Decoding Menopause: Understanding the Transition with Evidence-Based Insights

By Lakeview Physio
Rama Swami
BPTh, DR(PT), Pelvic Health Physiotherapist
Pelvic Health
May 23, 2024

Pelvic Health Physiotherapy has been proven to help with menopause symptoms and in improving quality of life.


Women are undeniably masterpieces, both on the outside and within. As a Pelvic Health Physiotherapist, my focus delves deeper into the intricacies of women's health.

Currently, millennials like me are the largest demographic experiencing hormonal shifts. Despite this, millennials often find themselves grappling with a lack of evidence-based reliable information about menopause. This knowledge gap, coupled with societal conditioning and deficiencies in medical care, often leave many women feeling bewildered and susceptible to misinformation surrounding this natural transition.

The Menopause Foundation of Canada’s landmark research of Canadian women aged 40 to 60 shows that among those going through perimenopause/menopause, more than half (54%) believe the topic is still taboo. A shocking one in two women (46%) feel unprepared for this stage of life. Even more remarkable, four in 10 women report feeling alone. How can something that happens to more than 50% of the population be such a mystery?

Let’s Decode Menopause

In her book, the Menopause Manifesto, Dr. Jen Gunter describes menopause as being puberty in reverse! It is an inevitable phase for every person with ovaries who lives long enough. With life expectancy increasing, women now spend a significant portion of their lives - about a third or more – in post-menopause. Menopause is merely a transition, not a disease.

Menopause signifies a shift in hormonal levels within a woman's body, and understanding these changes is pivotal to empowering women with the knowledge necessary to navigate this phase of life confidently.

Stages of Menopause

The journey through menopause unfolds in three distinct stages:

1. Early Perimenopause:

Ovaries still produce eggs, but the good ones are gone. Periods become erratic and sometimes women have 2 periods in the same month.  Ovulation might not happen every month. Hormonal secretion ranges from very heavy and dip to very low. There is a more dramatic fluctuation between estrogen and progesterone. High hormone levels cause exaggerated PMS symptoms. Low hormone levels cause psychological symptoms, some hot flashes, and sleep disturbances.

That's why this is called the hormonal roller coaster.

2. Late Perimenopause:

Eggs and follicles are extremely scarce. Hormone secretion is very low. This leads to missed periods. Intervals without periods are longer and more frequent.

This is a sign that the hormonal fluctuations have reduced. At this time all the symptoms of low estrogen become very evident - hot flashes, sleeping issues, urinary symptoms, vaginal discomfort etc.

3. The Final Menstrual Period:

Menopause is officially recognized when 12 consecutive months have passed since the final menstrual period (FMP). While the average age of menopause in Canada is around 51 years, individual experiences may vary widely.

How to find out what stage you are in?

The length of menopause transition significantly varies woman to woman. it is subject to other factors beside the hormonal changes like age, medical conditions, exercise, family history, social determinants, etc. The only predictable thing about Menopause is that it is unpredictable.

Tracking your cycles is the first step to find out what stage you are in.

As you approach perimenopause, your total cycle length will begin to change. A 7-day change in either direction (shorter or longer) when you have had regular cycles before indicates the beginning stages of perimenopause. Cycles often get shorter before getting longer, but every person has a unique experience. You may also notice changes to the volume of blood lost with each period. Perimenopausal cycles can be heavier than normal or lighter than normal.

Keep a list of ALL other symptoms, even the seemingly unrelated ones.

Using a menopause symptom tracker will help.

Physical symptoms:

Hot Flashes and/or Night Sweats

Period Changes

Body and Joint Aches


Headaches and/or Migraines

Skin and Hair Changes

Heart Palpitations

Dry Eyes

Dry Mouth and/or Dental Complications

Mental health and mood related symptoms:

Anxiety (Nervous, Stressed)


Low Mood

Feeling Not Yourself, Low Confidence

Mood Swings

Low Motivation or Energy

Crying Spells

Genitourinary and Sexual health symptoms:

Vaginal/Vulva Dryness, Itching, Burning

Painful Sex

Urinary Incontinence/Leaking Urine

Urinary Urgency

Urinary Tract Infections (UTIs)

Low Libido/Sexual Desire

Sexual Arousal Issues

Cognition and Sleep related symptoms:

Brain Fog

Sleep Disturbance


Concentration Issues

Short-term Memory Challenges

Poor Word Finding

Slower Processing Speed

Navigating Treatment Options

While menopause symptoms can be challenging, effective treatment options exist, including hormone therapy (HT). HT offers relief from symptoms such as hot flashes, night sweats, and genitourinary symptoms, and can also reduce the risk of osteoporosis and cardiovascular disease.

Pelvic Health Physiotherapy has been proven to help with menopause symptoms and in improving quality of life.

Engaging with Your Healthcare Provider

Open communication with healthcare providers is crucial in addressing menopausal symptoms effectively. Women are encouraged to compile a comprehensive list of symptoms and engage in shared decision-making with their doctors and Pelvic Heath Physiotherapists to determine the most suitable treatment plan tailored to their individual needs.


Deciphering the complexities of menopause is essential in empowering women to embrace this transformative phase of life with confidence and grace. By fostering informed discussions and access to evidence-based resources, we can dismantle the stigma surrounding menopause and pave the way for a more supportive and inclusive healthcare landscape.


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