How half of the adult population goes through half of their lives —from the age of forty— within a process that their own physicians were not trained to see. Let us remember the obvious: more than half of adults are women. All women.
By Claudia Aranda, Montréal, Quebec
It started with a cream. What I discovered afterward compelled me to investigate why, for five years and more, no doctor —of any specialty— saw what was happening to me. This is the chronicle of that search and of the void I found: a gap in medical training that in Quebec has precise consequences on precise bodies, and a standard that recognizes only one symptom out of more than thirty.
I. The cream
It was prescribed to me for a mechanical, almost administrative reason. I was too dry for them to perform a gynecological exam; there was no way to insert the speculum. Vaginal estrogen cream, for four months, and then try again. I used it expecting nothing more than to finally undergo that examination.
What happened afterward no one had told me about. Within a few weeks, I began to feel different. My mood returned. My libido, which I had given up for dead, returned. My self-esteem improved, even while carrying the obesity I drag around. In front of my psychiatrist, I stopped being irritable and defensive: I felt calm, rational, light. One day I told him, surprised myself: I feel happier since I started using vaginal estrogen. Not the other way around. It was I, the patient, who informed the specialist of my own improvement.
That surprise is what made me sit down to investigate. And in investigating, I stumbled upon a word that at my age I did not know: perimenopause. I did not know what it was. I did not know it existed. I could not believe I had not studied it years earlier, when perhaps I would have insisted, demanded, until I found someone who knew. But that disbelief, over time, transformed into something else. If I, who make a living researching, who reads and knows how to search, had arrived here without knowing what was happening to my own body, then the silence was not my failure. It was the size of half of humanity.
II. The consultation
I arrived prepared. I had studied everything I could, I had even consulted with specialists, I carried on my phone an organized summary of my medical history. I was excited. This time, I thought, they will diagnose me properly and finally my pains will end.
It was a few weeks ago, at the Family Medicine Clinic of a Montreal hospital. In French, which is not my mother tongue, I told the doctor that I had a summary on my phone. She replied that she had half an hour to see me and that there was no time for that. That I should choose a single pain. One.
I chose what could kill me that same morning: the dizziness, the sodium that plummets —once I fainted in the hospital cafeteria—, the finger I lost. I received test orders, a referral to the plastic surgeon for the finger, a spot on the bariatric surgery list. The system activated, efficient, for each fragment separately. And at some point during that half hour, when I insisted, she said the phrase that summarizes these five years better than any statistic:
I don’t care at all about your capsulitis, and if you don’t have hot flashes, there are no estrogens.
I am not writing to accuse one person. I write it because that phrase is not an individual outburst: it is the exact translation, spoken aloud, of a standard. In Quebec, with few exceptions, menopause is not treated. Hot flashes are treated. The rest —joint pain, depression, dryness that kills desire, frozen shoulder— remains outside the framework, distributed among specialists who each look at their own piece and none at the whole.
III. The three stages: what each one is
Much of the confusion begins because a single word, menopause, is used to name three different things. The imprecision is not innocent: whoever does not distinguish the stages cannot treat each one accordingly.
Perimenopause is the transition. It generally begins between forty and forty-four years of age, although it can start earlier, and is characterized by menstrual cycles that become irregular —the length of the cycle changes, the flow changes, the amount of bleeding changes— while the first symptoms appear. In the body, follicle-stimulating hormone begins to rise and ovarian reserve markers fall. It is the key stage and the most ignored, because the woman still bleeds: for the criterion that only recognizes the absence of menstruation, here “nothing is happening,” when in reality almost everything is happening.
Menopause is not a stage but a date. It is a single point, which is also diagnosed retrospectively: it is confirmed when twelve consecutive months have passed without menstruating, with no other cause to explain it. The average age is around fifty-one.
Postmenopause is everything that comes after that date. It is subdivided into an early stage, the first years, with frequent vasomotor symptoms and high hormonal variability, and a late stage, in which long-term risks such as osteoporosis and cardiovascular disease come to the forefront.
When menopause occurs between forty and forty-four it is called early menopause; when it occurs before forty, premature ovarian insufficiency. This staging follows the international system known as STRAW+10. It is worth stating clearly something that the staging makes clear: these stages describe the end of reproductive function, not aging. They are different things. Aging is a continuum that runs from birth; menopause is a bounded endocrine event that occurs in the prime of adulthood. Confusing them is the first error, and it is an error with clinical consequences.
IV. Early perimenopause: when the body changes and the period still comes
There is a silence within the silence, and it surrounds women who begin to feel changes in their thirties or early forties, when menstruation is still regular or just beginning to change. The widespread belief is that if you still bleed, nothing hormonal can be happening. That belief is false and has consequences.
Perimenopause can begin in the mid or late thirties, although the average age of onset is around forty-five. The first signs are usually changes in the menstrual cycle: periods that shorten or lengthen, heavier or lighter bleeding, cycles that become unpredictable. But the cycle is only the tip of the iceberg. The drop in progesterone —the first to decline, because ovulation becomes irregular— triggers symptoms that have nothing to do with the period: insomnia, anxiety, irritability, mood swings, brain fog. Estrogen, for its part, begins to fluctuate erratically, and with it thermoregulation, mood, sleep quality, and joint integrity become unregulated. A thirty-eight-year-old woman who sleeps poorly, is irritable, has dry skin and painful joints, and whose cycles have become irregular, is not a “stressed” or “anxious” woman: she is a woman in perimenopause. But because she is still bleeding, no one looks at the hormones. She is referred to a psychologist, a rheumatologist, a physiatrist. She is prescribed anxiolytics, anti-inflammatories, sleeping pills. What is not prescribed, because no one thinks of it, is the only intervention that could address the root of the problem: the hormone that is beginning to be lacking.
V. Why the body changes without estrogen
Here is the knot that explains everything else, and that dismantles the prejudice at its root. Menopause does not arrive because the body “wears out.” It arrives because the ovarian follicle reserve —fixed in number from fetal life, that is, finite from before birth— is depleted. When depleted, the ovaries stop producing estrogen in sufficient quantity. It is not aging that turns off the ovaries: it is the depletion of a counted reserve that triggers the hormonal drop.
And that drop does not stay in the reproductive system, because estrogen was never just a reproductive hormone. Its receptors are distributed throughout the body: in bone, muscle, brain, cardiovascular system, skin, and urinary tract. Estrogen participates in maintaining bone density, muscle mass and strength, neurotransmission and temperature regulation, blood vessel function and lipid profile, skin thickness and hydration, and the integrity of the urinary and vaginal mucosae.
Hence a single hormonal deficit produces symptoms in systems that seem unrelated to each other. When estrogen drops, bone loses mass faster, muscle decreases, thermoregulation becomes unbalanced and hot flashes appear, mood and sleep are altered, skin thins and dries, mucosae atrophy. They are not separate diseases that by bad luck coincide in the same person at the same age. They are the branches of the same trunk. This is the physiological fact that compartmentalized medicine is not designed to see: it distributes the branches among different specialists and no one looks at the trunk.
VI. The symptom map
More than thirty symptoms are recognized as associated with perimenopause and menopause. Organizing them by system is what allows them to be recognized as a set rather than as a collection of isolated ailments.
Vasomotor symptoms —hot flashes and night sweats— are the best known and affect the majority of women; their average duration exceeds four years and in many cases extends beyond a decade. They are, moreover, the only symptom that the Quebec standard recognizes without question, which says a lot about what is left out.
Genitourinary symptoms —dryness, pain during intercourse, urinary urgency, recurrent infections— affect a very high proportion of postmenopausal women and, unlike hot flashes, do not tend to improve on their own over time: they worsen.
Musculoskeletal symptoms —joint and back pain, stiffness, tendinopathies, frozen shoulder— are the group that recent literature has begun to name as a set, and they deserve particular emphasis because they appear early, already in perimenopause, around age forty. That is precisely the blind spot within the blind spot: they arrive when the woman is still bleeding, when for current clinical criteria “menopause has not yet occurred,” and therefore they are almost never attributed to hormones. They are sent to the traumatologist, the rheumatologist, the physiatrist, and treated as wear and tear, poor posture, or isolated accident, years before anyone thinks to look at estrogen.
Added to these are mood symptoms, cognitive symptoms —the so-called brain fog—, sleep symptoms, metabolic symptoms —weight changes, fat redistribution, lipid alteration, insulin resistance— and dermatological symptoms, including hair loss. Some of these groups are established consensus; others, such as musculoskeletal and much of cognitive, are emerging evidence. This distinction must be maintained, because it is what separates a rigorous text from a militant one.
VII. What exists to treat it
Against the idea that “there is nothing to do” or that “you have to endure it,” the therapeutic arsenal exists and is described in current guidelines. But it is worth distinguishing two horizons: the criterion that still predominates in common practice and the preventive and comprehensive approach applied by true specialists, which is more ambitious and arrives earlier.
Hormone therapy is the most effective treatment for most symptoms. Treatment is indicated when menopausal symptoms interfere with daily functioning and quality of life. It is administered as estrogen alone, in women without a uterus, or as estrogen combined with a progestogen, in women who retain the uterus. And the route matters as much as the molecule. The oral route passes first through the liver and is associated with a slightly higher risk of thrombosis. The transdermal route —patch or gel— avoids this first liver pass and has a more favorable thrombotic risk profile. The local vaginal route —creams, ovules, rings— acts on the genitourinary tissue with practically no systemic effects, and is the first-line treatment for dryness and pain. It is, precisely, the cream with which my story begins.
But, which hormones exactly and what is each one for? Not all hormones are the same, and not all are administered in the same way. The confusion surrounding hormone therapy begins precisely by not distinguishing what each one does.
Estrogen is the hormone most associated with the classic symptoms of menopause. When replaced, it improves hot flashes and night sweats, vaginal dryness, sleep quality, and helps maintain bone density and cardiovascular health. But not all estrogens are the same: estradiol (the most active form) is preferably administered transdermally (patch or gel) to avoid the first liver pass and the consequent thrombotic risk. Local vaginal estrogen (creams, ovules, rings) acts exclusively on the genitourinary tissue and is the first-line treatment for dryness and pain.
Progesterone (or its synthetic analogs, progestogens) is indispensable in women who retain the uterus, because it protects the endometrium from the continuous stimulus of estrogens, preventing hyperplasia and endometrial cancer. But progesterone is not just a “shield” for the uterus: it has its own effects on the nervous system. Micronized progesterone (the “bioidentical” form) has a calming effect on the central nervous system, improves sleep, and reduces anxiety. Many women in perimenopause, even before needing estrogen, benefit from a “progesterone first” approach to address the insomnia, irritability, and mood swings that appear when ovulation becomes irregular.
Testosterone is the great forgotten one, and yet it plays a crucial role in women’s health. Unlike estrogen and progesterone, which drop drastically in menopause, testosterone decreases more gradually from age forty. But its drop is no less relevant: testosterone is essential for sexual desire, energy, orgasmic function, and the maintenance of muscle and bone mass. In postmenopausal women, the combination of testosterone with estrogen can have beneficial effects on desire and sexual function, and some studies suggest it could also reduce cardiovascular risk. However, testosterone is not approved for use in women in all countries, and its prescription requires a careful evaluation of risks and benefits.
Here is the paradigm shift that most practice has not yet incorporated. For years, the criterion was the so-called window of opportunity: initiating therapy before age sixty or within the decade following menopause. That criterion still appears in guidelines, and it is already more than many patients receive. But the cutting-edge approach has surpassed it: it starts from the simple principle that, if what happens is that eggs are depleted and with them estrogen falls, intervention should begin in perimenopause —when the woman is still bleeding— and be sustained, adapted to each person, throughout adult life. It is not about waiting for damage to appear to treat it, but about preventing it before it sets in. Several recent international consensus statements support this vision: the European Society of Endocrinology published in 2025 a clinical practice guideline for the evaluation and management of menopause and perimenopause; the Asia Pacific Menopause Federation published in 2024 a consensus providing an updated algorithm for the management of perimenopausal and menopausal women; and in France, the Haute Autorité de Santé confirmed in 2025 the place of menopausal hormone therapy as an effective treatment in various situations. Science advances. Practice, not at the same pace.
And that approach is not only hormonal: it is comprehensive, and therein lies its true power. Targeted hormone therapy adjusted to each patient is accompanied by a preventive program that includes muscle strengthening with localized exercise, bone density monitoring, joint work and stretching, and a protein-rich diet. This is exactly what prevents capsulitis, tendinopathies, fractures, and muscle loss before they occur, instead of chasing them one by one when they are already chronic. The logic is preventive, and that is why it is also the most efficient: in the long term it avoids an enormous amount of medical spending currently dedicated to treating injuries that should never have occurred.
It is worth, nevertheless, being honest about what the hormonal component does and what it does not: it improves with good evidence hot flashes, genitourinary symptoms, arthralgias, and sleep; it is not a solution for weight gain nor does it by itself reverse cognitive decline. For those who cannot or do not want to use hormones, there are non-hormonal options with evidence, including certain antidepressants for hot flashes and, more recently, a new class of drug —fezolinetant, a neurokinin receptor antagonist— approved in 2023 for moderate to severe hot flashes.
And there is a point that deserves emphasis because it is where practice errs most due to excess fear: the difference between real and perceived contraindications. Real are, for example, breast cancer with positive hormone receptors, undiagnosed bleeding, active thromboembolic disease. Perceived —that is, not truly contraindications— are things like mere family history of breast cancer, which does not prohibit treatment but requires case-by-case evaluation. Many women who were indeed candidates went without treatment due to fears that current guidelines do not support.
VIII. What those who know say
It is worth pausing on what recent science affirms, because the contrast with clinical practice is the heart of this matter. We are not facing a gap in knowledge. Knowledge exists, is recent, and is solid. What fails is its distribution.
In March 2024, The Lancet published a series of four articles on menopause that reordered the debate. The first, “An empowerment model for managing menopause,” by Hickey and colleagues, proposes a new approach that goes beyond the treatment of specific symptoms to encompass a broad model of support for women during this life stage, using the World Health Organization’s empowerment model. The second, “Optimising health after early menopause,” by Mishra and colleagues, addresses early menopause —between 40 and 44 years— which affects approximately 8% of women in high-income countries and 12% globally. The third, dedicated to mental health during the menopausal transition, reviewed twelve prospective studies and reached a nuanced conclusion that is worth citing precisely, because it protects the argument from exaggeration: there is no convincing evidence of a universal increase in the risk of major depression during the transition. But there are vulnerable subgroups, defined by menopause-related risk factors —severe or sleep-disrupting vasomotor symptoms, prolonged transitions— and by psychosocial factors such as stressful life events; the highest risk is concentrated in women with a history of depression. And there is a warning that runs through this entire text like a thorn: the erroneous attribution of psychiatric symptoms to menopause, or failure to recognize them in time, delays diagnoses and effective treatments.
That thorn cuts both ways. It cuts against those who over-psychiatrize —who see a sick personality where there is a biology in transition— and against those who ignore hormones entirely. For years I received one label after another that were put on and taken off me, with medication so strong that, for more than one period, it annihilated my existence. No one thought in time to look at estrogen.
The second pillar is newer and touches bone directly. In October 2024, the journal Climacteric published an article by Vonda J. Wright and colleagues —from the University of Central Florida College of Medicine and Duke University School of Medicine— titled “The musculoskeletal syndrome of menopause.” The authors propose a term to name what until now was distributed among traumatologists, rheumatologists, and physiatrists without common denominator: the set of musculoskeletal signs and symptoms associated with estrogen loss. It includes arthralgia, muscle mass loss, bone density loss, osteoarthritis progression, increased tendon and ligament injuries, and adhesive capsulitis, the so-called frozen shoulder. They estimate that more than seventy percent of middle-aged women will experience musculoskeletal symptoms, and that one quarter will be disabled by them during the transition from perimenopause to postmenopause.
It must be said with rigor: it is an emerging term, in the process of consolidation. The authors propose it precisely to improve clinical recognition of something that today is diagnosed fragmented or not diagnosed at all. But that it is emerging does not make it irrelevant; it makes it urgent. Because it describes, with name and statistical estimate, exactly the picture that had me with capsulitis in both shoulders, with a severed tendon in a finger that I ended up losing, with months of being unable to get out of bed due to back pain. Each of those episodes was treated as an isolated accident. None as what recent literature suggests they were: manifestations of the same process.
The third pillar is the most established of all, and it is the one that gave me something back. In 2014, a consensus of the International Society for the Study of Women’s Sexual Health and the North American Menopause Society —now The Menopause Society— coined the term genitourinary syndrome of menopause, in an article signed by Portman and Gass. It replaced old and stigmatizing names such as vulvovaginal atrophy. It names the set of symptoms associated with estrogen decline that affects the genitals, sexual function, and urinary tract: dryness, burning, pain, loss of desire, recurrent infections. Its first-line treatment —local vaginal estrogen, the same cream with which this story begins— has a safety and efficacy profile that is established consensus. It is cheap, it is safe, and it had been available for decades. It was given to me when they could no longer insert the speculum, that is, when my body had already screamed. Not to prevent. To unblock a procedure.
IX. Why they did not see it
The uncomfortable question is how such available knowledge does not reach the consultation. The answer lies in training.
The available evidence on the training gap is still scarce, and it should be treated with caution. The most cited study is by Vesco and colleagues, from 2024: they designed a menopause curriculum for residents in gynecology, internal medicine, and family medicine in six American programs, with 200 target residents and 115 who completed the evaluations. Before receiving that training, the proportion of correct answers from residents on a menopause knowledge test was sixty-eight percent. After training it rose to seventy-nine point one percent. It is a single study, with methodological limitations and from a single country; it cannot be generalized without saying so. But it points in the direction that any woman who has pilgrimaged through consultations knows firsthand: the doctors who see her were not sufficiently trained in this.
Regarding Quebec and Canada specifically, one must be honest about what does not exist. There are no published studies measuring how much space the province’s medical schools —Montréal, McGill, Laval, Sherbrooke— dedicate to the topic, nor documents from the Collège des médecins du Québec or the Royal College’s competency framework that detail specific training in menopause. This absence of local literature is, in itself, a datum: the void has not been studied because the void is not perceived as a problem. There is, however, voluntary educational activity —the Canadian Menopause Society offers accredited training, with participation from Quebec specialists; the Société des obstétriciens et gynécologues du Canada maintains clinical guidelines and educational materials—. But it is optional continuing education, accessed by those already interested. Not a guaranteed content in the base of the career. The result is a lottery: the patient falls, by chance, into the hands of someone who specialized on their own, or of someone who repeats what they learned twenty years ago.
And here it is important to name the long shadow of a historical misunderstanding. In July 2002, the Women’s Health Initiative study, published in JAMA by Rossouw and colleagues, followed more than sixteen thousand postmenopausal women aged 50 to 79 and concluded that, in its population, the risks of certain hormone therapy outweighed the benefits. The additional absolute risks per 10,000 women-years were: 7 more coronary heart disease events, 8 more strokes, 8 more pulmonary embolisms, and 8 more invasive breast cancers. The interpretation that spread was alarmist and generalized, and caused a worldwide collapse in the use of hormone therapy. Subsequent reanalyses nuanced the finding: the study population had an average age of sixty-three, and the risk-benefit balance is different —and generally favorable— for women who initiate treatment near the onset of menopause. The misreading of 2002 educated an entire generation of doctors in fear. Many of those who practice today learned that hormones were dangerous, and they did not update. The consequence falls on patients: what could prevent years of damage is not prescribed, due to a fear that science has already corrected.
X. The cost
That this is treated as a minor, almost cosmetic issue, clashes with its scale. In Canada, a report from the Menopause Foundation of Canada with economic analysis by Deloitte, in 2024, estimated that untreated menopause symptoms translate into about five hundred and forty thousand lost workdays per year, equivalent to two hundred and thirty-seven million Canadian dollars in productivity for employers, and three billion three hundred million in income that women forgo by reducing their hours, lowering their salary, or leaving their jobs. The report also notes that 95% of women will experience one or more of the more than thirty symptoms of menopause; half declare they were not prepared for this stage. These are estimates from a single source with methodological assumptions that are not detailed, and thus they should be cited. But even taken with prudence, they outline a magnitude that no healthcare system should treat as marginal.
To that added cost must be added what does not appear in any report: the cost of the procedures that are performed. In my own half-hour consultation, test orders were generated, a surgical referral, an enrollment in a surgery list. The system generously spends chasing each symptom separately, while refusing to look at the cause that unites them. It is more expensive to treat ten fragments than one process. And it becomes infinitely more expensive when the fragment not treated in time becomes a chronic injury, a permanent pain, a lost finger. There lies the other side of preventive logic: what is saved is not only money, it is body.
XI. The blind spot
There is a way of telling this story that reduces it to bad luck, to a succession of distracted doctors. It is not that. What I found, at the end of the search, was something more difficult to name: a collective blind spot, a place where many people converge who exercise roles that require qualification, and who on this precise topic do not have it.
The traumatologist who treated my finger. The psychiatrists who around my forties tried with me diagnosis after diagnosis —bipolarity, personality disorder, structural depression, reactive depression— without ever considering estrogen, until arriving here in Quebec to my psychiatrist in my fifties, and I hope he is the last, who is attentive and humane, who has treated me with care, and who nonetheless had no reason to look there, because his training did not train him for that. The family doctor with her stopwatch and her only permitted symptom. And also, in the last link, the one who was supposed to accompany me in the administrative and the emotional: my social worker. I asked her several times to stop during a procedure that overwhelmed me; she did not, and that pressure triggered a crisis that left me three days unable to get out of bed. I lost, because of that crisis, the appointment with the gynecologist. When I later suggested that we review what post-traumatic stress disorder is, which I also suffer from at a point in my life where a accumulation of ailments has come together, she replied that she had studied it at university. Perhaps she studied it. But at the moment that mattered, she did not know, or did not remember, to stop.
None of them acted in bad faith. That is the point, and it is what makes it serious. It is not about villains, but about a design: a compartmentalized medicine, structurally incapable of seeing a process that simultaneously crosses the locomotor apparatus, mood, skin, metabolism, and sexual life. Each specialist looks at their box. Menopause does not fit in any box because it crosses all of them. And in Quebec, the standard that orders treating only hot flashes closes off from the start the possibility of seeing it whole.
XII. What the cream demonstrated
I end where I began, because the cream demonstrated something that orders everything else. If such a simple, cheap, and available treatment could restore my mood, my libido, and my calm within weeks, then much of what for years was treated as structural illness, as character, as destiny, had a cause that no one looked at. My own body gave me the answer that the system denied me.
The serious thing is that the damage was avoidable: frozen shoulder, years of pain, were recognizable and preventable with knowledge that already existed. What was avoidable for me can still be avoided for those who come after. That is the meaning of writing this.
The remedy has a name that I learned to underline during this search: qualified care. Not just any care. The right one, the up-to-date one, the one that exists and is denied to most. That there are so few professionals truly trained in menopause —that finding one is, for half the adult population, almost a matter of luck— is not an accident. It is a decision made, without being made, every time a medical school dedicates a margin to this topic, every time a provincial standard reduces a process that lasts half of life to a single tolerated symptom.
And here is my blind spot, the one I have not managed to cross. The cream gave me back a part, and by another route I finally found someone to treat my shoulder and back pain. But the hormone replacement therapy that evidence suggests I need cannot be given to me by any of those who treat me today. My psychiatrist cannot prescribe it. The gynecologist will not do it. The hospital I went to —St. Mary’s in Montréal, the same one where I always receive care— has no answer for me, because I do not have the only symptom the standard recognizes. I remain, then, on the outside of that door, with one foot already inside thanks to a cream and a pain that someone finally attends to, but without the underlying treatment that does exist and that continues to be denied to me. The uncertainty eats away at me: I do not know if in my own hospital they will treat me as I deserve. I hope, with my fingers crossed, that next time I get a more empathetic doctor, someone who looks beyond the single symptom and sees the whole person. Because I no longer remember what it feels like to live without pain, and I have a brutally intense need to feel good again.
I write this still with pain in my shoulder as I type. I do not write it from the exit, because I have not left. At times I have lost my autonomy due to pain crises. I write it also from the threshold, which is the only honest place from which I can write it. I do not write to tell that I was saved. I write so that the door that they continue to close on me will cease to be closed.
—
References
Hickey M, LaCroix AZ, Doust J, Mishra GD, Sivakami M, Garlick D, Hunter MS. An empowerment model for managing menopause. The Lancet. 2024;403(10430):947-957. doi:10.1016/S0140-6736(23)02800-3.
Mishra GD, Davies MC, Hillman S, Chung HF, Roy S, Maclaran K, Hickey M. Optimising health after early menopause. The Lancet. 2024;403(10430):958-968. doi:10.1016/S0140-6736(23)02801-5.
Mukherjee A, Davis SR. Menopause. The Lancet. 2024;403(10430):969-983. doi:10.1016/S0140-6736(23)02802-7.
Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-333. doi:10.1001/jama.288.3.321.
Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466-472. doi:10.1080/13697137.2024.2380363.
Portman DJ, Gass ML. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Menopause. 2014;21(10):1063-1068. doi:10.1097/GME.0000000000000329.
Vesco KK, et al. Menopause curriculum for internal medicine, family medicine, and obstetrics and gynecology residents. Menopause. 2024;31(2):115-122. doi:10.1097/GME.0000000000002294.
Menopause Foundation of Canada. Menopause and Work in Canada. Deloitte Canada; 2024. Available at: https://menopausefoundationcanada.ca/world-menopause-month-2024/.
European Society of Endocrinology. Clinical practice guideline for the evaluation and management of menopause and perimenopause. 2025.
Asia Pacific Menopause Federation. Consensus statement on the management of perimenopausal and menopausal women. 2024.
Haute Autorité de Santé (HAS). Place du traitement hormonal de la ménopause. 2025.
