In your 40s
Bone-density loss
Transmenopause (a technical term for the one year before the last menstrual period up to two years after the last period) is associated with significant bone-density loss. “Women may lose about seven percent of the bone density at their spine and almost six percent of the bone density at their hip,” says Dr. Aliya Khan, a clinical professor of medicine and director of the Calcium Disorders Clinic at Mcmaster University in Hamilton. You’re at a higher risk if you have a low body weight, smoke, consume more alcohol than outlined in Canada’s Low-risk Alcohol Drinking Guidelines or have a family history of osteoporosis.
Weight-bearing and strength-training exercises are key, as is getting enough calcium and vitamin D. “Maintaining a normal body mass index is also important for bone health during the menopause transition,” says Dr. Khan. “A low body weight is associated with greater rates of bonedensity loss postmenopause.” It’s a good idea to chat with your healthcare provider about arranging a bone-density test and blood work.
Moodiness and decline in cognitive function
You can thank dips and fluctuations in estrogen and progesterone for contributing to the decline in cognitive functioning (including forgetfulness and difficulty concentrating) and the increase in moodiness and depressive symptoms, from mild mood swings to (in susceptible individuals) major depressive episodes. A New England Research Institutes follow-up to data collected by the Massachusetts Women’s Health Study found that women who experienced a perimenopause of more than 27 months were twice as likely to have “elevated depressive symptoms.” But don’t
let that worry you too much; some estimates peg the number of women who experience mood symptoms at this stage at 10 to 20 percent, and much of it depends on how vulnerable we are to hormone-related changes.
Mood fluctuations and feelings of depression don’t last—phew! “They commonly return to normal after menopause, once the hormonal swings stop,” says Dr. Christine Derzko, obstetrician-gynecologist and an associate professor in the reproductive endocrinology and infertility division at the University of Toronto. “The severity of symptoms may be greatest in those with a history of depression,” she adds. Speak to your physician or psychiatrist; treatment options include antidepressants, psychotherapy or hormone replacement therapy (or a combination). Be kind to yourself, get enough sleep, pay attention to triggers and don’t skip medications or therapy sessions.
Sleep disturbances
Prepare for fatigue. “When you hit perimenopause, your ovaries produce varying amounts of estrogen and progesterone, until the levels of these are consistently low. This can result in symptoms such as sleep disturbance, hot flashes and night sweats,” says Dr. Khan. A study published in the journal Nature and Science of Sleep in 2018 found that 26 percent of women experience severe symptoms during the menopausal transition, including insomnia.
Going to bed at the same time each night, avoiding caffeine and turning off electronic devices (bye-bye, smartphone) before bedtime helps. “If menopausal symptoms are very significant and impact quality of life, low-dose hormone replacement therapy with estrogen and progesterone can be used for short periods in women who have a low risk of breast cancer, cardiovascular disease or cerebrovascular disease,” says Dr. Khan.