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Health education · Hormonal healthSaint‑Hyacinthe
Hot flashes, night sweats, disrupted sleep, mood changes, brain fog, vaginal dryness or a menstrual cycle that is becoming irregular? These changes may be part of perimenopause or menopause.
At Clinique IPS du Palais in Saint-Hyacinthe, our team can support you in better understanding your symptoms, assessing your situation and discussing the various treatment options, hormonal or non-hormonal, based on your health profile.
Menopause is the permanent end of menstrual periods due to decreased ovarian activity.
It is generally recognized after 12 consecutive months without a menstrual period, when no other cause explains their absence.1,2,3
In Canada, the average age of menopause is 51, but the age varies from person to person.2 The period leading up to menopause is called perimenopause.
Perimenopause is a period of hormonal transition that can begin several years before the last menstrual period.2 During this time, estrogen and progesterone levels can fluctuate significantly. Cycles may then become:
Menopause symptoms can appear even before menstrual periods have completely stopped.
Possible symptoms
The experience of menopause varies enormously from person to person. Some people have very few symptoms, while others find their sleep, mood, sexuality or quality of life significantly affected.2
Palpitations or discomfort during sexual intercourse are sometimes reported as well. Not all of these symptoms are necessarily present in the same person.
Hot flashes are among the most characteristic symptoms of the menopausal transition.2 They can cause:
When they occur at night, they are often called night sweats. They can lead to frequent awakenings and contribute to significant fatigue during the day.
Sleep problems are common during perimenopause and menopause. They may be related to night sweats, hot flashes, hormonal changes, stress, anxiety, mood changes or other sleep disorders.
A person may experience, for example:
It is important not to automatically attribute all sleep problems to menopause, especially when they are significant or persistent.
During this period, some people notice:
However, menopause does not necessarily explain all psychological changes. An assessment may be appropriate when symptoms are significant, persistent or affect daily functioning.
During perimenopause, some people describe:
These symptoms are sometimes called brain fog or mental fog.2 They can also be influenced by lack of sleep, stress or other health problems.
Some people report palpitations during perimenopause or menopause. They may be felt as a racing heart, a pounding heart, irregular beats or a sensation of extra beats.
However, palpitations can also have several other causes and should not automatically be attributed to hormones.
Yes.
Libido can be influenced by several factors during this period: hormonal changes, sleep quality, stress, mood, pain or vaginal dryness, the relationship with a partner, medications or other health problems.
A decrease in desire therefore does not necessarily mean that a single hormonal factor is responsible.
Genitourinary health
Lower estrogen levels can change the tissues of the vulva, vagina and urinary tract.
Together, these manifestations are sometimes grouped under the term genitourinary syndrome of menopause.1
This can lead to:
The assessment begins mainly with:
In a person of the usual age of menopause with characteristic symptoms, the diagnosis is often based on the clinical history. Tests may be ordered when another cause needs to be ruled out or when the situation is less typical.
No.
According to recommendations for clinicians, no blood test is necessary to diagnose perimenopause or menopause.1
Hormones fluctuate a great deal during perimenopause, so a single measurement does not always clearly determine whether a person is in perimenopause. Depending on age, symptoms and context, the health professional will decide whether certain tests are relevant.
Treatments
The options can be divided into two broad categories: hormonal treatments and non-hormonal treatments.1
Treatment depends on:
Canadian recommendations
Hormone therapy can be used to treat certain symptoms of perimenopause and menopause. It is particularly effective for hot flashes and night sweats.
According to current Canadian recommendations, systemic hormone therapy is considered a first-line option for bothersome vasomotor symptoms, in the situations described here.1,3 However, the decision remains an individual one.
Estrogen is the main hormone used to relieve several menopause symptoms. For example, it can help reduce:
Systemic estrogen can be given in different forms, including a transdermal patch, a gel or a tablet. The choice depends on the individual profile.
In a person who still has their uterus and uses systemic estrogen, progesterone or another progestogen is usually needed to protect the endometrium.1,3
In a person who no longer has a uterus, systemic estrogen can generally be used without progesterone.
However, the treatment strategy depends on the clinical context.
Choosing the form
It acts throughout the body and can be used, for example, for hot flashes and night sweats.
It acts mainly in the vaginal area and can be used for symptoms such as dryness, irritation, pain during sexual intercourse or certain urinary symptoms.
Local vaginal estrogens result in much lower systemic exposure.1
Safety
Hormone therapy is not appropriate for everyone.
In people aged 60 or younger or within 10 years of menopause, without contraindications, current recommendations generally consider that the benefit-risk balance can be favourable when it is used to treat significant symptoms.1
The decision must nevertheless be individualized.
A thorough assessment is needed when there is, for example:1
High blood pressure is not a contraindication to hormone therapy, but it is part of the overall cardiovascular risk to consider.1
Estrogen can be given through the skin, notably as a patch or a gel.
Transdermal preparations are associated with a lower risk of thrombosis than oral forms, which can make them a good option in certain situations.1,3
However, the choice depends on the clinical profile and should be discussed with a health professional.
Hormone therapy is not the only option. Non-hormonal treatments can be used in certain situations, particularly when:1,2
The choice depends on the type of symptoms and the medical profile.
Certain habits can contribute to overall well-being during this period:
These measures do not necessarily replace treatment when symptoms are significant, but they are part of a comprehensive approach.
The decrease in estrogen after menopause can contribute to a decrease in bone mineral density.2
Depending on age and risk factors, the health professional may discuss:
Overall health
After menopause, several cardiovascular risk factors become particularly important to monitor. A comprehensive health approach can therefore be relevant during this stage of life.
This may include, among other things:
Seeking care
A consultation may be appropriate in any of these situations.
Unusual bleeding should be assessed according to the context. It is particularly important to see a health professional for:
Unexplained vaginal bleeding must be assessed before considering certain hormone therapies.1
Depending on your situation, our team can, among other things:
Clinique IPS du Palais also offers a program dedicated to hormonal health and hormone therapy.
Frequently asked questions
In Canada, the average age of menopause is 51, but there are significant variations from person to person.
Yes. This is very common during perimenopause.
Not necessarily. In many people, symptoms and menstrual history help guide the assessment.
Yes. They can begin during perimenopause.
Yes. Night sweats and hormonal changes, among other things, can affect sleep.
Some people report them, but palpitations can have several other causes. They should be assessed according to their context.
Weight changes observed around menopause are multifactorial. Age, metabolism, sleep, physical activity and body composition can all play a role.
It has benefits and risks that depend on the individual profile. In some younger people close to the onset of menopause, without contraindications, the benefit-risk balance may be favourable.
When systemic estrogen is used and the uterus is still present, protection of the endometrium with progesterone or a progestogen is generally necessary.
Yes. Certain non-hormonal options can be discussed when they are preferred or when hormone therapy is not appropriate.
This page provides general information and does not replace an individualized assessment by a health professional.
