens), and evening primrose oil are commonly used, though evidence for their effectiveness is mixed, and results vary from person to person. These are not currently recommended as studies have not found them to be any better than placebo.
“Natural” does not always mean safe. Some herbal products may interact with medications or have side effects, and quality can vary. It’s a good idea to discuss any complementary therapies with your healthcare provider.
Dietary supplements
Some people try vitamins (like vitamin E), omega-3 fatty acids, or magnesium, but strong scientific evidence for symptom relief is limited.
Acupuncture
Acupuncture may help some people with hot flashes and sleep, though research results are mixed and benefits are often modest.
Mindfulness therapies
Practices such as meditation, paced breathing, and relaxation techniques may reduce stress and improve your ability to cope with symptoms.
In collaboration with the Women's Health Research Institute and the BC Women's Health Foundation, we are offering an educational series for the public on topics related to menopause and midlife.
A new webinar will be offered every two months.
Menopause Supplements: Myths or Facts with Dr. Alison Shea
Nov. 24, 2026
Registration: Details coming soon
