With Dr. Shafeena Premji, physician and Director of Mahogany Medical Clinic and The Village Medical, and Janet Ko, President of The Menopause Foundation of Canada. It’s interesting how Western medicine has framed women’s sexual and reproductive health. It has a history of presuming normalness means youth and reproduction, so ageing and not reproducing means “abnormal”. Take the term “menopause”, sometimes described as estrogen deficiency, a diminishment of ovarian activity, and a failure of endometrial development.
No wonder we aren’t eager to talk about menopause. Of course, this ties to our cultural fear and loathing of getting older and the lack of medical research that accompanies it. It’s particularly intense for women and gender-diverse people, who face ignorance and invisibility as they get older.
Dr. Shafeena Premji and Janet Ko join us to dig into menopause – before, during, and after – and the gaps those who go through it contend with.
Janet Ko is President and Co-Founder of The Menopause Foundation of Canada. Her personal journey to get support convinced her that menopause was an urgent gender equity issue. Janet has held numerous senior leadership positions and is an award-winning communicator. She’s dedicated to helping women thrive through their menopausal years as a passionate speaker and advocate.
Dr. Shafeena Premji is a family physician and founder and director of Mahogany Medical Clinic and The Village Medical, where she offers prenatal care, women’s health consultations, and a menopause clinic. Dr. Premji serves on Board of the Canadian Menopause Society and the Medical Advisory Board of the Menopause Foundation of Canada. She’s dedicated to supporting women through their menopausal transition and supporting her colleagues in identifying helpful menopausal treatments.
Menopause is a gender equity issue of truly epic proportion.
But it seems like menopause and the changes before, during, and after are hardly discussed.
So let’s talk about it.
I’m Andrea Gunraj at the Canadian Women’s Foundation.
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It’s interesting how the world of Western medicine has framed women’s sexual and reproductive health. It has a history of presuming that normalness means youth and reproduction, so ageing and not reproducing must mean abnormal. A tinge of loss has been baked into the lexicon.
Take the term menopause, which is sometimes described as “estrogen deficiency”, a diminishment of ovarian activity, and a failure of “endometrial development”.
No wonder many of us aren’t eager to talk about menopause and what comes before, during, and after. Of course, this ties back to our cultural fear and loathing of getting older and the lack of medical research that accompanies it. This is particularly intense for women and gender-diverse people, who face a lot of ignorance and invisibility as they age.
Women’s aging is too often considered a tragedy. That’s backward. The experience of aging, the growing and developing and learning that comes with it is in so many ways a privilege.
Dr. Shafeena Premji and Janet Ko join us to dig into the topic of menopause – before, during, and after – and the gaps those who go through it have to contend with.
Janet Ko is president and co-founder of The Menopause Foundation of Canada. Her personal journey to get support convinced her that menopause was an urgent gender equity issue. Janet has held numerous senior leadership positions and is an award-winning communicator. She’s dedicated to helping women thrive through their menopausal years as a passionate speaker and advocate.
Dr. Shafeena Premji is a family physician, and founder and director of Mahogany Medical Clinic and The Village Medical, where she offers prenatal care, women’s health consultations and a menopause clinic. Dr. Premji serves on the board of the Canadian Menopause Society and the Medical Advisory Board of the Menopause Foundation of Canada. She’s dedicated to supporting women through their menopausal transition and supporting her colleagues in identifying helpful menopausal treatments.
My name is Shafeena Premji and I am a family physician in Calgary, Alberta. This is going to be my tenth year in practice, so I’m very excited to celebrate that milestone.
I have a family practice in Calgary. I own two medical clinics, which are family medicine clinics, but we have a very strong focus on women’s health. And in particular, my practice does have a strong focus on maternity care, postpartum care, labor and delivery. And a new passion over the last five to six years in particular has been around perimenopause and menopause. I really take great pride and pleasure in meeting women in their 30s, 40s, 50s, 60s and 70s who are still struggling with menopause.
Something unique about me is that before I became a physician, I was a henna artist, or still am a henna artist, and I’ve been doing henna for more than half my life. I’ve traveled all around the world doing bridal henna for brides and a lot of my earnings from that helped me to pay for my medical school training, so something I hold very dear and a very soulful part of who I am.
I’m Janet Ko and I’m the president and co-founder of the Menopause Foundation of Canada, which is a national nonprofit advocacy organization dedicated to raising awareness of the impact of menopause on women and society.
I’m very passionate about helping women thrive in the prime of their life. I’m 55 right now, I’m a menopausal woman, and I think this is a great time of life and people should look forward to it. Before this role, I’ve always worked in corporate communications and was an SVP of Communications in life sciences, pharmaceuticals and the senior living sector.
Something about me that people may not be aware of is that I was deeply honored recently to be awarded one of Canada’s Top 25 Women of Influence. And I think that award is really for everybody in the menopause movement, including Dr. Shafeena Premji and the other amazing menopause specialists across the country who have dedicated their lives to this important time in a woman’s life.
But it was really meaningful for me because my mom was able to share in that experience of being at the ceremony, and she’s a woman who immigrated to this country when she was 19. She came by herself, she did not know the language, she landed in Halifax and my entire life she always just told me “do your best, if you do your best, you can put your head on the pillow at night and feel good about what you’ve done.” And I believe if you do your best with positivity and openness, an open heart, and a clear intention, good things will come. And that’s what’s happened with the Menopause Foundation of Canada. It’s really great intentions, doing our best, and an amazing group of women have rallied around to make that organization come to life.
So let’s start with a basic question. What is menopause?
Menopause, quite simply, is the time in a woman’s life when your periods end. Menopause happens 12 months of being period-free. One thing that we really want women to understand is that menopause is about more than hot flashes. If you think you’re too young for it, if you think you’re already through it, think again because menopause lasts between one third to one half of a woman’s life. There are three stages of menopause. There’s perimenopause which usually begins for most women in your 40s. Then you reach menopause, which is really that one day you are period free for 12 months and then you’re in post-menopause. That means you’re at increased risk for things like osteoporosis and heart disease and the genitourinary syndrome of menopause. So we really want women to understand that menopause is something you will live with for up to half of your life.
And to add to Janet’s definition of menopause, we also have a subcategory of women who go through either premature or early menopause. Premature menopause is also called premature ovarian insufficiency, and this is when women under the age of 40 go into menopause early. And there are many various risk factors and causes. One of the most common ones would be if your mother also went into menopause prematurely or early before 40. We also have another subcategory of women who are in early menopause and that’s defined as going into menopause between 40 and 45.
What’s the link between menopause and gender inequities and injustices? What are the gaps and issues that have to be addressed?
Menopause is a gender equity issue of truly epic proportion. If you consider there are 10 million women in Canada over the age of 40 making up more than one quarter of the population and one quarter of the workforce in our country, and our needs related to menopause have largely been ignored and overlooked.
The Menopause Foundation of Canada launched a landmark report in October of 2022 where we surveyed women between the ages of 40 and 60. And what we found was that one in two women were unprepared for this stage of life, and that in a world where no topic is off limits, menopause is still a taboo topic, with more than half of those surveyed believing that they couldn’t talk about menopause. Even more remarkable, menopause is a universal experience and yet four in ten women go through this time of their life feeling alone.
This is a topic that needs to be broken apart. We need to unpack menopause. We need to break the stigma. We believe that from a health equity perspective, this is really important. Our data revealed that while the physician is the most trusted source of information for menopause and women are very comfortable and confident going to their physicians asking for questions, the reality is that 72% of women who turned to their family physician found the advice that they received unhelpful or only somewhat helpful. And 40% of those women felt that their symptoms were under treated or not treated.
So we have this large population of women who are looking for help and support and they’re not getting that. We’re not getting that from society and we’re not getting that from the health care system.
Unfortunately, our residency programs have really limited the amount of exposure for residents and students to be able to really have a good grasp and understanding of what women experience when they are transitioning through this time of their life.
Our residency programs, both family medicine as well as obstetrics and gynaecology don’t have any formalized training. And so a lot of it is sort of learned on the spot and many centers across the country don’t even have a formalized menopause clinic. So you know, residents, clerks, medical students don’t have the opportunity to actually present to a menopause clinic that’s high volume, where they can be able to, you know, be exposed to what some of the concerns around treatment and assessment of these patients are.
The other challenge also is, go back 20 years, The Women’s Health Initiative, where that large study looked at women and hormone therapy, and there was a big fear and scare in regards to breast cancer risk, heart attack risk, stroke risk. And so both patients as well as, well women and physicians, have been afraid of the word “hormone therapy” and what that would mean in terms of risks, particularly for individual women.
Both of those things in combination has made it really really difficult for patients to be able to access care, but for physicians to be able to feel strongly comfortable in providing that sort of care.
Now, what would you recommend to those who will or are going through menopause to deal with these medical gaps?
For women, we need to close the menopause knowledge gap. So women need to become their own best health advocate. The more we know the better able we are to demand better for ourselves. And women in the prime of their lives should not be blindsided by menopause, and we deserve to feel healthy and to make contributions in ways that are meaningful to us. Whether that’s to our families, our communities, to the workplace, it’s very important that we do not embrace the notion that you have to put up with symptoms of menopause that could last up to a decade or more.
Perimenopause could be four to eight years and many women then have symptoms well past when they reach their menopause. So it’s really important that we understand what is happening to our bodies and that we understand there are lifestyle choices, there are safe and effective treatment options, and if you’re not getting the information you need from your family physician, demand more – ask to see a menopause specialist.
And I would tell women to please look for evidence-based sources of information, join the Menopause Foundation of Canada at menopausefoundationcanada.ca. You can download a free symptom tracker, you can find a physician, you can connect to resources from the North American Menopause Society, Society of Obstetricians and Gynaecologists of Canada, Canadian Menopause Society.
So really take control and recognize that you deserve to feel healthy, and this should be a great time of life and we should not fear menopause. We just need to take control of it.
Thank you, Janet, for laying that out so beautifully. If I were a woman and I wanted to counsel her about how to help her get the most effective and appropriate menopausal care through her doctor’s office, one thing that I would suggest for her to do is to seek out a menopause expert who has a certification which leads them to provide evidence-based recommendations and therapies.
We have a certification that’s called the North American Menopause Society or NCMP Certification Program. It’s an examination that physicians are able to write, both family doctors as well as gynaecologists, where we write an examination; we get this designation. And so a woman who is seeking out a hormone expert or a doctor who’s going to be helping them access appropriate therapies which are Health Canada approved, that they should access somebody who has that certification.
And as Janet mentioned, there are many, many credible resources now available online. You can actually search for a North American Menopause Society practitioner through the North American Menopause Society website. We also recently launched the MQ6 Tool, a very simple six question assessment tool that patients can take to their family doctor or to their gynaecologist. And there is a section in that that is specifically for the woman and also a section that’s for the healthcare provider. And it provides an interactive algorithm so that family doctors or doctors, gynaecologists, who may not necessarily be familiar with all the various available therapies, it provides an excellent summary of what that looks like.
And so the woman and her family doctor or her gynaecologist can have a good way of interacting where they’re both actively involved in the decision process of their treatment.
Alright, now what? Learn more by visiting menopausefoundationcanada.ca. It has great resources as well as landmark national research on menopause experiences released in 2022.
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