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stigmaAbove: Vered Eyal

Written by: Marcia Kaye
Photos by: John Packman

In her late 40s, Vered Eyal had every intention of going through menopause without any medical intervention. The Toronto organizational consultant had always lived a healthy lifestyle, which included a plant-based Mediterranean diet, organic fruits and vegetables, regular exercise, yoga and meditation.

But while her habits were excellent for her overall health, Vered had no idea that they wouldn’t be enough to see her through a difficult menopause that was just on the horizon.

Within a couple of years, once her cycle began to change and then eventually stop, Vered was experiencing disturbing symptoms: hot flashes, sleep problems and mood changes that included inappropriate bursts of rage and bouts of extreme sadness. She dragged herself out of bed every morning exhausted and lethargic. For a long time, the busy mother of two children and stepmother of three downplayed her symptoms. “As women, we’re used to dealing with some discomfort with our bodies and we suck it up and live with that,” she says. She took a year off work. She consulted a naturopath and tried various herbal formulations, with little success.

Vered’s family doctor referred her to the Mature Women’s Health Clinic, part of the Frances Bloomberg Centre for Women’s and Infants’ Health in Mount Sinai Hospital. She met with director Dr. Wendy Wolfman. Since Vered didn’t have a disease, she half expected the physician to dismiss her symptoms. On the contrary, Dr. Wolfman took them very seriously. “What I like about Dr. Wolfman is she is really all about quality of life,” Vered says. “We had a long conversation, and I was impressed by how open and knowledgeable she was. She gave me tons of information.”

"The biggest public misconception is that these are trivial, short-lived symptoms that women have to endure, almost like a woman’s burden.”

- Dr. Wendy Wolfman

Like many women, Vered remembered the hormone therapy (HT) scare of 2002. Widely-published results of the United States’ Women’s Health Study Initiative (WHI) linked HT (a term including either estrogen alone or an estrogen-progesterone combination) to an increased risk of a number of health conditions, including breast cancer and heart disease. That caused women to run in fear of HT and many physicians to pull their patients off it. (Menopause is defined as the point at which there have been no menstrual periods for one year. That occurs in North American women, on average, around age 51.) However, subsequent re-analyses of some of the data, as well as follow-up studies, showed that there was no increase in breast cancer at all in women who took HT for three years and only a tiny increase after five years. And while HT may not help protect women over 60 from heart disease, as was once thought, it could do exactly that for younger women who experience a very early menopause before age 40. Both the Society of Obstetricians and Gynaecologists of Canada and the North American Menopause Society recognize HT as an option for managing troubling menopausal symptoms.

Last October, Vered began a low level of hormone therapy. Within three days she felt dramatically better. The hot flashes vanished, her sleep improved, her energy returned and her mood lifted. Now 52, Vered plans to stay on the medication for four years and undergo regular monitoring for heart disease and breast cancer, both of which run in her family. “I’m not promoting hormone replacement therapy,” she emphasizes, “because every woman is different. Dr. Wolfman makes sure you get what’s right for your circumstances. And right now I’m feeling really, really good.”

About 1,600 women come to the menopause clinic every year. But Dr. Wolfman says thousands more suffer in silence. “The biggest public misconception is that these are trivial, short-lived symptoms that women have to endure, almost like a woman’s burden,” she says. About 70 to 80 per cent of all women will experience unpleasant menopausal symptoms. For 20 per cent of them, their symptoms will be severe and life-altering. Ten to 15 per cent of women will continue to have hot flashes into their 70s. Within three years of menopause, half of all women will experience bladder, urethral or vaginal problems because of the lack of estrogen in genito-urinary tissues. “It’s something that no one talks about. And since these are complaints of aging, there’s been a stigma of shame talking about them.”

But Dr. Wolfman is talking about them. Her new position as inaugural holder of The Carol Mitchell Chair in Mature Women’s Health means she’ll be able to reach more people to increase awareness and educate the medical community. She runs an annual course for up to 400 physicians and other health professionals, in conjunction with Dr. Harold Drutz, former head of Mount Sinai’s Division of Urogynaecology. She lectures throughout the community to family practitioners, allied health professionals and medical students. Mount Sinai has a unique fellowship in Mature Women’s Health for obstetricians and gynecologists from across Canada and around the world.

There are two clinics a week for menopausal patients. There is also a clinic for women with premature ovarian insufficiency, a condition affecting one per cent of women under 40 and bringing on premature menopause. Causes are mostly unknown but may include certain surgeries, cancer treatments such as chemotherapy, autoimmune diseases and genetics. Dr. Wolfman says many studies now show that women who have a very early menopause and who don’t receive replacement hormones up to age 50 may have a higher risk not only of heart disease but also of Parkinson’s and dementia. “So that’s one very important group of women who I don’t think have been adequately served by the medical community,” she says. The interdisciplinary clinic, run jointly with endocrinologists from Toronto’s Women’s College Hospital, is one of the only clinics in North America for women with premature ovarian insufficiency. Women with this issue are encouraged to come to the clinic, both to seek treatment and to contribute to a growing body of information for future research about this condition.

Above: Andrea Marcus

Andrea Marcus of Thornhill, Ontario experienced an earlier than average menopause around age 44 and started taking HT for severe hot flashes, night sweats, headaches, muscle pain and fatigue. It worked well, but about 15 years later, after hearing the frightening news about HT, she went off it cold-turkey. All her symptoms returned, plus a new one — frequent urinary tract infections. With a longstanding connection to Mount Sinai Hospital (she was born there and had her two children there), Andrea asked for a referral to the Mature Women’s Health Clinic.

Andrea is now on a low-dose HT regimen that has resolved her symptoms. “It’s been unbelievably successful,” she says. Now 70, under Dr. Wolfman’s guidance she is gradually cutting back the dosage. “I have the utmost respect for Dr. Wolfman. The way she talks to me — and I’m sure other patients — is just so professional and straightforward and honest. She gives you information about this study or that study so you can make informed decisions. I feel totally in control.”

There’s a whole array of body-identical HT therapies available, such as pills, gels, patches and local vaginal treatments. But HT is not for every woman, says Dr. Wolfman. Some women will not want to take it, some won’t benefit from it, and some shouldn’t take it, including those with unexplained bleeding, new cardiovascular disease or a history of certain cancers or stroke, as well as women initiating treatment over age 70, because of an increase in cardiovascular disease in that age group.

There are also many effective non-hormonal options, including gabapentin (an anti-seizure drug) and SSRI antidepressants. For mild to moderate symptoms the clinic may also recommend acupuncture, cognitive behavioural therapy or simple lifestyle changes such as dressing in layers, lowering room temperatures and avoiding triggers such as alcohol, spicy foods and stress. Andrea says she was impressed that the clinic also coordinated her care with other specialists, such as a urologist.

It’s crucial to tailor therapies to every individual patient, says Dr. Wolfman. Her overarching goal is to ensure that women who are at the peak of their lives in terms of their knowledge, skills and experience can continue to function well without being sidelined by bothersome symptoms. “It’s so rewarding to hear patients say, ‘Thank you for giving me my life back.’”

The establishment of Dr. Wolfman as inaugural holder of The Chair in Mature Women’s Health was the brainchild of Carol Mitchell (nicknamed “Mitch”), CEO and Portfolio Manager of iMaGiNe Wealth Management, a small hedge fund. As a professional woman on Toronto’s Bay Street for 30 years, Mitch had met a vast number of midlife women, and she began to see a pattern in some of their stories and their lives. “I could see the physiological strain and the toll it took on women, on their relationships, their loved ones, their kids,” she says. “It was heartbreaking.”

Mitch, who holds a phys ed degree as well as an MBA, has always been interested in women’s health issues. She heard about Dr. Wolfman, who is also a Professor in the Department of Obstetrics and Gynaecology at the University of Toronto. The two women met and talked, and Mitch decided to create a Chair to help de-stigmatize menopause. The Chair would consist of an endowment, with an initial target of $2 million. The funds would be invested in perpetuity, with the return on investment available for the chair-holder’s work. Today, after two years, with Mitch as lead donor and fundraiser, $2 million has been raised. The goal has now been set at $3 million — with Mitch and her family committing to match every new donation until they reach their target. At fundraising events where Dr. Wolfman speaks, Mitch says it’s telling to see how misinformed, uninformed and desperate many women are for help.

Mitch emphasizes that she wouldn’t have founded, sponsored and marketed this Chair for anyone but Dr. Wolfman. “She’s a trailblazer. She works tirelessly towards tailoring the treatment for every individual. It’s her MO to make quality of life better for people who are suffering.” Another primary goal of the program is to have young doctors, female and male, become menopause specialists as the next generation of Dr. Wendy Wolfmans. As Mitch says, “It’s like you want to clone her!”

Dr. Wolfman says, “I’m so grateful to Mitch and to all the people who have donated. It means that, hopefully, all the work I’ve done to establish these internationally recognized clinics and build the fellowships — really, my life’s work — will stay forever at Mount Sinai.”

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