Menopause: Symptoms and Management Options in Quebec

Visit menopause is a physiological step de la vie d’une femme, mais ses symptômes peuvent affecter de manière marquée la qualité de vie pendant des years. Au Québec, l’âge moyen de la ménopause est d’environ 51 years oldand près d’une femme sur deux rapporte des symptômes modérés à sévères [1]. Pendant longtemps, les options thérapeutiques ont été mal comprises ou évitées par crainte. Aujourd’hui, les recommandations canadiennes et internationales offrent un cadre clair et nuancé. Cet article fait le tour de la périménopause, des symptômes, de l’Menopausal hormone therapy (MHT), des alternatives non hormonales, de la prévention de l’ostéoporose et des ressources au Québec.

On this page

• Perimenopause and menopause
• The most frequent symptoms
• How is the diagnosis made
• L’hormonothérapie ménopausique (HTM)
• Non-hormonal alternatives
• Urogenital symptoms and local hormone therapy
• Prévention de l’ostéoporose
• Cardiovascular and metabolic health
• Lifestyle and well-being
• Resources in Quebec
• Myths and misconceptions
• Frequently asked questions
• Sources

Perimenopause and menopause

Perimenopause

• Period that precedes menopause, generally 4 to 8 years
• Visit Hormones (estrogen, progesterone) fluctuate irregularly
• Visit cycles become irregular (shorter, longer, heavier, or lighter)
• The first symptoms often appear from the quarantine
• Risk of pregnancy encore présent malgré l’irrégularité — la contraception stay relevant
• Often period underrated and little recognized by women themselves

Menopause

• Confirmed after 12 consecutive months without menstruation
• Average age in Quebec: around 51 years old (40 to 58 years old in the majority of cases)
• Early menopause before 40 (premature ovarian insufficiency)
• Induced menopause by surgery (bilateral ovariectomy), chemotherapy, radiotherapy
• Diagnosis Clinique In most cases, without the need for hormonal testing
• Mark the end of natural fertility

Postmenopause

• Postmenopausal period, which lasts rest of your life
• Visit vasomotor symptoms (hot flashes) last for an average of 7 to 10 years, but can persist longer
• Increased long-term risks: Osteoporosis, cardiovascular diseases, urogenital atrophy
• Visit Follow-up of health becomes particularly important
• Several women are experiencing this period with a improvement of the quality of life after the initial symptoms

To remember

• Visit menopause est confirmée après 12 mois consécutifs sans menstruations, à un âge moyen d’environ 51 ans au Québec
• Visit perimenopause Who precedes him (4 to 8 years) explains the first symptoms from the forties
• Près d’one in two women reports moderate to severe symptoms
• Visit symptoms incluent bouffées de chaleur, troubles du sommeil, changements d’humeur, brouillard mental, symptômes urogénitaux, douleurs, perte de densité osseuse
• L’Menopausal hormone therapy (MHT) is the treatment the most effective for hot flashes and moderate to severe urogenital symptoms
• Ideally started before age 60 or within 10 years of menopause in otherwise healthy symptomatic women
• Several Non-hormonal alternatives Existing: ISRS/IRSN, gabapentin, CBT, lifestyle, local estrogen for urogenital symptoms
• Visit prevention de l’ostéoporose passe par densitométrie osseuse (DMO) au besoin, calcium, vitamine D, activité physique en charge, arrêt du tabac
• Visit SOGC And the North American Menopause Society orient Canadian recommendations in 2026

The most frequent symptoms

Vasomotor symptoms

• Hot flashes Sudden sensation of intense heat, from the torso towards the face, lasting a few minutes
• Night sweats that disturb sleep
• Palpitations, sentiment d’anxiety in puffs
• Frequency variable : from a few episodes per month to several per hour in severe cases
• Average duration: 7 to 10 years old, sometimes more
• More pronounced in early postmenopause
• Influenced by the stress, l’alcool, la caféine, les repas épicés

Sleep disorders

• Insomnia d’endormissement
• Nighttime awakenings frequent, often linked to night sweats
• Early awakenings
• Feeling of Unrefreshing sleep
• Daytime fatigue qui affecte le travail, l’humeur, les relations
• Risque d’sleep apnea to consider (increased prevalence after menopause)
• Circle vicious avec l’anxiété et les autres symptômes

Changements d’humeur et symptômes cognitifs

• Irritability, sautes d’humeur
• Anxiety new or updated
• Sometimes depressive symptoms, especially during perimenopause
• Brain fog, difficulty concentrating
• Memory problems (words that «go missing», frequent forgetfulness)
• Feeling of perte d’efficacité
• For the majority, these symptoms s’améliorent postmenopausal
• Distinguer d’une Major depression which requires specific treatment

Urogenital symptoms

• Vaginal dryness, discomfort, itching
• Dyspareunia Pain during sexual intercourse
• Decrease of the libido
• Urinary emergencies, frequent urination
• Urinary tract infections repeated
• Incontinence urinaire d’effort ou d’urgence
• Aggravation progressive in time if not treated
• Frequent taboo: underreported in consultation

Physical symptoms

• Joint pain and muscular (knees, hands, shoulders)
• Stiffness morning
• Modifications weight and body composition (gain of abdominal adipose tissue)
• Changes de la peau (sécheresse, perte d’élasticité)
• Hair finer, hair modifications
• Modifications breasts
• Headaches, sometimes hormonal migraines changed
• Palpitations and other mild cardiovascular symptoms

Long-term risks

• Bone density loss accelerated — silent in the short term, long-term consequences
• Risque accru d’Osteoporosis and fractures
• Increased risk cardiovascular
• Increased risk of type 2 diabetes
• Atrophy urogenital progressive
• Effects on the cognitive health long-term (active research)

How is the diagnosis made

Clinical diagnosis

• Repose sur l’history and the symptoms
• 12 months absence of menstruation in a woman over 45 years old
• No need to Hormone dosages in the majority of cases
• Evaluation symptoms and their impact on quality of life
• Recherche d’other causes Possible symptoms (thyroid, anemia, depression, other)

When to ask for hormone tests

• Suspicion of early menopause (before age 40)
• Symptoms Between 40 and 45 years old with diagnostic uncertainty
• Présence d’un intrauterine device qui rend l’absence de règles non interprétable
• Hysterectomy without removal of the ovaries (no baseline bleeding)
• Women using a Hormonal contraception continuously
• FSH, estradiol and sometimes TSH depending on the context

Overall health check

• Blood pressure, weight, waist circumference, BMI
• Lipid profile, blood sugar
• TSH Signs suggestive of dysthyroidism
• Vitamin D if needed
• Screening of cervical cancer (Pap test) according to the schedule
• Mammography screening according to the Quebec program (PQDCS, from age 50)
• Screening of colorectal cancer (FIT, colonoscopy) according to recommendations
• Bone densitometry according to risk factors
• Evaluation of vaccinations (Vaccines: COVID-19, influenza, pneumococcus, shingles, DTaP)

L’hormonothérapie ménopausique (HTM)

Visit HTML is the most effective treatment against moderate to severe hot flashes and urogenital symptoms. Canadian recommendationsSOGCand internationalNorth American Menopause Society, International Menopause Society, British Menopause Society) position it as a First-line option in the healthy symptomatic woman [2,3].

When to start

• Ideally before 60 years old or in the 10 years following menopause
• This « fenêtre d’opportunité »is associated with a better risk-benefit ratio
• Possibility to start in perimenopause in the symptomatic woman
• Individual discussion benefits and risks
• Consider each woman in her global context

Les types d’hormones

• Estrogens only in women who have had a hysterectomy (without a uterus)
• Estrogen + progestin : chez les femmes avec utérus (le progestatif protège l’endomètre)
• Estrogens: estradiol (oral, transdermal) or conjugated equine estrogens (oral)
• Progestogens micronized progesterone (often preferred for its safety profile), medroxyprogesterone, dydrogesterone
• Tibolone alternative in some countries, less available in Canada
• Combinations cyclical (causing bleeding) or continues (without bleeding after a few months)

Les voies d’administration

• Oral tablets, convenient but first-pass liver effect
• Transdermal route : timbres ou gels d’œstradiol, contournent le foie, Lower thrombotic risk
• Vaginal route : crèmes, ovules, comprimés vaginaux, anneaux d’œstradiol — pour les symptômes urogénitaux purs
• Way intrauterine for the progestin (levonorgestrel-releasing IUD): an option in certain cases
• Visit transdermal route is generally preferred in women with vascular risk factors

The profits

• Marked diminution Hot flashes and night sweats
• Improvement of sleep, de l’humeur et du brouillard mental
• Improvements to Urogenital symptoms
• Prevention of bone loss and fractures
• Possible reduction risk of type 2 diabetes
• positive effect on quality of life global in symptomatic women
• Possible neutral or favorable effect sur le risque cardiovasculaire si débutée dans la fenêtre d’opportunité

The risks

• Thrombotic risk (deep vein thrombosis, pulmonary embolism): increased with oral route, weaker with transdermal route
• AVC Slightly increased risk with oral route, especially after 60 years of age
• Breast cancer : risque légèrement augmenté avec la combinaison œstrogènes + progestatif après quelques années d’utilisation, plus marqué selon le type de progestatif
• Cancer de l’endomètre : risque augmenté avec œstrogènes seuls chez la femme avec utérus (d’où le besoin de progestatif)
• Bleeding unexpected, which require assessment
• Tension Mammary, transient fluid retention
• The risk depends on typethe dosethe durationthe way and of profile individual

Contraindications

• Personal history of breast cancer or hormone-dependent cancer
• Background of Venous thrombosis or pulmonary embolism
• Antécédents d’AVC or coronary disease
• Illness hepatic active
• Vaginal bleeding I did not investigate
• Pregnancy
• Some contraindications are Family members according to the route and dosage, to be discussed with the doctor

HTM duration

• Variable according to the symptoms and benefits
• No Maximum duration arbitrarily set
• Reassessment annual symptoms, risks, preferences
• Several women are taking HTM several years, some their whole lives
• Stop progressive recommended to limit the sudden return of symptoms
• Discussion individual with the doctor

Bioidentical composite hormones

• Terms used for hormones chemically identical à celles produites par l’organisme (œstradiol, progestérone)
• Several pharmaceutical products approuvés contiennent des hormones bio-identiques (timbres d’œstradiol, gels, progestérone micronisée)
• Bioidentical hormones composed (in compounding pharmacy) are not Not recommended neither by the SOGC nor by the North American Menopause Society due to the lack of data on their safety, efficacy, and quality
• Prefer the pharmaceutical products approved by Health Canada

Non-hormonal alternatives

Hot flash medications

• ISRS and IRSN low dose: paroxetine (at a lower dose than for depression), venlafaxine, escitalopram
• Gabapentin or pregabalin: useful especially for night sweats
• Clonidine alternative in some cases
• More recently, Fezolinetant (Neurokinin 3 antagonist): approved for moderate to severe vasomotor symptoms in women not using HTM
• Choice according to the profile, comorbidities, other medications
• Mentoring by the doctor

Cognitive Behavioral Therapy (CBT)

• Efficiency demonstrated pour les symptômes vasomoteurs et l’insomnie
• Approach structured, multiple sessions
• Work on the thoughts, behaviors, stress management
• Particularly useful in women incapable or hesitant to take HTM
• Available in private cabinet, in a group, online
• Combinable avec la HTM ou d’autres traitements

Lifestyle

• Physical activity régulière (150 minutes d’aérobie modérée par semaine, plus de la musculation)
• Balanced diet, ideally of Mediterranean type
• Limiter l’alcohol, caffeine, very spicy foods (frequent triggers)
• Smoking cessation
• Maintien d’un weight health
• Management stress yoga, meditation, mindfulness
• Good sleep hygiene
• Clothing layered, cool environment for the night

Natural products and supplements

• Soy isoflavones modest efficacy, variable quality
• Black cohosh (Black cohosh): uncertain efficacy, watch for interactions and liver effects
• Red clover, dill, several others: data limited
• Acupuncture can help some women
• Visit placebo plays an important role in studies of vasomotor symptoms
• Discuss avec le médecin avant d’utiliser des produits naturels, en raison des interactions et de la qualité variable

Are you experiencing perimenopause or menopause symptoms that are affecting your daily life? Clinique Omicron offre un service d’hormonothérapie, des bilans de santé et l’évaluation personnalisée des symptômes à nos points de service au Québec, avec téléconsultation possible pour le suivi. Make an appointment or opt for the teleconsultation.

Urogenital symptoms and local hormone therapy

Genitourinary Syndrome of Menopause (GSM)

• Terme moderne pour décrire l’ensemble des Urogenital symptoms liés à la baisse d’œstrogènes
• Atrophy of the vaginal and urethral mucosa
• Dryness, itching, dyspareunia
• Urinary emergencies, frequent urination, recurring urinary tract infections
• Incontinence urinaire d’effort ou d’urgence
• Symptoms progressive without a tendency for spontaneous resolution
• Often underreported due to taboo or lack of knowledge about treatments

Local hormone therapy

• Vaginal estrogens at low dose: creams, tablets, suppositories, rings
• Action locale with Minimal systemic absorption
• Security high, even in many women with contraindications to systemic HTM (to be assessed individually)
• Efficiency Excellent on urogenital symptoms
• Application daily Initially (2 to 3 weeks), then 2 to 3 times per week
• Treatment in the long term, car les symptômes reprennent à l’arrêt
• Prasterone (Vaginal DHEA): alternative

Other approaches

• Vaginal moisturizers (Non-hormonal): Used regularly (2 to 3 times a week)
• Lubricants for sexual intercourse
• Ospemifene Selective estrogen receptor modulator (SERM) for dyspareunia
• Vaginal laser : option discutée, données encore limitées sur l’efficacité à long terme et la sécurité
• Rehabilitation pelvic floor (perineal physiotherapy)
• Processing Urinary tract infections recurrent by prevention

Prévention de l’ostéoporose

Visit bone loss s’accélère à la ménopause en raison de la baisse des œstrogènes. La prevention and the screening early ones are essential for reducing the risk of fractures [4].

When to have a bone density test (DEXA scan)

• Women to risk dès 50 ans : antécédents de fracture, antécédents familiaux d’ostéoporose, IMC bas, prise de cortisone, ménopause précoce, tabagisme, etc.
• All women are 65 and over according to Canadian guidelines
• Men aged 70 and over at risk
• According to the clinical context and the Risk factors
• Repeat to 2 to 5 years according to the results and the treatment

Interpret the results

• T-score : comparaison à la densité osseuse d’une jeune adulte de référence
• T-score ≥ -1.0 normal
• T-score between -1.0 and -2.5: Osteopenia
• T-score ≤ -2.5 Osteoporosis
• Assessment of absolute risk 10-year fracture risk (FRAX, CAROC) combining BMD and risk factors
• Decision of treatment based on this overall risk and not on the T-score alone

Preventive measures

• Calcium intake : 1 000 à 1 200 mg/jour, idéalement par l’alimentation
• Vitamin D 800 to 2,000 IU/day according to Canadian recommendations (Osteoporosis Canada)
• Physical activity involving load (walking, jogging, dancing) and Weightlifting
• Smoking cessation
• Modération de l’alcohol
• Prevention of chutes (vision, balance, environment)
• Evaluation common in women at risk

Traitements de l’ostéoporose

• Bisphosphonates (alendronate, risedronate, zoledronate): first-line in most cases
• Denosumab monoclonal antibody anti-RANK ligand
• Teriparatide or romosozumab for severe or very high-risk cases
• HTML preventive effect on bone loss, to be integrated into the overall discussion
• Raloxifene (SERM): option for some women
• Followed by Family doctor, NP, rheumatologist or endocrinologist according to the complexity

Cardiovascular and metabolic health

Cardiovascular risk

• The risk cardiovascular increases after menopause
• Modifications lipid profile (increase in LDL, decrease in HDL)
• Increase in blood pressure
• Increase waistline and abdominal adipose tissue
• Increased risk of type 2 diabetes
• Tracking essential regular: blood pressure, lipids, blood sugar

Preventive measures

• Physical activity régulière (150 min/semaine d’aérobie + musculation)
• Power supply Mediterranean type
• Maintenance d’un poids santé
• Smoking cessation
• Modération de l’alcohol
• Management stress
• Processing Risk factors (hypertension, dyslipidemia, diabetes) if present
• Assessment of Global cardiovascular risk by the physician (Framingham scale, others)

Lifestyle and well-being

Physical activity

• 150 minutes d’aérobie modérée par semaine (marche rapide, vélo, natation)
• Weightlifting 2 to 3 times per week
• Activités d’balance and flexibility (yoga, tai chi, pilates)
• Improvements to vasomotor symptoms, du sommeil, de l’humeur
• Preservation of muscle and bone mass
• Reduction of cardiovascular risk
• Approach progressive With sedentary women, collaboration with a kinesiologist

Power supply

• Mediterranean diet : fruits, légumes, légumineuses, grains entiers, poissons, huile d’olive
• Sources of calcium dairy products, fortified plant-based beverages, sardines, green vegetables
• Proteins sufficient to preserve muscle mass
• Limit added sugars, ultra-processed foods
• Hydration adequate
• Moderation of the caffeine et de l’alcool en cas de symptômes vasomoteurs
• Consultation nutritionist as needed (covered by certain insurances)

Sleep

• Sleep hygiene Regular hours, cool and dark room, limited screen time in the evening.
• Nightwear in natural fibers, breathable sheets
• Avoid the late meals, l’alcool, la caféine en fin de journée
• Routine soothing in the evening
• Evaluation de l’apnée du sommeil si ronflements, fatigue diurne, somnolence
• Approaches Cognitive Behavioral Therapy for Insomnia effective
• Medication as needed, in collaboration with the doctor

Mental and emotional health

• Recognize the changes emotional as part of the transition
• Support your spouse, loved ones, friends
• Groups Support and online communities
• Psychotherapy in case of persistent depressive or anxious symptoms
• Acknowledgement that this step can be a opportunity to redefine one's priorities
• Demander de l’aide en cas de distress Info-Social 811 option 2

Sexuality

• Approaching sexuality with doctor : a often taboo but important subject
• Processing Urogenital symptoms that can transform your sex life
• Communication with the partner
• Sex therapy if needed
• Recognize that the libido peut varier mais qu’une sexualité satisfaisante reste possible
• Adapt practices and the rhythm

Resources in Quebec

Medical support

• Family doctor ou IPS: first point of contact
• Gynecologist in case of a complex situation
• Clinics of menopause in some hospitals
• Endocrinologist for special cases (early menopause, dysthyroidism)
• Rheumatologist ou endocrinologue pour l’ostéoporose
• Nutritionist, kinesiologist, perineal-pelvic physiotherapist
• Psychotherapist or sexologist if needed

Organizations and information

• Society of Obstetricians and Gynaecologists of Canada (SOGC) Information for the Public and Professional Guidelines
• North American Menopause Society international resources
• International Menopause Society and British Menopause Society
• Osteoporosis Canada : information on prevention and treatment
• Quebec Menopause Society and professional associations
• Heart+Stroke for cardiovascular prevention
• L’Appui pour les proches aidants if needed

Support and communities

• Groups local and online support
• Platforms French-speaking specialists on menopause
• Programs in work environment recognizing the health challenges women face in mid-career
• Information high-quality general public (institutional websites, specialized podcasts)
• Coverage of the growing topic in Quebec media

Myths and misconceptions

« L’hormonothérapie cause le cancer du sein »

Important nuance. The risk is slightly increased avec la combinaison œstrogènes + progestatif après plusieurs années d’utilisation, mais reste moderate et dépend du type d’hormones, de la dose et de la durée. Avec estrogen alone (in women who have had a hysterectomy), the risk is lesser. The panic qui a suivi l’étude WHI de 2002 a été largement nuancée par les analyses ultérieures. Pour la femme symptomatique en bonne santé, le rapport Risk-benefit est généralement favorable dans la « fenêtre d’opportunité ». Discussion individuelle essentielle.

« Il faut endurer, c’est naturel »

Outdated vision. Menopause is physiological, but his symptoms can significantly affect quality of life for years. effective treatments existent. Women n’ont pas à souffrir en silence. La consultation médicale permet d’évaluer les options selon le profil individuel. La « tolerance » symptoms should never be an imposed goal.

«Compounded bioidentical hormones are safer»

False. Bioidentical hormones compounded in a compounding pharmacy are not Not recommended by the SOGC nor by the learned societies because of lack of data on their safety, efficacy, and quality (dose variability). Several pharmaceutical products contain already bioidentical hormones (estradiol, micronized progesterone) with regulatory oversight. Prefer the approved products by Health Canada.

«Menopause causes depression»

Not necessarily. Visit changements d’humeur are common, especially in perimenopause, but a Major depression don't touch all women. The risk of depression is slightly increased in perimenopause, especially in those with a history. A Medical evaluation distingue les changements d’humeur passagers d’une dépression nécessitant un traitement spécifique. La HTM aide certains symptômes d’humeur, mais ne remplace pas le traitement antidépresseur si nécessaire.

« La ménopause, c’est la fin de la sexualité »

False. Several women are maintaining a satisfying sex life or the rediscover at this stage. The Urogenital symptoms (dryness, pain) can be effectively treated, notably by local estrogens. The libido peut varier, mais plusieurs facteurs autres qu’hormonaux y contribuent (relation, stress, sommeil, médicaments). En parler avec le médecin permet d’identifier les solutions.

Frequently asked questions

At what age should I start talking about menopause with my doctor?

From the quarantine, especially if you notice any Irregular cycles, of hot flashes, des troubles du sommeil ou d’humeur. La perimenopause peut débuter plusieurs années avant la ménopause confirmée. Un dialogue précoce permet d’anticipate, de comprendre les changements et d’envisager les options en cas de symptômes incommodants.

L’hormonothérapie est-elle couverte par la RAMQ ?

Most of the produits d’hormonothérapie (estrogen, progesterone, combined) are cutlery par le régime d’drug insurance from the RAMQ or private insurance. Check the specific status of the Prescription product. The Vaginal estrogen are also covered. Some formulations most recent can have specific terms.

Can I get pregnant during perimenopause?

Yes. Fertility decrease mais n’est not bad jusqu’à la ménopause confirmée (12 mois sans menstruations). La contraception remains relevant during perimenopause. The discussion with the doctor about method The most suitable for this period (IUD, progestin-only oral contraceptives, etc.) is useful.

How long do hot flashes last?

Duration variable. On average, hot flashes during 7 to 10 years old, but some women live longer (sometimes 15 to 20 years), d’autres beaucoup moins. Elles sont plus intense in early postmenopause. Several treatments as they exist to relieve them, to be discussed according to your profile and preferences.

Is it too late to start HTM at 65?

Usually, one avoid to start systemic HTM after 60 years or more than 10 years after menopause, because the benefit-risk ratio est moins favorable (risque cardiovasculaire et AVC accrus). Cependant, l’local vaginal hormone therapy remain security At any age for urogenital symptoms. Individual discussion essential with the doctor.

What to do if my symptoms are harming my work performance?

Consult your doctor for evaluate therapeutic options (HTM, non-hormonal alternatives, CBT). Also discuss with your employer or the human resources department of arrangements possibilities: breaks, ventilation, clothing, remote work. The Menopause at work is increasingly recognized as an organizational health issue. The programme d’aide aux employés (PAE), if available, can also be a resource.

My doctor refuses to prescribe HRT, what should I do?

Several reasons may motivate ce refus, certaines pertinentes (contre-indication réelle), d’autres liées à une outdated information. You can: ask your doctor to discuss current recommendations (SOGC 2023, NAMS), request a second opinion, consult a menopause clinic or a gynecologist. Bringing sources like the SOGC can help orient the discussion.

Sources

1. Society of Obstetricians and Gynaecologists of Canada (SOGC). Menopause Directives 2023.
2. The North American Menopause Society (NAMS). 2022 Hormone Therapy Position Statement.
3. International Menopause Society (IMS) and British Menopause Society (BMS) — 2024-2025 Recommendations.
4. Osteoporosis Canada. Lignes directrices canadiennes 2023 sur l’ostéoporose.
5. INESSS — Institut national d’excellence en santé et en services sociaux. Reviews of hormonal medications.
6. Health Canada — Information on Approved Hormone Products.
7. Heart+Stroke Women and heart disease, cardiovascular health at menopause.

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