A new chapter in women’s health

Psychologist Lori Brotto (BSc’97, MA’99, PhD’03) dates her interest in researching menopause to an unlikely turning point: the creation of Viagra in 1999. At the time, Dr. Brotto was a graduate student studying sexual behaviour in rats, but the new “blockbuster” drug attuned her to cultural attitudes about gender—like studies showing that sexual problems in women were twice as prevalent as in men, yet with no equivalent medical treatments.

“Women’s health research in general lags decades behind men’s health research,” Dr. Brotto says. “It was only by the year 2000 that women were routinely included in clinical trials.”

Major knowledge gaps persist to this day. Dr. Brotto points out that although roughly half the population spends about one-third of life in post-menopause, relatively little research is devoted to understanding its basic mechanics, let alone the nuances. Some studies suggest that long-term consequences of menopause could include an increased risk of osteoporosis and heart disease, but we know staggeringly little about the effects over time. The paucity of data is even more dire for gender-diverse, intersex, and trans people who are experiencing menopause.

Without adequate scientific knowledge, we’re left with a fog of misinformation and insidious stereotypes about menopause, forcing many to navigate symptoms from night sweats to mental health challenges with scant support. “Most women who go to a primary care doctor with menopause symptoms will be dismissed or told it’s a normal phase of life,” Dr. Brotto says. “It is a normal phase of life—but that doesn’t mean you have to suffer in silence.” Better clinical care and quality of life in menopause is possible, but first we need robust data.

Dr. Brotto and her colleagues are leading the way. As a professor in the UBC Department of Obstetrics and Gynaecology and director of the Women’s Health Research Institute, Dr. Brotto helped lead a landmark study, the Health and Economics Research on Midlife Women in British Columbia (HER-BC) report. The first-of-its-kind study examined the impacts of menopause on 2,133 participants across the province. The findings paint a much-needed picture of the impacts of menopause on quality of life, and begin to chart a path forward for improved health outcomes both during and after menopause.

Dr. Brotto and her team found that 90 per cent of HER-BC participants experienced at least one menopause symptom that was significantly bothersome for them, like hot flashes, sleeplessness, or depression. While these symptoms are incredibly common, many participants reported feeling surprised and underinformed as they entered midlife, hungry for basic information. “Nobody prepares you for it,” one participant told the HER-BC team.

These symptoms aren’t just uncomfortable. The stigma and the lack of support during menopause affect anything from a person’s social life to their socioeconomic stability and career success. Women aged 40 to 60 make up nearly half of all women workers in the province, and a striking one-third of HER-BC participants reported that menopause symptoms impacted their jobs in some way. Many missed days of work or cut back on their hours, while nearly one in 10 reported “having to turn down a promotion or career advancement in the last half year due to menopause symptoms.”

And workplace attitudes towards aging present major equity concerns, with several HER-BC participants reporting being fired for reasons related to their menopause. As a result of these findings, HER-BC put forward a call to action, warning of workplace discrimination and recommending that the BC Human Rights Clinic ensure that employers are not violating the rights of workers experiencing menopause symptoms—a form of discrimination that is all too common given persistent stereotypes of aging women as irritable or incompetent.

Dr. Brotto’s work makes clear that those cultural narratives have a direct impact not only on how women think about menopause, but also on their physical experiences of symptoms. As a psychologist, she knows that “the brain and the body are not disconnected. Our beliefs, our outlook, our cultural values—they all impact our physiology.” The good news? Debunking stereotypes through research can transform people’s experiences of aging. “A little bit of data shared with the public can have such a profound impact,” Dr. Brotto says.

The ripple effects of that data are already being felt. As a result of the HER-BC study, Dr. Brotto says that the UBC Faculty of Medicine will introduce a new curriculum unit for medical students to learn about menopause for the first time, one of the few medical schools in Canada to do so.

Beyond campus, too, Dr. Brotto’s next projects seek to shape the future of menopause knowledge. She’s working with an interdisciplinary team to build a Research Agenda for Menopause and Midlife Women’s Health, charting research priorities and providing clinical recommendations. The results downstream will be new publications of life-changing knowledge, not least among them further research into the intersections of menopause and gender diversity, and menopause and race.

As wider change gains momentum slowly but surely, what can people entering midlife do to set themselves up for a healthy and happy transition through menopause? Accessing science-backed information is key, Dr. Brotto says. She recommends gynecologist Dr. Jen Gunter’s book The Menopause Manifesto (2021) and the free online speaker series from the BC Women’s Hospital’s Complex Menopause Clinic. Robust information allows people to demand to be taken seriously: “If you have any concern about whether your health experience might be part of menopause and you get dismissed, seek a second opinion,” Dr. Brotto says. “Advocate for yourself.”