Canadian Women's Health Today

The Impact Of Menopause On The Musculoskeletal System: A Practical Overview

2025-08-22T15:29:44+00:00

Key Points

• Menopause is associated with a rapid decline in estrogen, which significantly affects bone, joint, and muscle health.

• Bone loss accelerates during the menopause transition, with up to a 10% reduction in spine bone density within the first five years after the final menstrual period.

• Menopausal hormone therapy (MHT) has been shown to be effective in preserving bone density and reducing fracture risk.

• Musculoskeletal symptoms, such as pain, stiffness, and joint discomfort are common and often underrecognized during the menopause transition, sometimes leading to misdiagnosis.

• Foundational strategies for preserving musculoskeletal health during and after menopause include lifestyle interventions such as strength training, balance exercises, and adequate protein and vitamin D intake.

Menopause represents an important phase in a woman's reproductive life, marked by the permanent cessation of menstrual periods, signalling the end of the reproductive years. In North America, the average age of onset is 50.5 years, generally occurring between the ages of 45 and 55. Hormonal fluctuations and symptoms of hypoestrogenism—such as hot flashes, night sweats, mood and cognitive changes—can begin up to 10 years before menopause, during the perimenopausal or menopause transition. These symptoms stem from fluctuations in sex hormones, primarily estrogen, which has receptors distributed throughout the body and impacts nearly every organ system, including the bones, joints, and muscles. In this review, we will summarize the effects of hypoestrogenism on bone, joint, and muscle health during and beyond the menopause transition.

Risk Reduction In Pregnancy: Evidence-Based Use Of Aspirin For Prevention Of Preeclampsia

2025-08-22T15:29:43+00:00

Preeclampsia is a multisystem disorder that emerges in the second half of pregnancy, characterized by the onset of hypertension and end-organ dysfunction. Globally, hypertensive disorders of pregnancy are the second leading cause of direct maternal death.¹ Preeclampsia alone it is estimated to affect up to 5% of all pregnancies. This condition poses serious risks to both mother and fetus, including increasing the likelihood of complications such as preterm birth, fetal growth restriction, and long-term cardiovascular consequences.

Given the severity of complications associated with preeclampsia, prevention strategies are essential, particularly for individuals at high risk. One of the most well-established interventions is the use of low-dose aspirin, which has been shown to significantly reduce the risk of preeclampsia in select high-risk populations. Leading obstetric organizations, including the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the American College of Obstetricians and Gynecologists (ACOG) have issued guidelines recommending aspirin prophylaxis for individuals with specific risk factors for the development of preeclampsia. Despite this, awareness and implementation of these guidelines vary, highlighting the need for continued education and standardization of care.

This article explores the current evidence and guidelines supporting the use of aspirin for preventing preeclampsia. By understanding the benefits of aspirin, identifying appropriate candidates most likely to benefit, and ensuring proper administration, healthcare providers can improve maternal and fetal outcomes and reduce the burden of this serious condition.

When You Don’t Look But You Do Find: Pragmatic Approach To Management Of Asymptomatic Endometrial Thickening In Postmenopausal Patients

2025-08-22T15:29:42+00:00

The endometrium varies in thickness through the menstrual cycle, largely in response to estrogen and progesterone stimulation. Following menopause, the endometrium should remain homogenously atrophied due to the relatively low circulating levels of estrogen. In postmenopausal women, the endometrium is considered thickened when it measures greater than 5 mm. Measuring endometrial thickness includes assessing the width of the anterior and posterior layers of the endometrium made on the midline sagittal image obtained by transvaginal ultrasound. The principal objective of investigating a thickened endometrial lining is to diagnose endometrial hyperplasia or cancer. Patients who experience postmenopausal bleeding and are found to have an endometrial thickness greater than 5 mm necessitate endometrial sampling. However, whether endometrial sampling is required in the absence of symptoms, namely postmenopausal bleeding, is a more nuanced clinical decision. This article provides an approach to evaluating patients presenting with asymptomatic endometrial thickening, including a review of guidelines for when further testing is warranted. It will specifically address unique populations, namely patients using menopausal hormonal therapies as well as those on tamoxifen.

Analgesia For Office Gynecology

2025-08-22T15:29:42+00:00

Intrauterine device (IUD) insertion and endometrial biopsy are two common and essential procedures routinely performed in office-based gynecology. IUDs offer highly effective contraception and also serve as important treatments for dysmenorrhea, abnormal uterine bleeding, and endometrial hyperplasia or cancer. Endometrial biopsy remains a first-line diagnostic tool for evaluating abnormal uterine bleeding. Despite their utility, both procedures are often associated with moderate to severe pain, which can discourage patients from pursuing them. As patient comfort becomes an increasing priority for both patients and providers, clinicians should become familiar with the effective analgesic strategies available in this setting.

How To Tackle Sleep Concerns In Peri-And Post-Menopausal Women

2025-08-22T15:29:41+00:00

Sleep concerns represent a common symptom of menopause, affecting approximately half of women during perimenopause and postmenopause. Often, sleep difficulties increase throughout the menopausal transition, particularly when not assessed and treated early on. Recent Canadian data highlights an increased risk among women for insomnia, more daytime sleepiness, and elevated rates of sleep-related conditions such as obstructive sleep apnea (OSA), REM sleep behaviour disorder, and restless leg syndrome. The etiology of poor sleep in this population is multi-factorial. While vasomotor symptoms (VMS) such as hot flashes and night sweats contribute to sleep disturbance, other contributing factors include hormonal changes, comorbidities, chronic pain, and age-related changes in circadian rhythm. A range of helpful options are available, including lifestyle and behavioural approaches and pharmacotherapy, which can ameliorate sleep quality to improve the lives of women during this important transition and thereafter.