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Menopause is the time in a woman’s life when she stops menstruating (or if she does not have a uterus, the time when her ovaries stop producing the necessary hormones for menstruation). The average age that this happens is 51. Some women will start earlier, and some later. Often during the years leading up to menopause, women will experience many nuisance symptoms. Often their menstrual cycle will change, and they can become more frequent and heavier, or start becoming more sporadic (missing cycles) before finally stopping altogether. As a result of the changing hormones, women can experience hot flashes, night sweats, mood changes, sleep disturbances, and vaginal dryness.

We consider a woman to be fully menopausal when she has not had a period for over a year. The symptoms of menopause, however, can persist for much longer. For example, on average women will experience hot flashes for seven years.

Some women are lucky and are not much bothered by their menopausal transition. Other women are very affected by their symptoms during this time in their life. Fortunately there are options for management.

Hormone replacement therapy (estrogen & progesterone if you have a uterus, just estrogen if you do not) is the gold standard for relief of vasomotor symptoms of menopause (hot flashes/night sweats). These are typically prescribed in the lowest dose possible for the shortest time needed to control symptoms. As with any medication, there are risks and you should discuss with your doctor whether the benefits outweigh those risks for you. If you are experiencing mainly vaginal symptoms of menopause, topical vaginal estrogen may be prescribed. This is given in a much lower dose and does not have the same risks as taking oral estrogens.

Non-hormonal therapies have not been found to be as effective as hormonal therapies for relief of menopausal symptoms, but can provide some relief especially in woman who cannot or choose not to take hormonal therapies. These include some medications that are typically used for depression or hypertension.

Behavioural modification, such as wearing layers, using ice packs, etc. may be enough if the symptoms are mild or short-lived.

For more information about the menopausal transition please see www.menopauseandu.ca and www.menopause.org/for-women.