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"Shirley, what needs to change?"

This is the question I hear over and over in my head ever since CBC Chief Correspondent, Adrienne Arsenault, asked me on-air earlier this year: What needs to change?


Back in February 2023, The New York Times published an article titled “Women have been misled about menopause.” The journalist pointed to the glaring gap between the experiences that cause women to (needlessly) suffer, and the evidence-based solutions that exist.



So why the gap?



The gap in women’s midlife health exists for 3 reasons:


When it comes to learning how to navigate perimenopause to menopause to postmenopause with confidence and ease, women have been let down because:


1. Menopause is commonly referred to in a negative context; and punctuated by the word “symptoms.” Being a woman has been culturally intertwined with pain and discomfort (i.e. expect pain with periods, pregnancy and perimenopause and postmenopause.) This keeps many women away from the quality health education and information they need (and deserve!) in order to make important health decisions.


Menopause, as a negatively-viewed social construct, also gets in the way of women celebrating their age and stage—including wisdom, confidence and beauty.


2. Women’s health education has traditionally focused on one area: how to make a baby, and then how not to make a baby. Women (and sometimes, health care professionals) are rarely taught the roles and responsibilities of estrogen and progesterone (when cycles are regular), and informed how they can best invest in their health when those same hormones fluctuate or decline. (It would be like a bread baker not knowing the role that yeast plays in their recipe, or not understanding the implications when such a key ingredient is left out!)


What’s a good example?


Estrogen and the role it plays as our “juicy” hormone.


When cycles are regular, estrogen is the hormone released during the first two weeks. Estrogen has numerous responsibilities—it keeps our skin, eyes, mouth, joints, vulvas and vaginas lubricated. After we reach menopause, estrogen goes for a steep decline.


Another example—hyaluronic acid, a naturally-occurring molecule, plays a similar role to estrogen, especially for our skin, vulva and vaginal health. And the decline of hyaluronic acid begins as early as our 30s and 40s.


Preparing women with this important information empowers them make health decisions that can either prevent or treat discomfort and disruption to quality of life; it will also help to reduce the sheer surprise some women experience postmenopause.


(If this is you, I assure you: you are not alone, and you must know there are easy, viable solutions!)


3. Proven solutions for investing in a woman’s future heart, brain, bone and vaginal health are not yet at the forefront of routine health conversations.


Example?


Women lose 20% of their bone mass within the first five years of postmenopause, 1-in-3 of us will break a bone due to osteoporosis and hormone therapy prevents bone loss. It’s a real health problem with an evidence-based solution. Yet, few know about it.


As of April 2023, contraception is free in the province of British Columbia. Why? Because the cost to manage unintended pregnancies, exceeds the cost to provide a contraception subsidy.

It is time to make a similar case for midlife women to prevent osteoporosis—an issue that comes with an inconceivable price tag—especially when you factor in how a fracture, such as a broken hip, impacts an individual, their family, their caregivers and the health care system for potentially years or decades. If the individual loses mobility, that can, in turn, impact brain health, incontinence and more.


In Canada, bone density is not screened until age 65. Yet, the average age of menopause is 51.2 and 20% of bone loss happens within the first five years of postmenopause. Hormone therapy can be used as first-line therapy for prevention of bone loss. However, by age 65, we have missed a key window of opportunity.


We’ve neglected to remind women of this:


“You deserve to feel amazing…and here are all the evidence-based options to take you there.”


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