First-of-its-kind B.C. study looks at impacts of menopause

Many women start experiencing menopausal symptoms during perimenopause. (MementoJpeg/Moment RF/Getty Images via CNN Newsource)

A first-of-its-kind-study in B.C. is shedding much-needed light on how women are impacted by menopause – from the symptoms they suffer, to having their concerns dismissed by doctors, to paying out-of-pocket for effective treatments, to being fired from their jobs.

Lead researcher Dr. Lori Brotto, a professor of Obstetrics and Gynecology at UBC, says women's health in general is woefully under-researched, getting only seven per cent of available national funding. Of that seven per cent, only a small portion goes to studying menopause, which impacts all biological females to varying degrees.

"There's more that we don't know than we do know when it comes to midlife health," Brotto told CTV News.

In British Columbia, there are more than 875,000 women between 40 and 65 years old, the final report Health and Economics Research on Midlife Women in British Columbia says. The study involved surveying and interviewing 2,000 women in the province – half who were in perimenopause and half who were post-menopause – and revealed common themes in their experiences, producing a series of recommendations for change.

"We were interested in looking at the range and intensity of menopause-associated symptoms. We were interested in looking at where women were getting help, how much they paid out of pocket, what was covered by their insurance, how much relief they got from the different treatments that they obtained," Brotto explained.

"And we also looked at impacts on mood and well-being and loneliness, and impacts on the workplace, days missed of work, performance, promotions, etc."

More than just hot flashes

Other research into menopause has shown most women – 80 per cent – report symptoms that can include hot flashes, disturbed sleep, cognitive issues like brain fog, mood changes, vaginal and urinary issues, weight gain, fatigue and joint stiffness.

Understanding the range of symptoms, Brotto said, is crucial to understanding their impact.

"It's really important that in raising awareness of menopause make sure that women and the general public know that it's more than just, feeling a bit warm at night," she said. "There's so many more symptoms that go beyond that."

Study participants generally reported being uninformed about these symptoms and unprepared for their onset.

"Some women will actually say they feel like they're going crazy, or they feel like they're having symptoms of a heart attack," according to Brotto.

The first recommendation out of the study is to prioritize public health campaigns about menopause.

"Even though half the population will experience the menopause transition, there is a general lack of awareness about this life stage. A consequence is that people didn’t know what to expect, what their symptoms were, or how to manage," the report says.

Dismissive doctors and out-of-pocket costs

The report also recommends increasing education among primary-care providers and other medical professionals. Study participants, the majority of whom had family doctors, reported frustrating experiences when trying to get information or treatment.

"Even those women who brought up menopause or managing menopause symptoms or asked questions about evidence-based treatment, the majority of them said that it was met with dismissal," Brotto said, adding that others reported that their doctors would not discuss menopause at all while others still were unwilling to discuss hormonal treatment.

"There's still quite a few doctors that haven't updated their medical knowledge and still believe that menopausal hormone therapy causes breast cancer."

Hormone therapy was one of the things women said was not adequately covered by their extended health plans, and was one of the treatments for which they paid out of pocket. On average, study participants spent $900 to access treatments including massage and psychotherapy that were not covered by the province's medical services plan or by private insurance.

Impact on working women

Women in B.C. make up 48 per cent of the paid workforce, the study notes, and nearly half of working women are between 40 and 65. The effect of menopause on women's participation in the workplace was one of the issues highlighted by the study, which found one third of women reported "a significant negative impact," according to Brotto.

Having difficulty concentrating or performing tasks and being denied promotions were among the workplace impacts. Missing days of work was also a common theme.

Women told the researchers they were too embarrassed to tell their employers why they needed time off, using vacation days to attend appointments or tend to symptoms.

In addition, some of the participants reported being fired.

"While that seems like a really small number, 20 out of 2,000, if you were to extrapolate that up across the whole population of B.C. or the population of Canada, we're now talking about thousands and thousands of women that are potentially being fired or laid off because of menopause," Brotto said.

One of the report's recommendations is to address these workplace impacts by pushing employers to provide accommodation, pointing out that B.C.'s Human Rights Code protects women on the basis of age, sex, and disability.

Beyond the negative impacts on individual women, the report says there are costs when workplaces don’t address an issue that impacts swathes employees.

"In Canada, a recent report found that untreated symptoms of menopause costs the economy $3.5 billion per year, and are associated with $237 million in lost productivity. As many as 10 per cent of women in Canada leave the workforce entirely due to unmanaged menopause symptoms," the report said.

Brotto said the impact on the bottom line should be enough to make even the most reluctant workplaces take menopause seriously.

In general, Brotto said, there is more conversation about menopause and more awareness of its effects than there once was. She cited a recent promise by the provincial and federal governments to fund coverage for hormone therapy as one significant and positive step.

Still, she said stigma and shame are pervasive and that a lot of women are left to "suffer in silence."

The full report is available online.