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Menopause Doesn’t Have to be a Mystery

Menopause Doesn’t Have to be a Mystery

By Angelique Montano-Bresolin

Pelvic Health Physiotherapist

Menopause is a natural part of the aging process for women, marked by the end of menstrual periods and the end of fertility. It is typically defined as occurring 12 months after a woman’s last menstrual period, and it is diagnosed retrospectively.

According to the North American Menopause Society, the average age for menopause is 51 years, although it can occur anytime between the ages of 40 and 60. The onset and duration of menopause can be affected by a variety of factors, including genetics, lifestyle, and medical history.

During menopause, the body’s production of estrogen and progesterone decreases, leading to a number of physical and emotional changes.

Some common signs and symptoms of menopause include:

Hot flashes: Hot flashes are sudden feelings of warmth that can spread over the face, neck, and chest. They can be accompanied by redness, sweating, and rapid heartbeat

Vaginal dryness: Decreased estrogen levels can cause thinning, drying and thus inflexibility of the vaginal walls, leading to discomfort during sex and an increased risk of infections

Mood changes: Decreased estrogen levels can affect brain chemistry and lead to mood changes such as irritability and anxiety

Sleep disturbances: Hot flashes and other menopausal symptoms can disrupt sleep, leading to fatigue and difficulty falling or staying asleep

Memory and concentration problems: Some women may experience “brain fog” or difficulty with memory and concentration 

Hot flashes

First-line management techniques that can help alleviate menopausal symptoms are as follows:

Hormone therapy: Also known as menopausal hormone therapy (MHT or HT), involves taking estrogen and/or progesterone to supplement the body’s declining levels. HT can be taken in a variety of forms, including pills, patches, gels, and creams. However, HT is not right for everyone and carries some risks. It’s important to discuss the potential risks and benefits with a healthcare provider before starting HT

Lifestyle changes: Eating a balanced diet, exercising regularly, and getting enough sleep

Vaginal estrogen: In the form of creams, tablets, or rings, can help alleviate vaginal dryness and discomfort

Moisturizers and lubricants: Can help alleviate vaginal dryness and discomfort during sex

Pelvic physiotherapy:

  • Also known as pelvic floor physical therapy
  • Can help alleviate symptoms such as incontinence, pain, and sexual dysfunction associated with menopause
  • Involves exercises and techniques to optimize the functioning of the muscles of the pelvic floor and other surrounding muscles, tissues and joints.

Vaginal estrogen, moisturizers, and lubricants can all be effective in managing menopausal symptoms, but they also have some potential risks and drawbacks.

The Pros and Cons of Oral Treatment Options:

Vaginal estrogen

Pros: Can effectively alleviate vaginal dryness and discomfort

Cons: May be cumbersome to use for some individuals and each individual should be screened my a medical practitioner to ensure the risks do not outweigh the benefits


Pros: Non-hormonal and easy to use

Cons: May need to be applied frequently to maintain effectiveness


Pros: Non-hormonal and easy to use

Cons: May need to be re-applied frequently and some types can decrease condom integrity

It’s important to discuss the pros and cons of these and other treatment options with a healthcare provider to determine the best course of action.

In conclusion, menopause is a natural part of the aging process for women or vagina owners. It may be a trying time for some that can be filled with fear, frustration and mystery. But by advocating for yourself and seeking out help, you can find the best option(s) to support your journey during this transition and beyond.

To learn more, visit The Pelvic Health Hub or follow me on Facebook or Instagram!       

Angelique Montano-Bresolin, Reg. PT, BSc. PT, HBA Kin, received her Honours Bachelor of Arts Kinesiology degree from the University of Western Ontario and her Bachelor of Science in Physical Therapy from the University of Toronto. She has practiced as a Registered Physiotherapist in Ontario for over 20 years with a specialty practice in pelvic health physiotherapy. Angelique received her training in the field of pelvic floor rehabilitation both in Canada and the United States through the Herman and Wallace Pelvic Rehabilitation Institute, Pelvic Health Solutions, UroSante, the Women’s Health Division of the Canadian Physiotherapy Association and the American Physical Therapy Association. She acts as a Clinical Internship Supervisor and Guest Lecturer for the Toronto Metropolitan University Midwifery Education Program and the University of Toronto Physical Therapy Program. Angelique also acts as a teaching assistant for the educational company, Pelvic Health Solutions. In 2012, she founded Proactive Pelvic Health Centre, Toronto’s first private multi-disciplinary clinic in Toronto, devoted to pelvic health rehabilitation for people of all genders, ages and stages of life. Her latest passion project is the creation of Pelvic Health Hub in 2021, a digital boutique of online education courses and holistic pelvic health products.


North American Menopause Society. (2020). Menopause FAQs. Retrieved from