What is Menopause?

Menopause is when a woman is no longer biologically able to ovulate and is essentially the end of the child-bearing phase of a woman’s life. This is confirmed when a woman has no vaginal bleeding for 12 consecutive months. When women are transitioning into menopause, it is called perimenopause, and this phase is generally around 45 and 55 years of age. In North America, on average, 50% of women reach menopause at 52 years of age and 90% of women have reached menopause by 55 years of age.

During perimenopause, many changes happen that can affect a woman physically and emotionally. Symptoms such as hot flashes, night sweats, mood swings, difficulty in concentrating or memory problems, weight gain, and vaginal dryness may start to develop, and the severity of each symptom is different for everyone. Frequency of periods also start to change and become irregular, with some periods heavier or lighter than others, and it may be harder to predict when the next period will happen.

Reproduction:

A woman is born with about 1 to 2 million immature eggs and as she ages, that number declines. During a woman’s lifespan, only about 400 to 500 eggs become mature and are released from the ovaries (called ovulation), where they can be fertilized and produce babies. However, not all menstrual cycles will cause ovulation.

On average, women only have 300 to 400 immature eggs remaining at menopause and due to hormonal changes, the eggs eventually stop maturing and menstrual cycles stop. Therefore, if a woman is still experiencing menstrual cycles, even at irregular intervals, there is potential for pregnancy.

How do Contraceptives Work?

Contraceptives like hormonal birth control add extra estrogen and/or progesterone to a woman’s menstrual cycle, thereby preventing ovulation. It can also thicken vaginal fluids, making it difficult for sperm to move, and it thins the uterine lining, preventing a fertilized egg from attaching to the uterus.

Hormonal birth control does not delay menopause. Menopause is a natural part of aging; a woman’s eggs will still deteriorate, and the number of eggs will still decline, even if birth control is preventing ovulation each month.

Non-hormonal birth control, like condoms or diaphragms, prevent sperm from meeting an egg and copper IUDs make the uterus too acidic for sperm or eggs to survive.

Withdrawal Bleed vs. Menstrual Bleed

True menstrual bleeding occurs if an egg is released from the ovary, but it does not get fertilized by a sperm. Hormonal changes then cause the lining of the uterus to shed, and the woman experiences bleeding that lasts between 2 to 7 days.

Withdrawal bleeding occurs when a woman takes a break during short-acting hormonal birth control (like tablets, the patch, or the vaginal ring), resulting in a drop in estrogen and progesterone levels, causing the uterus to shed and bleeding occurs. For this reason, a woman taking hormonal birth control cannot use the presence of a withdrawal bleed to confirm if she is still fertile because ovulation did not occur, and bleeding is the result of a drop in hormone levels.

Hormone Replacement Therapy (HRT)

HRT is different than birth control as it contains much lower levels of estrogen and progesterone and is used to replenish what the body no longer makes for itself at menopause.

HRT dosing is based on symptom improvement, not bloodwork, with close monitoring and follow-up with healthcare providers. Typically, treatment is started at a low dose and increased slowly to the lowest effective dose that will manage menopausal symptoms while minimizing the risk of side effects.

Switching from Birth Control to Hormone Replacement Therapy

If a woman is sexually active, stopping birth control too soon may result in an unintended pregnancy and irregular bleeding. The Center for Disease Control (CDC), the American College of Obstetricians and Gynecologists, and the Menopause Society recommend that hormonal contraceptives be used until the average age of menopause (52 to 55 years old). If a woman decides to stop birth control, barrier methods, like condoms, should be used to prevent pregnancy until menopause is confirmed.

Some women may want or need to take HRT to manage menopausal symptoms or maintain bone health. Each woman’s experience with HRT is different: some find that it works wonderfully, while others complain of severe mood swings. A 12-week trial should help determine if the chosen method is effective. Non-hormonal prescription medications and non-prescription products are also available to help manage symptoms.

Making a Decision

There is no right or wrong answer on when to stop birth control and transition to HRT and it is different for everyone. Your healthcare provider or London Drugs pharmacist can explain the risks and benefits of different options and a thorough discussion should occur before any treatment options are decided.

Anyone can fall, but some people have a higher risk of falling than others. One of the factors that increases that risk is getting older. In fact, in Canada, about 20% to 30% of people aged 65 years and older experience a fall each year. The Public Health Agency of Canada (PHAC) reports that about 85% of all injury-related hospitalizations for older adults are due to falls, some of which are fatal.

As we age, we have a higher risk of falling for a number of reasons:

• Older people tend to have more problems with balance and muscle weakness than younger people do.
• Many health conditions linked to aging and falls include dementia, heart disease, low blood pressure, shortness of breath, numbness in the legs or feet, and vision problems.
• Seniors are more likely to be taking medications that can have an impact on their thinking, make them drowsy or confused, affect their vision or balance, or cause dizziness.

While not all falls cause serious injuries, it is important to remember that some do and to take precautions to prevent them. Among the problems falls can cause are cuts and bruises, sprains, pulled muscles, broken bones, like hip, ankles and wrists, or head injury.

PREVENTION

There are several precautions that can be taken to reduce your risk of falling. The first step is to discuss the medicines you take with your doctor or London Drugs pharmacist. Ask them if your medications have side effects that could increase your risk of falling. It may be possible to reduce your risks by adjusting doses, changing medications, rearranging what time you take them, or switching to other medications with less risks of drowsiness or dizziness.

Eating at regular intervals and nutritious foods is is another way to help safeguard your overall health, which, in turn, will help you stay strong and make it less likely that you will fall. Fluctuations in blood sugar (high or low) can also make you unsteady on your feet. Talk to your doctor about testing.

Another important step is to be physically active. There are exercises especially designed to help improve strength, balance, and the ability to walk steadily. Before starting any new exercise program see your doctor for an evaluation. If appropriate, the doctor may recommend that you see a physical therapist who can develop a program to meet your personal needs.

The next step is to look around your home and identify potential situations that could cause you to trip and fall. Then make any necessary changes to reduce your risk. Here are some suggestions that can help:

• Keep boxes, newspapers, electrical and phone cords, and other tripping hazards out of walkways.
• Keep high traffic areas clear of things such as small tables, plant stands, and magazine racks.
• Make sure rugs are secured to the floor.
• Insall sturdy handrails on stairways, and use them every time you go up or down.
• Store necessities where they are easy to reach so you won’t have to climb up or get into an awkward position to access hem.
• Keep your floors dry. Clean up any spills immediately.
• Place non-slip mats in your bathtub or shower, and a bath mat to avoid drips on the bathroom floor.

When you are outside, try to walk in well-lit areas, use handrails where available and avoid rushing. Be especially careful when stepping over curbs or when walking on uneven surfaces.

Other things you can do to help protect yourself include:

• Wear low-heeled shoes that provide proper support.
• Get regular eye exams to ensure that your vision is sharp so you won’t trip over things you don’t see clearly.

ASSISTIVE DEVICES

There are a group of products called assistive devices that can help prevent falls and injuries. Here are some examples of the types of devices that are available and how they can help:

• Assistive devices such as canes, crutches, and walkers can provide support and improve balance.
• A bath seat and a handheld shower nozzle can allow you to sit while showering.
• Safety grab bars and raised toilet seats can make it easier to get in and out of a tub and onto and off a toilet without falling.
• Hip protectors can be worn to protect the hip bone from injury in the event of a fall.
• There are also devices that can extend your reach and have “claws” at the end to help you grasp something that you can’t reach by yourself.
• Fall detection devices, smart watches or phones can be worn to automatically dial for emergency help if a fall is detected, preventing a minor injury from becoming more serious.

London Drugs carries a wide range of assistive devices, and your pharmacists can help you decide which ones would be right for you and how to use them properly.