Amanda Thebe’s perimenopause ordeal began after a boxing class when she was 42.
When she came home unusually exhausted, the Toronto-based fitness coach chalked it up to pushing herself too hard. But the exhaustion didn’t go away, and evolved into extreme vertigo that left her unable to stand. “I was crawling on the floor, I was throwing up,” she told the Star.
Over the following months, Thebe developed debilitating migraines, chronic fatigue, depression and incontinence. “I went from being the fittest I’ve ever been going into my forties, to, by 44, being literally on my knees every morning when I woke up. I couldn’t function,” Thebe said. One day, she woke up, looked in the mirror and thought, “Is this what old age looks like?’”
She saw numerous physicians and specialists, but none could pinpoint what was wrong. Two years after Thebe’s symptoms began, she finally found a gynecologist who linked her symptoms to perimenopause. “You’re not losing your mind,” she said the doctor told her. “You’re just losing your estrogen.”
Menopause and perimenopause, the stage leading up to a person’s final period, can profoundly affect health and longevity. A growing body of evidence suggests menopause can accelerate the biological aging process — but even though up to 80 per cent of women experience menopause symptoms, relatively little is known about the phenomenon.
“We know that menopause marks the end of reproduction, but we’re beginning to understand that menopause is actually a full body transition,” said Jennifer Rabin, a clinical neuropsychologist and scientist at Sunnybrook Research Institute and an assistant professor at the University of Toronto.
How menopause makes your body age faster
Most women hit menopause, which officially begins 12 months after the last period, at age 51 in Canada, but it can range from ages 45 to 55.
In the years before menopause, the body will dramatically reduce production of the hormones estrogen and progesterone. In this perimenopause phase, which is on average four years, symptoms often begin, Rabin said.
“We see changes across systems that are really important for aging and longevity — so the brain, the immune system, cardiovascular system and metabolism,” said Rabin.
Last year, a major paper found signs of accelerated biological aging across various organ systems in women who were peri- or post-menopausal. The greatest acceleration was seen in the liver.
A 2016 landmark study suggested that menopause could speed up one’s biological aging process by an average six per cent — or more for women who undergo menopause earlier.
If a woman entered early menopause at age 42, by age 50, her body would be a full year older biologically than a woman who entered menopause at 50, as one of the authors explained.
Research suggests women who undergo premature menopause before age 40 are at greater risk of heart disease, Alzheimer’s disease, osteoporosis and early death, said Dr. Marie Christakis, the clinical lead at Mount Sinai Hospital’s Weston and O’Born Centre for Mature Women’s Health and an assistant professor at the University of Toronto.
“It seems women who go through menopause earlier are more susceptible to the things we know are bad for the brain — vascular risk factors, hypertension, diabetes, obesity,” Rabin added.
What menopause means for your health
The lead-up to menopause carries profound changes for the body. It is linked with increased levels of cholesterol and a change in body composition; losing lean muscle and gaining more fat around the organs and abdomen. “All of those things can increase the risk of cardiovascular disease down the line,” Christakis said.
“The transition is when things are chaotic, when there’s abnormal lipids, there’s abnormal stress variables, there’s an abnormal inflammation. It’s a time of great stress,” said Dr. Jerilynn Prior, an endocrinologist and professor emerita at the University of British Columbia.
The loss of estrogen is linked with increasing insulin resistance, putting women at risk of prediabetes or diabetes itself. We also see an acceleration of bone loss at menopause, raising the chance of osteoporosis, Christakis said. These factors may help explain why women generally experience more chronic illnesses than men.
In September, Rabin’s team published a paper that found signs of dysregulation in the body’s inflammatory, metabolic and synaptic (a measure of how well cells “talk” to each other) processes, across the menopause transition.
They also found increases in proteins associated with Alzheimer’s disease. We know that Alzheimer’s disease is more common in women after menopause. Some believe estrogen plays a role in protecting the brain, but more research is needed on this.
We have very little research on menopause in general, Rabin said. Women have historically been under-represented in medical studies; today, just 6.4 per cent of grants funded by the Canadian Institutes of Health Research are dedicated to women’s health. Menopause and perimenopause account for 0.15 and 0.08 per cent of the total funding.
What you can do to stay healthy through menopause
There are five key areas that women should prioritize, according to Dr. Paula Rochon, a geriatrician and professor of medicine at U of T.
They are: Eating healthy (such as a Mediterranean-style diet), getting enough sleep, exercising regularly (with a mix of cardio, strength and balance training), maintaining strong social connections and avoiding substances like alcohol and nicotine.
Ideally, you’d start focusing on these before perimenopause. “You don’t want to wait for problems to develop,” Rochon said. “You want to think about what you can do in a more proactive way.”
You may also consider hormone therapy, which Rabin calls the “gold standard” for addressing vasomotor symptoms like night sweats and hot flashes. It works by replacing some of the hormones the body stops making during perimenopause.
There are risks attached; hormone therapy may increase one’s risk of heart disease, certain cancers and more. However, newer formulations have been shown to be safer, Rabin said, adding that women are advised to take hormone therapy within 10 years of menopause, or before age 60. Starting it after the age of 60 or more than 10 years after menopause increases the risk of serious complications.
Thebe’s final period came when she was 48. For the six years she was in perimenopause, and another two years afterward, she continued experiencing severe symptoms. They didn’t begin to diminish until she was in her early 60s.
Her main advice for women at this life stage: Eat well, sleep well and — perhaps most crucially — stay active. That’s easier said than done, especially when your symptoms leave you feeling drained. If a workout feels like too much, try going for a walk or some simple exercises, even if it’s just for five minutes.
“Even on those days where I felt dreadful, I asked myself: ‘What’s one thing you can do for yourself today that will make you feel better?” Thebe said. In order to do that, she threw herself into research, eventually distilling her findings into a bestselling book, “Menopocalypse.”
“As soon as I found out what I was dealing with,” Thebe said, “it gave me power back.”
