Impact of Menopause

Menopause can have a significant impact on a woman’s life. While the experience varies considerably among individuals, the evidence clearly shows that menopause represents a significant life transition with far-reaching consequences. Up to 80% of women experience menopause symptoms, with 25% seeking treatment due to severity. Symptoms can last 7 – 8 years or longer as many of these symptoms start in the perimenopause, affecting quality of life and work productivity. Early menopause or premature ovarian insufficiency raises the risks of osteoporosis, cardiovascular disease, cognitive issues, and early mortality. The impact of menopause symptoms when not adequately managed is staggering. In a survey from the Menopause Foundation of Canada (MFC) in 2022 in Canada, one in two women felt unprepared for menopause and 4 in 10 women felt alone during this time.2 Many individuals suffer in silence as they are not getting the care they need. Despite evidence supporting menopause hormone therapy (MHT) as the most effective option for vasomotor symptoms, stigma and fear persist, limiting menopausal care access. There is a real need for improved menopause support in Canada.

Summary of impact of menopause:

Quality of life: Menopause symptoms can significantly diminish quality of life for women both physically and mentally.3

Work productivity: The effect of symptoms on work productivity is being recognized. Women experiencing menopausal symptoms report higher degrees of work impairment than women not experiencing menopausal symptoms.3

Economic Impact: In Canada a reported $3.5 billion per year proposed loss to the economy from lost productivity, missed days of work and lost income.3 Up to 10% of women will quit their jobs because of severe symptoms that impact their ability to function.4

Long-term health: Women with prolonged and severe vasomotor symptoms have been linked to negative outcomes later in life including cardiovascular disease.5

Hormonal Changes:

Ovarian aging is a complex interplay of declining ovarian function and compensatory mechanism that creates a unique hormonal profile that varies considerably between individuals. Estrogen levels drop dramatically with menopause, however this decline in estrogen is not linear but rather characterized by significant fluctuations during perimenopause. Estrogen levels may surge to higher levels at times before eventually falling. Progesterone also decreases with menopause and this decline starts during the perimenopause. FSH levels are elevated as a compensatory mechanism to low estrogen levels, as a response to stimulate ovarian function and produce more estrogen. Luteinizing hormone (LH) also increases significantly, though not to the same degree as FSH.

Long Term Health Consequences

Menopause is associated with a range of long-term health consequences, primarily due to the decline in ovarian hormone production, especially estradiol.

Metabolic syndrome: A marked increase in the incidence of metabolic syndrome is seen with menopause including increased central abdominal fat, hypertension, and insulin resistance. This increased rate of metabolic syndrome does not subside with time.5, 6
Cardiovascular Disease: Menopause accelerates adverse changes in cardiovascular risk factors. The menopause transition is associated with an increase in low-density lipoprotein cholesterol (LDL-C) and a less favorable lipid profile. Additionally, impaired endothelial function and changes in arterial elasticity are seen.5
Bone health: Bone mineral density declines with the loss of estrogen. Bone loss starts during the perimenopause and this loss accelerates sharply during the late perimenopause. Though the greatest loss is the first 10 years after the final menstrual period, bone loss accelerates sharply during the late perimenopause and the first 1 – 2 years after the final menstrual period.5
Cognition: Cognitive function, particularly verbal memory, may worsen during the transition but generally stabilizes or improves after menopause, then follows an age-related decline.5

It is important to recognize that many of these changes begin during the menopause transition. As such, perimenopause presents a critical time to initiate screening for long term disease risks and to implement evidence based preventive health strategies.