The Agenda with Steve Paikin (Audio) - What You Need to Know About Menopause

Episode Date: March 27, 2025

Is menopause finally having a moment? After years of suffering alone, more and more women have begun to share their symptoms and discuss treatment options. We're joined by Dr. Wendy Wolfman, Trish Barbato, and Christina Frangou.See omnystudio.com/listener for privacy information.

Renew your 2.0 TVO with more thought-provoking documentaries, insightful current affairs coverage, and fun programs and learning experiences for kids. Regular contributions from people like you help us make a difference in the lives of Ontarians of all ages. Visit tvo.me slash 2025 donate to renew your support or make a first-time donation and continue to discover your 2.TVO. Is menopause having a moment? From the advocacy work of activists to high profile women like Halle Berry discussing it openly, what may have once felt like a solitary experience for millions of women is being brought into the mainstream. Joining us to discuss why we welcome,

on the line from Calgary, Alberta, Christina Frangu, freelance writer and a journalism professor at the Southern Alberta Institute of Technology and the Dalla Lalla School of Public Health at the University of Toronto. And with us in studio, Dr. Wendy Wolfman, Director of the Menopause Clinic and the Premature Ovarian Failure Clinic at Mount Sinai Hospital

and Professor in the Department of Obstetrics and Gynecology at the University of Toronto. And Trish Barbato, Co-Founder and Director of the Menopause Foundation of Canada. Welcome to you all. Thank you. Can I say how excited I am to speak about this because talking about menopause has been very kind of like, you don't talk about that.

You don't talk about that, especially on television. And now we're on TV talking about this. So thank you so much. Dr. Wolfman, I wanted to start with you to just help us understand the terms. Can you define, explain to us what is perimenopause, menopause, post-menopause? How do we mark these? Right, so actually menopause is a point in time and it refers to the last menstrual period. And you can only define it retrospectively after you haven't had a period for a year.

And the reason that it happens is that women are born with a certain number of eggs and over their lifetime these eggs decline and around the age of 35 they start accelerating a loss and then over a period of time because of this acceleration of loss, there are changes not only in a woman's fertility, but also the cells around the eggs that produce hormone, typically estrogen, and then when women ovulate, progesterone. And because this wonderful computer that occurs every month in reproductive age women

starts to fail, then we start having changes in our cycles and that's one of the first hallmarks of the perimenopause, typically in women's 40s, late 40s, and then because of these fluctuations in hormones, women start experiencing symptoms. Sometimes they can experience symptoms of very high levels of estrogen, such as sore breasts, even nausea, heavier periods, particularly if they also have some underlying pathology on their uterus and it responds in a different way. And then, actually, in the six months before the last menstrual period, women can start experiencing symptoms of decreased estrogen and we can talk about that afterwards. I was surprised to learn that perimenopause can actually start as early as 35.

When you're explaining about what's going on with the hormones, can you explain to us what's actually happening to our body? Because I think the idea, whenever we hear about menopause, we hear about the hot flashes. But what else is happening to our body? Well, because of these fluctuations of hormones, women can experience these symptoms that I mentioned, which can be sore breasts, sometimes migraine headaches get worse. If they have fibroids, those fibroids can grow. In those years before, they can have more mood change.

And in the year before the last menstrual period, we also know that now, and this we didn't know before, that there are acceleration, a lot of, some of the problems that might go on after menopause, changes in blood pressure, changes in body fat. So women put more fat on their visceral area or their tummy area. Also, they can have acceleration of bone loss,

which actually within three years of the menopausal period, you can lose 10% of your bone. And a lot of these things are silent. These are serious things that happen to our physical body But yet menopause is something that we don't really talk about and now it seems like we're living through a time when a lot Of celebrities are talking about Trish, what do you think about what do you make of that moment right now? That's happening right now? Yeah

Well, I'm really excited about it because more has happened in the last 12 months on menopause than the last 1200 years probably. So I'm really excited that we are talking about menopause. And it's so critical because as Dr. Wolfman said, people underestimate, women underestimate, but society underestimates the length of time that this is happening for. Perimenopause can happen two to ten years before menopause. Postmenopause goes on until you die. So we're in a long, long period, decades, where women can be suffering from symptoms that are having a huge impact on her health, on her life, on her ability to work,

on her ability to care for elders, children, et cetera. So it's a huge issue that as a society, as a workplace, as a healthcare system, we must address. And Christina, we know that 100% of women will have some kind of symptoms of perimenopause, menopause. We'll go through this, yet we're only talking about it really now. Can you talk to us a little bit about how it impacts people's daily lives? Oh, I mean, it's massive. I wrote a story for the Toronto Star

about this a couple of months ago, and one of the people I spoke with was a gynecologist here in Calgary. She has a two-year wait list for people who want to see her about their menopause symptoms, but she was struggling with brain fog and memory loss and forgetting the word for things that she used in the operating room. And she didn't even recognize those symptoms in herself. And so she went and she

saw her doctor to say, like, am I going to be able to continue working? And so I think it's that pervasive. It's, you know, forgetting things at work. It's having the hot flashes when you're sitting there with your friends. It's absolutely not being able to sleep at night. It's all of these things. And it's weird because within my friend circle anyway, even on social media, a lot of us seem to get up at the same time in the middle of the night, like three o'clock in the morning, you're just up. And when you think about your career, a lot of us during this time, we're doing, you know,

we're in senior positions of leadership and it's frightening to see like when you're dealing with brain fog how that could impact your career. Dr. Wolfman, can you help us understand what's happening to our brain during this stage of life? Can I digress a bit? Because we got as far as the menopause and I want to be clear that the symptoms occur due to lack of estrogen are different and The really important symptoms are hot flashes Which is a sensation of heater warmth starting in the chest and moving upward to the head and neck Night sweats which interrupts sleep and therefore may impact

cognition also You talk about brain fog, which is not a well-defined term. And then also, we know about 40% of women have sleep issues. Mood changes, especially in women who are vulnerable to changes in mood around hormonal change, like puberty, postpartum, and then around menopause. But there can also be new changes in moods, such as irritability, anger.

Even people can have panic attacks around menopause. And then we also know that there are symptoms that we don't talk about hardly at all, and they're called genitourinary syndrome of menopause. And that refers to the lack of estrogen on the vulva, the vagina, and the pelvic floor muscles. And that causes dryness, irritability, difficulty with intercourse, and decreased sexual desire is a validated menopausal symptom.

So all these things occur when estrogen starts to go down once those eggs I talked about become depleted. And as Trish said, the symptoms we used to think happened for about maybe a couple of years, but there's something called the study of women across the nation that validated that the average time they last is seven to ten years. 40% of women have symptoms into their 60s, and 10 to 15% of women have these symptoms into their 70s. That's a long time.

It's a long time. It's a long time. Christina, you mentioned that there was a two-year waiting period for just to get the care that you need. Can you help us understand how menopause was treated in the past? Oh, I mean, it's such a fascinating story, and Wendy can help me out here a little bit in telling it. But Canada has a long history here. You know, in the beginning it was sort of ignored, and then about a century ago an endocrinologist in

Montreal discovered that if you gave women estrogen, they didn't seem to have so many problems, but that was a really expensive way to deal with it. They were getting the estrogen from estrogen made by the placenta during pregnancy. And when they realized that was too expensive, they moved to using a pregnant mare's urine. And that led to a medication called Premarin, which was one of the most highly prescribed drugs in North America for a long, long time. And the marketing around it is so interesting. And I mean, get on the internet and do like searches for old magazine ads for this.

They're all marketed to men. You know, they say like, keep her this way. Premarin, it's for husbands too. Like really women and their needs were sort of an afterthought in the way this was marketed. And then we got to, it was given to women in their 40s, 50s, 60s, I think even 70s, Wendy can jump in here with the exact age groups that this was being given to. And then in 2002, everything changed with

the results from the Women's Health Initiative study when that came out. And suddenly it set off this big scare. And that had to do with cancer, right? Did you want to talk about it? Right. So this is actually an excellent study, although we talk about it now maybe in not such positive terms. But it is a prospective randomized control trial, which means that you divide up the women and compared

what they're taking to placebo or a sugar pill, and then you follow them over a number of years. And over those number of years, they had assessments going forward every year or so looking at all the risk factors. And actually, it wasn't a study to see whether taking hormone therapy prevented symptoms. It was a study to see whether taking hormone therapy prevented the diseases of aging. So the things they were looking at were cardiovascular disease, which is the biggest killer of women, a stroke,

disease which is the biggest killer of women, stroke, clots in the legs and clots in the lungs, and breast cancer, all cancers and mortality. The study was supposed to go on for eight years and they had pre-stopping points and they had there's the Women's Health Initiative had a big observational arm where women got nothing. And then the hormone therapy arms, they had estrogen alone for the women who had no uterus, because we use the progestin mainly to prevent uterine cancer, which had been discovered in the 1970s

that if you take estrogen alone, it increases your risk of uterine cancer. And the drugs that were chosen were, as Christina said, Premarin, which was the most commonly prescribed hormone therapy at that time. Premarin, pregnant mare's urine. So it comes from pregnant horses because they make lots of estrogen when they're pregnant. So it was easy to synthesize. And the progestin was called medroxyprogesterone acetate,

which is a synthetic type of progestin and is very good at preventing uterine cancer. So they had an arm for Premarinolone, for the women who had a hysterectomy. And for women who had a uterus, they got both the estrogen and the progestin. After 5.2 years, a previously described hazard ratio was exceeded for the women on both the estrogen

and progestin. And so the study was stopped. And it was mainly exceeded for cardiovascular disease but when they broke the code they also found there was more breast cancer. In the women who took the estrogen alone, that study kept going on for 6.8 years and they stopped it because there was a teeny tiny bit more stroke. But actually now we have a 20-year reevaluation of the WHI. In the women that took the estrogen alone, there was 20% less breast cancer. Not more.

In the women that took the estrogen and the progestin, there was a little more breast cancer. There was a little more breast cancer, but when you looked at the ages 50 to 59 in that study, all the risk factors were very, very small and probably benefits outweighed the risk. So in essence, hormone replacement therapy does not necessarily cause cancer? Not in that study with Premarin alone. I think because Trisha I want to bring you back into this because when it comes to trying to figure out what is happening to you, we have a family doctor shortage in this country. If you don't have a family doctor you end up relying on the internet. And then this study has been brought up a lot

as to maybe why women shouldn't have access to HRT. How do you, what do you think is going on around the messaging around what's available to women during this phase of life when there seems to be a lack of information? Yeah, well I think exactly what you said. What we have is we have the stigma and the taboo and the silence around menopause. We have the inability for women to understand

what is happening to their bodies. We have lack of knowledge and we do not have access to appropriate care and treatment in this country, all leading to an avalanche of suffering for women. And that must end. What we found in our data is that women trust their primary care physician. They trust that person as the one they want to get advice from and to counsel them on what should happen around their symptoms. What we found is that less than 40% found that help to be

effective. They felt untreated, undertreated and so there is a lack of knowledge, not their fault. They have no education, hardly any education on menopause. So we're talking about millions and millions of women trying to get help, not able to get it. You said you mentioned, you used the word suffering, and I think when people hear about menopause, it's just kind of shrunken into this, oh it's just a of shrunken into this, oh, it's just a process of aging. Is there a lack of research and funding in this area and understanding of what's really

happening? There is a huge lack of funding and resourcing and research in this area, and I'm sure Dr. Wilfman will attest to this. There are so many areas that we need to deeper dive in. You talked about some of the symptoms, but there's so many symptoms. Another thing we found in our data, women did know, 80% you, yes, night sweats and hot flashes. But when you got into other symptoms,

they had no idea they were associated with perimenopause or menopause. Things like frozen shoulder, itchy skin, joint aches, changes in taste, like all kinds of different symptoms that women were experiencing, they could not attribute that to what was happening in their bodies. They didn't realize it was associated with this time of life. Dr. Wolfman, I'm going to come back to you, but I want to bring Christina back in.

Christina, you cover this issue of women's health. In your view, is there a lack of funding and research for women's health in general? Oh, absolutely. And we're about to see big changes come from the United States and the amount of support there is for women's health. And so it's not about to get any better. I don't have the figures off the top of my head to tell you how much or how much little research there is.

But to say, you know, it took years before this was even really discussed. And we don't have specialists available to help women with these issues. And Trish talked a little bit about women have these symptoms that, you know, are ignored, that are symptoms of perimenopause. I also wonder about the other effect, and that's women know these things can be symptoms of menopause or perimenopause, but then they ignore them and they don't get them checked out and maybe they're actually something else. And so we just need better supports for women in terms of research and availability of healthcare

practitioners. It seems now that if you have a family doctor, you're one of the lucky few. Are family doctors equipped to manage menopause? One of the women I spoke with in my story, a gynecologist, said, no, they're really not. And they're also like the WHO, the WHOI, that when those results came out, there was so much fear about putting women on hormone therapy. And so there was a lot of directing women towards to gynecologists for specialized care.

But here in Alberta, I mean, we have this massive wait list for gynecologists. I imagine it's the same across the country. And so here, gynecologists are saying, we want family doctors to take up more of this. Family doctors don't really have a lot of training in this. And so women don't quite know where to turn. And Dr. Wolfman, if you do have a family doctor, and maybe that family doctor is not giving

you the help that you need, and there's not enough treatment options, where do they turn? So I think it's a huge problem because even in the undergraduate curriculum, even in the gynecology curriculum, there's so little time spent on menopause. As a gynecologist, you spend hours and hours in the operating room. You spend hours and hours delivering babies, and you're trained in what we call MFM, maternal fetal medicine.

And yet, we hardly have any lectures or time on menopause. And every woman, if she lives long enough, will go through menopause. Not every woman now gets pregnant. Women live longer. They spend 30% to 40% to 50% of their lives after menopause. So we've been really trying to push more in the curriculum. There was actually a study in the US looking at all the residency programs across the US.

They surveyed about 300 and only something like 30 percent had instruction in menopause. So this goes to, I think, what Christina said about there was a big backlash after the WHI, and people were afraid to prescribe hormone therapy, but it left women not knowing where to go. And it was also physicians who were afraid and faculties who perceived this as trivial, related to ageism, a women's problem, not real medicine. I think the other thing that happened in the last few years is we now know the physiology of a hot flash within the brain and we know that a hot flash is an inappropriate stimulation of your thermostat. We being mammals, having to keep our temperature within a narrow

range and when that's transgressed, you start sweating to lower your temperature. So I think this discovery has changed also the attitude of physicians to respect the symptoms and also the discovery that women who have very severe symptoms have a higher risk of cardiovascular disease as they age. So I think this is changing the discussion for physicians, but we have a lot of work to do in our undergraduate faculties and our postgraduate faculties. And we at the menopause clinic at Mount Sinai, we try and run courses. There are organizations such as the Canadian Menopause

Society, the International Menopause Society. Endocrinologists also are very interested in this field. So we're all trying to get on board to improve education and access, because we know it's so lacking. We talked about lack of research. The Biden administration actually had an initiative to improve funding for women's research. I don't know what will go with that now, but they had started that and I think we should do that in Canada, too. It's an opportunity, perhaps.

Yes, absolutely. I wanted to get into some data from Trisha's organization, because some people might think that this is not something that impacts me. But women, we make up half of the economy. This is from the Menopause Foundation of Canada. Women over 40 are a quarter of the workforce. From age 45 to 59, 14% of women leave work,

compared to just 10% of men. Unmanaged symptoms of menopause cost $3.5 billion per year, $3.5 billion per year, including $237 million in lost productivity. Dr. Wolfman, what should we take away from these numbers? This speaks to the import of treating symptoms. This has been really the passion of my life, to allow women to utilize all their skills that they've acquired over their lifetime during menopause and postmenopausally. And in this way, we improve not only the health of ourselves, our partners, our families,

but even our nation. Our goal is to make sure that women are not prevented by their symptoms from functioning at their highest level. And we have ways of doing that. We can age gracefully. We can accomplish so much after menopause. And, you know, we should do it. Yeah.

And I was really excited, Trish, to see the numbers because I think some people might not take this seriously unless they see that it impacts the economy. What do workplaces need to do to be inclusive spaces for women who are going through menopause? Yeah, I think it's really important for workplaces to appreciate that this does hit their bottom line. Women are taking sick days. They're going on short-term disability.

They are not taking promotions. They are going from full-time to part-time. They are not taking promotions. They are going from full-time to part-time. They are retiring early. So the data shows that this is what women do in order to cope. They sacrifice their work in order to keep their health and keep other parts of their life going. Employers do not want that to happen. They don't want that as a cost to their bottom line, but they want to keep these women that have all this wisdom and experience and knowledge and can coach and mentor and can move up and break the glass ceiling.

So it is a really positive opportunity for employers that they can embrace. And the lift is not that much. It's about educating your workforce. It's about reviewing your policies and looking for anything that can help women at this stage of life, enhancing those policies, looking for anything that can help women at this stage of life, enhancing those policies, looking at their benefits program and do they have

coverage for things like pelvic floor therapy or for hormone therapy and other things that would be helpful to a woman in her treatment stage. So not a big lift, really big return. Christina, Trish mentioned, you know, there is still a stigma around menopause and you also said that some women might actually ignore their symptoms because actually admitting that something is happening might be just too scary to deal with. I make fun of my husband all the time. I send him memes of what's going on with me.

How do men become a part of this conversation? What is their role? You know, I think we have to really welcome them into this conversation. When I was writing this piece for the Toronto Star, I was out one night with a group of my friends and we all, as soon as I started talking about it, all the women sort of leaned over on the table. We were talking so quickly, hands flying everywhere. And afterwards, one of my friends texted me and said her partner had texted her, said

to her on the way home, you know, you just pushed us right out of the way and we see this happening and we are worried about you and we wanna be a part of the conversation. So I think in our personal lives, in our workplaces, making sure this is not just a conversation among women but a conversation for everybody because it has massive effects on our families, on our workplaces, on the way we all live. And so let's start this conversation about what we can do about it.

Do you feel as if we're reaching a turning point around this conversation? I think so. I was just, I was thinking when Dr. Wolfman came on this call, like I remember 15 years ago pitching a story about her work and having zero interest. And in the last year we've had big stories in the Toronto Star, in the New York Times. We're here today. And so I think the conversation is changing. I do have hope. I see you nodding.

I just want to add something. I feel like Canada could become a leader in this. We have an opportunity to take a lead in increasing knowledge to women, in having accessible care and treatment, and in creating menopause inclusive workplaces. We can do this. And you're saying this because the priorities in the US have changed, so maybe this is our opportunity to... It is our time. Yeah, and I'd also like to say that my hospital is a leader. We've raised $51 million towards a mature women's health center and because I'm on the board of the International Menopause Society I know that no place in the world has that happened. So yes. The hot and bothered

commercials were amazing. Yeah and you know the Hillary Weston Janice O'Byrne Center, we made an announcement a few days ago about it And I think we can act as global leaders and have other places emulate what we're doing So I think the future is rosy. I agree with Christina. I remember in 2018 there is a world menopause day in October, and we tried to pitch it to every newspaper, media, and the only one that was interested was Portuguese radio. I think partly that was because cannabis was released at the same time, and they got all the news.

And I'm thinking, but half the population is women. Why isn't anybody interested? We have one minute left, so I'm just going to go to Tr is women. Why isn't anybody interested? We have one minute left. So I'm just going to go to Trish. What do you think has changed? Why do you think this is, why do you think things are changing right now? Yeah, I think there's been a confluence of many things. Definitely we have data now in Canada that's been cited around the world, which is amazing.

We have more influencers, we have social media, and this is all wonderful because we should be the last generation. Like I feel like the baby boomers should be the last generation that had to deal with the silence, the stigma, the lack of access to treatment and care. Everything should be way better for the generations that are behind us, so let's just make that happen. There is a lack of education.

A lot of people are going online trying to find information. If you don't have a family doctor, you're going to go onto the internet. Do you worry about those gaps because not all the information online is accurate? I see a menopause gold rush happening right now. I think we're seeing all kinds of companies, whether they're hormones, compounded hormones, different supplements, different, all kinds of different advice. I think it's a gold rush out there right now for this and we see it happening before our very eyes So women need to be careful. It adds to the confusion. It was already complicated I think this is layering even more complexity to it. But in the end women must advocate for themselves

They really have to be legitimized, their symptoms and the way that they're feeling. And they have a right to feel good. They have a right to be at their peak. They have a right to be at their best. So that is enough for women to fight for. Don't suffer in silence. Thank you to all of you for being

a part of this conversation. I'm really proud that TVO was able to have this on the agenda. Thank you to all of you for being a part of this conversation. I'm really proud that TVO was able to have this on the agenda. Thank you so much for your time. We appreciate it. Thank you very much.