The Dose27:31What’s new in menopause treatments?
With menopause symptoms ranging from sleep trouble to burning mouth syndrome, people aren’t always sure what they’re experiencing, says Dr. Alison Shea.
So The Dose spoke to several clinicians and researchers at the forefront of menopause care in Canada about the latest treatments, ranging from hormone therapy to exercise and diet.
Here’s what they told us.
Hormone therapy
Hormone therapy delivered through a pill, patch or gel is considered the gold standard for someone in menopause experiencing night sweats and hot flashes, says Dr. Kelsey Mills, an obstetrician and gynecologist based in Victoria, B.C. The therapy can also help with symptoms that include insomnia, joint pain, vaginal dryness, vulvar irritation and pain during penetrative sex.
But though it’s a safe and effective treatment, Mills said, it’s not right for everyone.
Anyone with uncontrolled blood pressure issues, heart disease or liver cirrhosis should consider alternatives, she said. And breast cancer survivors are unlikely to qualify; some studies have found a correlation between hormone therapy and increased breast cancer risk.
A recent report found that women experiencing menopause symptoms said their concerns were often diminished and overlooked by doctors. These types of interactions are something advocates are trying to change.
Ideal candidates are under age 60, or within 10 years of menopause, who have symptoms that have a major effect on their day-to-day life. That means many women in the early years of menopause typically qualify; in Canada, the average age women hit this transition — defined as one year without a period — is 51, according to the Menopause Foundation of Canada, though the spectrum stretches from age 45 to 55.
Hormone therapy can also be the first line of defence to treat the early symptoms of perimenopause, especially hot flashes.
The perimenopausal period usually happens between 40 and 50, when levels of estrogen and progesterone start to fluctuate. Other early symptoms might emerge, too, including mood swings, changes in libido or weight gain or night sweats.
It’s about treating symptoms, not balancing hormones, “because hormones are all over the place in perimenopause,” said Shea, an associate professor of obstetrics and gynecology at McMaster University who also sits on the Canadian Menopause Society’s board of directors.
The non-hormonal route
For those who can’t — or don’t want to — use hormonal therapy, there are other safe and effective medications for some common symptoms, such as hot flashes and night sweats.
Dr. Michelle Jacobson says non-hormonal options like neurokinin receptor antagonists can interfere with the brain’s attempts to suddenly boost body temperature, minimizing hot flashes and night sweats, in a similar way to estrogen.
“They work at the same centre in the brain where hot flashes originate,” said Jacobson, co-founder of Coven Women’s Health and chief of obstetrics and gynecology at the William Osler Health Network.
A 2024 study found fezolinetant — one such medication approved by Health Canada for menopause symptoms — had a similar effect as 27 hormone therapy regimens in reducing vasomotor symptoms of menopause, including hot flashes and night sweats. In rare cases, the medication can affect liver function so anyone with cirrhosis or other liver issues might not be a candidate.
Lifestyle changes
The change in hormone levels that accompany menopause can affect everything from bone density and muscle mass to heart health and weight gain. And some of those symptoms could improve by making healthy food choices and getting exercise, Jacobson said.
Mills recommended at least 30 minutes of strength training three times a week, combined with 150 minutes of moderate to vigorous exercise, which falls in line with International Menopause Society guidelines.
Jacobson cautioned there’s little evidence to suggest that exercise can improve hot flashes, but she notes that weight loss can improve hot flashes for women who are overweight. And she said that menopause also correlates with worsening cholesterol and triglyceride levels, poorer insulin resistance — which increases the risk of Type 2 diabetes — and weight gain.
White Coat Black Art26:30The rise of paid menopause care
Overwhelmed by hot flashes, brain fog, and a frozen shoulder, Aidan Brame turned to a private clinic when the public system couldn’t help. Her experience highlights why more Canadians are paying [https://menopausefoundationcanada.ca/pdf_files/How_Assess_Virtual_Private_Clinics_EN.pdf] for menopause care, and what it reveals about gaps in the health system.
“So exercise and weight loss can be helpful for improving your overall cardiac health and outcome,” she said.
A healthier diet, like reducing how often you eat ultra-processed food or adding more calcium to your meals can help manage bone density loss during menopause, according to Shea.
GLP-1 drugs show potential
The link between weight gain and menopause also prompted some research into using GLP-1 drugs to help, both with and without hormone therapy.
New studies show that combining hormone therapy with weight-loss drugs – like Mounjaro and Zepbound – increased the amount of weight loss in the participants.
One such paper, a 2026 observational study of 120 post-menopausal women published in the Lancet found those taking hormone therapy alongside the GLP-1 drug tirzepatide were associated with “greater weight loss and improved cardiometabolic outcomes” than those not using hormone therapy.
A new study published in the journal Nature Medicine suggests that GLP-1 medications such as Ozempic and Wegovy could have a host of other potential benefits beyond treating obesity, including a reduction in drug and alcohol abuse and Alzheimer’s disease.
Still, Shea said more research is needed to better identify the interactions between hormone therapy and GLP-1s.
“We need larger perspective studies to see exactly what’s going on,” she said, noting that GLP-1 drugs have been associated with reductions in muscle mass, something that can already be accelerated during menopause.
Given the breadth of treatments available for menopause symptoms, all of the experts recommended consulting a physician or nurse practitioner to learn more.
