Menopause: The Must-Know Facts
1. Menopause is officially diagnosed after 12 consecutive months without a period. No spotting, no oops-I-thought-I-was-done. A full year.
2. The average age of menopause is around 51. But it can happen anytime between 40 and 58—and *still* be considered normal. Mother Nature’s not super punctual.
3. Perimenopause can start 8–10 years before menopause. FUUUUCCCKKKKK THIS . Yes, the pre-party is longer than the main event. Symptoms can begin as early as your late 30s or early 40s.
4. Menopause is a natural biological transition—not a disease. But wow, it can *feel* like one when you're Dr. Googling your 27th weird symptom.
5. Estrogen and progesterone levels drop significantly. And this hormonal nosedive is what triggers most of the symptoms.
6. Hot flashes affect up to 75% of women. And some unlucky souls get them for *a decade* or more. Fans, ice packs, and layers become survival tools.
7. Sleep disturbances are one of the most common complaints. Between night sweats and 3 a.m. anxiety parties, rest can feel like a thing of the past.
8. Menopause affects every woman differently. Some breeze through with barely a blip. Others—well, let's just say it’s more like a hormonal roller coaster in a thunderstorm.
9. **Hormone replacement therapy (HRT) is safe and effective for many women.** It’s not for everyone, but when prescribed appropriately, it can be life-changing. No shame in asking!
10. There are over 30 recognized symptoms of perimenopause and menopause (and still counting) It's not just hot flashes and mood swings—it's a full-body event.
11. Menopause increases the risk of osteoporosis and heart disease. Because declining estrogen affects bone density and cholesterol levels. Good time to check in with your GP.
12. You can still get pregnant during perimenopause. Yes, really. Until menopause is confirmed, contraception is still necessary unless you're actively trying.
13. Early menopause (before age 40) is called premature ovarian insufficiency (POI). And it happens to about 1% of women—often with a different treatment approach.
14. Lifestyle changes can significantly reduce symptoms. Exercise, good nutrition, stress management, and reducing alcohol/caffeine can be surprisingly helpful. But please know- we can’t yoga or meditate our way around this. It’s happening no matter what.
15. You are not losing your mind. Memory issues, brain fog, and emotional upheaval are *normal* (and often reversible).
16. Menopause doesn't mean you're "less feminine" or "past your prime." Quite the opposite—it can be a powerful, freeing, wise new chapter.
17. There is still stigma and silence around menopause. But more and more women are working to change that.
18. Menopause can impact work, relationships, and mental health. Acknowledging this is key to offering the right support—empathy over eye-rolls!
19. There are many non-hormonal treatment options. Herbs, CBT, acupuncture, lifestyle tweaks—there’s a whole menu beyond HRT.
20. You are not alone.
Millions of women are walking this path right now. The more we talk, the better it gets.
Here’s a fun and not even comprehensive list of perimenopause and menopause symptoms
Divided into categories for clarity—because when you're juggling hot flashes, existential questions, and remembering where you put your glasses (they’re on your head), organization *matters*.
🧠 **Cognitive & Emotional Symptoms**
- Brain fog (a.k.a. "Where did I put my nouns?")
- Memory lapses
- Difficulty concentrating
- Mood swings
- Anxiety
- Depression
- Irritability or rage (suddenly everyone is *very* annoying)
- Decreased motivation
- Loss of confidence
- Emotional sensitivity
- Crying for no apparent reason (hello, dog food commercials)
😴 **Sleep Disturbances**
- Insomnia
- Waking in the middle of the night (usually drenched in sweat)
- Difficulty falling back asleep
- Restless sleep
- Vivid or disturbing dreams
- Daytime fatigue
🔥 **Vasomotor Symptoms**
- Hot flashes (daytime infernos)
- Night sweats (bedtime saunas)
- Chills or cold flashes (just to keep things interesting)
- Flushing/red face
- Increased sweating
🧬 **Hormonal & Metabolic Shifts**
- Irregular periods
- Heavier or lighter periods
- Missed periods
- Shorter or longer cycles
- Weight gain, especially around the belly (oh joy)
- Slower metabolism
- Blood sugar dysregulation
- Thyroid dysfunction (in some women)
💪 **Musculoskeletal & Physical Changes**
- Joint pain or stiffness
- Muscle aches
- Back pain
- Decreased muscle mass
- Increased risk of osteoporosis
- Fatigue and reduced stamina
- Clumsiness or coordination issues
🧖♀️ **Skin, Hair, & Appearance**
- Dry skin
- Itchy skin (pruritus)
- Thinning hair or hair loss
- Facial hair growth (hello, chin whiskers!)
- Brittle nails
- Changes in body odor
❤️ **Cardiovascular Symptoms**
- Heart palpitations
- Increased blood pressure
- Higher cholesterol
- Dizziness or lightheadedness
🧘♀️ **Psychospiritual & Existential**
- Feelings of loss or grief
- Questioning identity or purpose
- Desire for reinvention
- Changes in libido (either up, down, or gone on vacation)
- Increased introspection or spiritual seeking
🧻 **Urogenital & Sexual Health**
- Vaginal dryness
- Painful sex (dyspareunia)
- Decreased libido
- Urinary urgency or frequency
- Recurrent UTIs
- Incontinence or leakage
- Pelvic floor weakness-
🦷 **Other Common Changes**
- Dry mouth or burning tongue
-Dry eyes
- Tinnitus (ringing in ears)
- Changes in taste or smell
- Digestive issues (bloating, gas, IBS-like symptoms)
- Allergies or sensitivities flaring up
- Breast tenderness or shrinking
- Acne (because why not revisit high school?)
Post-menopausal UTI’s
In addition to antibiotics, topical vaginal estrogen therapy is a recommended strategy to prevent recurrent UTIs in postmenopausal women. Canadian guidelines explicitly state that “vaginal estrogen should be offered to postmenopausal women who experience recurrent UTIs”. Estrogen helps restore the atrophic urogenital mucosa after menopause, improving local immune defences and lowering UTI risk. Data from clinical trials show vaginal estrogen can cut UTI recurrence by roughly 50–75% in this population.
However, for some reason- despite this evidence, relatively few women are actually using vaginal estrogen for UTI prevention. Utilization data are sparse, but experts describe vaginal estrogen as an “under-utilized” prophylactic tool.
For example, a 2024 survey of primary care physicians found that while 96% were comfortable prescribing vaginal estrogen for recurrent UTIs, only 58% said they do so often, indicating many eligible patients may not be receiving it. In practice, continuous low-dose antibiotic prophylaxis remains more common than estrogen therapy for preventing UTIs, even though guidelines advise using antibiotics only as a last resort. A BC study reinforces this: out of over 2.2 million UTI-related antibiotic prescriptions, only 1.3% were for prophylactic antibiotics, implying that most women, with recurrent UTIs were managed reactively (treating each infection) rather than preventively.
This low prophylaxis rate hints that the adoption of vaginal estrogen cream is also low – likely a small minority of postmenopausal women with recurrent UTIs receive estrogen supplementation. Barriers, such as lack of awareness- safety misconceptions, and the fact that estrogen cream isn’t officially labeled for UTI prevention contribute to its underuse.
Concrete figures on vaginal estrogen prescription counts in Canada are not published, but the trend is that usage is slowly increasing as awareness grows. Many menopause-age women are prescribed vaginal estrogen for symptoms of genital atrophy, which can have the added benefit of reducing UTIs. Still, in the context of UTI prevention, experts note a “crucial gap” – non-antibiotic measures like estrogen and cranberry are under-prescribed relative to antibiotics.
Efforts by organizations like the Society of Obstetricians and Gynaecologists of Canada to educate both providers and patients are ongoing, so that more women aged 40+ with recurrent UTIs are offered vaginal estrogen. In summary, only a modest fraction of Canadian women over 40 with recurrent UTIs are on vaginal estrogen therapy at present, but this is a recognized area for improvement. Future pharmacy utilization reports may start capturing these numbers as preventive therapy becomes more common.
References
1. Recurrent UTIs Are Common Post-Menopause
Why: Estrogen decline leads to vaginal atrophy, altered flora, and a more alkaline pH, making the urinary tract more susceptible to bacterial invasion.
Source:: Raz R, Stamm WE. *A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections.* N Engl J Med. 1993;329(11):753–6.
[Mayo Clinic – Recurrent UTI causes and risks](https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/expert-answers/recurrent-utis/faq-20058332)
2. Untreated UTIs Can Lead to Kidney Infections (Pyelonephritis)
Source: Rowe TA, Juthani-Mehta M. *Urinary tract infection in older adults.* Aging health. 2013;9(5):519–28.
: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [Kidney Infection Overview](https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-infection-pyelonephritis)
3. Delirium & Confusion in Older Women
Why: Systemic inflammation from infection can affect brain function in older adults.
Source: Inouye SK et al. *Delirium in elderly people.* Lancet. 2014;383(9920):911–22.
Centers for Disease Control and Prevention (CDC): [UTIs and delirium](https://www.cdc.gov/aging/publications/features/urinary-tract-infections.html)
4. Chronic Bladder Irritation (Interstitial Cystitis)
-Source: Hanno PM et al. *Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline.* J Urol. 2011;185(6):2162–70.
5. Incontinence and Pelvic Floor Dysfunction
Source: Robinson D et al. *Urinary incontinence in women: management.* BMJ. 2013;346:f2500.
Estrogen deficiency contributes to urogenital atrophy and incontinence symptoms.
6. Sepsis Risk in Older Adults
Source: Nicolle LE. *Urinary tract infections in the elderly.* Clin Geriatr Med. 2009;25(3):423–36.
Urosepsis is a known risk from untreated or under-treated UTIs in postmenopausal and older women.
7. Sexual Health Disruption & Dyspareunia
Source: Kingsberg SA et al. *Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE survey.* J Sex Med. 2013;10(7):1790–9.
Vaginal dryness and irritation make UTIs more likely and sexual activity more painful.
8. Mental Health & Quality of Life Impact
Source: Low LK, Tumbarello JA. *Women's experiences with recurrent urinary tract infections: a qualitative study.* Urol Nurs. 2010;30(5):300–7.
9. Preventive Use of Vaginal Estrogen
Source: Perrotta C et al. *Oestrogens for preventing recurrent urinary tract infection in postmenopausal women.* Cochrane Database Syst Rev. 2008;(2):CD005131.