About Teresa Isabel

My Story

My name is Teresa Isabel Dias and I am a pharmacist with over 25 years of professional experience in community pharmacy and drug information in Toronto. In 2013 I became a Menopause Practitioner (NCMP) certified by the North American Menopause Society (NAMS) after my son asked me if I was bipolar because my mood swings were so intense and were upsetting my family.

It’s not so long ago that the hormonal changes that came with menopause were regarded as craziness – “the madwoman in the attic.” The truth is until recently, menopausal women tended to suffer alone, embarrassed by hot flashes, and confused by hormonal mood swings.
I believe that menopause should come out of the shadows.
I provide education and support on symptom management for women at work and at home so that they feel like themselves again and enjoy a vibrant, and productive life.

I offer a unique perspective for groups and organizations on the subject of the menopause journey and its impact on women physically, mentally, and emotionally.

Media

Is your organization, interest group, or club seeking a speaker for a keynote address, podcast, industry seminar, educational session, leadership team development, lunch & learn, or hands-on breakout workshop?

Leveraging my professional healthcare experience, I provide training and coaching for organizations that want to improve the work environment for all employees.
I can deliver a topic that will excite and engage your audience, leaving them empowered to take action.

I have delivered education and training to the Universities of Waterloo, Toronto, and Brock, Maple Leaf Foods, Stantec, Royal Bank of Canada, Women in Government, and other major employers and associations. I have also written and presented to several pharmacy associations and the Pharmacy Practice + Business magazine.

Keynote

Menopause the Glass Ceiling No One Talks About

Why should we talk about menopause?
Many women experience physical, emotional, and mental challenges in midlife due to hormonal changes.
• all women experience menopause
• by 2025 over 1 billion women will be experiencing menopause, equal to 12% of the global population
• 8 in 10 women in menopause experience hot flashes and nights sweats that disturb their quality of life
• 1 in 4 women contemplate quitting their jobs due to lack of support during menopause
• menopause seems to be the last health taboo; we need to normalize it as we did with pregnancy and are doing with mental health
• it’s time to remove the shame around the topic of menopause
• discussion around race, gender, sexual orientation, and generational differences are occurring more openly at work, and menopause should be on the agenda too
• menopause doesn’t just affect women, it also affects their families, friends, and co-workers.

There’s a lot of mystery and misinformation about this stage of life, so just gathering some basic facts from a trusted healthcare professional is a good start.

WORKSHOPS FOR WOMEN AT EVERY STAGE OF THE MIDLIFE JOURNEY:

1. Menopause- It’s more than hot flashes
2. For a more comfortable (peri)menopause P.L.E.A.S.E. Yourself!
3. Essential vitamins and supplements for midlife health and an easier menopause
2. Cognition and mood changes in menopause
3. Body shape change, weight, and proper exercise in midlife
4. Sleep tips & tricks in menopause
5. Vaginal and sexual wellbeing in midlife
6. Menopause Hormone Therapy (aka HRT)
7. Bioidentical Hormone Therapy (BHT)8
9. Induced menopause. For breast cancer survivors and women who’ve undergone hysterectomy.
10. Disease prevention in midlife –heart disease, cancers, osteoporosis, dementia, and diabetes
11. Travel health- pre-trip vaccination, on-trip prophylaxis, medications, and more

5 Top Things Every Woman Should Know About Menopause

Women should know more about menopause so they can have an easier transition, less fear, more confidence, and better support.

If I had to pick the top five things every woman in menopause should know, this would be my list:

  1. Be aware of what your body is going through.

Menopause isn’t a mystery, or a disease, or the loss of anything. And it has nothing to do with men, either!

Meno (from menses) pause is the end of ovulation, menstruation, and fertility. Menopause is confirmed 12 months after the last menstrual period.

In the years leading up to menopause your body will go through hormonal changes – estrogen and progesterone levels fluctuate and decline. Changes are often challenging. You’re not crazy; what you’re feeling is real and it’s easier and less fearful to navigate the menopause transition if you know what’s going on. 

  1. Menopause isn’t something to be ashamed of.

Why would a human physiological event be something bad or shameful?

Some people call menopause puberty in reverse.

If you were born with ovaries, you can’t stop menopause from happening.

Culture and the media portray menopause as negative. But, in truth, menopause is not the loss of youth. Associating it with being old, over the hill, the end of womanhood, etc., is a myth, inaccurate, and misleading. The average age of menopause is 51 and many women can start perimenopause in their late 30s or early 40s. 

  1. You’re not alone.

Because there’s no intergenerational sharing, your mother and aunties may not tell you about their menopause, so you’re not prepared for it, you don’t know enough about it, and you feel isolated and alone in this journey. But you aren’t alone!  Millions of women worldwide are going through their own menopause.

If you’ve been through menopause then share your experience with those who haven’t yet, and if you’re not there yet ask older women to share.

Talk about it with other women, help break the secrecy and the taboo that surrounds menopause.

If we want things to change then we must be part of the change and not blame everything on the patriarchy.

  1. Seek help and don’t suffer in silence and alone.

Ok, menopause is a natural thing but suffering through it is an option.

You shouldn’t just put up with the symptoms—hot flashes, night sweats, sleepless nights, brain fog, fatigue, urine leakage, vaginal dryness, painful sex, loss of self-confidence, anxiety, palpitations, worry, and anger—just because you can’t avoid menopause.

If these challenges are affecting the quality of your life, if you stopped doing things you used to do because your menopause is bothersome, if it is affecting your intimate relationships, and/or if your work is being negatively affected by hormonal changes, then seek help.

There’s help. I can help you! 

  1. Don’t exclude hormone therapy from your tool box.

Google isn’t the best source of information and you shouldn’t choose your treatment options based on what you read on the internet.

I know, Google says that menopause hormone therapy (MHT), aka HRT, is bad for you, can cause breast cancer and strokes…

You shouldn’t confuse your Google search with my pharmacy degree (see photo!).

Anyone can post on the internet, and what they post can stay there FOREVER. There’s a lot of old information that’s no longer accurate since research is ongoing and treatment recommendations change based on the latest information.

Therefore, do not automatically exclude MHT as a possible solution to your menopause challenges without first educating yourself about the benefits and risks of MHT.

Seek the advice of a healthcare provider who’s well-versed in all things menopause, a NAMS Certified Menopause Practitioner (NCMP) like myself, and get the facts about MHT.

It takes time—which most physicians do not have—to explain what MHT is, how it works, and the immediate and long-term benefits and risks. Once you have spent the time, and learned accurate and updated information about MHT, then and only then you’ll be properly equipped to make an educated decision about your treatment.

Menopause Myth Busting

There are a lot of myths about menopause and I love busting them! I’ll let you in on some of my menopause myth-busting tips.

Women are so confused by the secrecy and myths surrounding the hormonal changes of midlife that it’s no wonder that most women have a hard time navigating menopause while staying vibrant and productive. 

Myth:  I’m too young for menopause

Fact:  Perimenopause, the years leading up to menopause when you start noticing changes, can start in your late 30s or early 40s. 

Myth:  All women get fat in menopause

Fact:  Fat tends to accumulate around the belly but you can get rid of it. I did and in the video I tell you how. 

Myth:  Menopause is hell and life is over

Fact:  OK, going through menopause can be turbulent, challenging, and hard. But it doesn’t have to be. I help the women in my practice accept themselves and their menopause because it is an unavoidable phase of a woman’s life (like puberty in reverse). We work on symptom management but also on mindset because it’s important to be PAUSE-itive and to see midlife as a time of many possibilities. Menopause is an ideal time to start thinking and working (through lifestyle interventions, counselling, and support) on who you want to be at 60, 70, 80 and 90! 

Myth:  Menopause is only hot flashes

Fact:  We wish! Especially those of us who also get mood swings (when I was in perimenopause my son once asked me if I was bipolar!) and rage (road, house, and work rage!); want to kill our husbands and scream at our kids; and experience low libido, itchy skin, aches and pains, anxious thoughts, hair loss, and difficulty concentrating and remembering our own kid’s names! 

Myth:  Menopause is something you just have to put up with

Fact:  This requires two explanations. Firstly, all women go through menopause and there’s no stopping that (for the definition of menopause watch the video). Secondly, no woman suffers needlessly and alone under my watch. True, many women experience physical, emotional, and mental challenges in midlife due to hormonal changes. But as a pharmacist and Certified Menopause Practitioner (NCMP), I provide education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.

Menopause Stages

The menopause stages can be confusing. Premenopause. Perimenopause. Menopause. Postmenopause. What do all these words mean and why is it important to use them properly when describing where you are in the continuum of menopause?

Here are some reasons why it is important to know where you are in this journey:

  • to know what to expect
  • to get the most effective and safe symptom management since, for example, hormone therapy will differ if you take it in perimenopause versus in postmenopause.

Premenopause/Reproductive Years

Between puberty—when ovulation (and accompanying production of estrogen and progesterone), periods, and fertility start—and perimenopause are the reproductive years, whether or not a woman gets pregnant.

Perimenopause/Menopause transition

Female sexual hormones—estrogen (the predominant female hormone) and progesterone—start fluctuating in perimenopause, indicating the start of changes in ovarian function. Women who previously had regular menstrual periods may start noticing changes, such as shorter intervals between periods, lighter or heavier bleeding, shorter or longer bleeds, spotting between periods, and in some months even no bleeding at all. This is usually the first change women notice in perimenopause, but many women also report hot flashes, fatigue, aches and pains, difficulty sleeping, headaches, dry itchy skin, mood swings, anxiety, depressive feelings, low sexual desire, hair loss, weight changes, body shape changes, palpitations, irritability, foggy brain, bladder problems, dizziness, and others. Perimenopause can start in a woman’s late 30s or early 40s and last 2-6 years.

Perimenopause is a journey. The unpredictability of not knowing when the next period is going to come, when or if ovulation is going to occur, and experiencing spotting can be upsetting and frustrating for many women.

Women who are sexually active and don’t wish to get pregnant must use birth control until at least 12 months after the last period because ovulation is unpredictable in perimenopause but may still occur. Perimenopause can start in a woman’s late 30s or early 40s and last 3-6 years.
Menopause

Menopause is the end of ovarian function, the end of ovulation and fertility, and consequently periods stop as well.

How do you know when you are in menopause? Menopause is confirmed when you haven’t had a period for 12 consecutive months. The next day you are in postmenopause! Congratulations! Celebrate this milestone!

All women go through menopause if they live long enough, and for most women it is a normal and natural event.

Menopause usually happens between 45 and 55 years of age, and the average age of menopause in North America is 51. Some women may experience early menopause, before 40 years old.
Postmenopause

These are the years after menopause is confirmed and postmenopause lasts for the rest of the woman’s life. Many women will live past their 80s and will spend one-third of their lives in postmenopause. It’s important to understand the protective effect of estrogen against diseases like stroke and heart attack, osteoporosis, and diabetes to help you make healthy lifestyle choices to ensure healthy aging and prevent disease.

Induced menopause/surgical menopause

Induced menopause occurs when a woman undergoes removal of both ovaries and/or chemotherapy and radiation treatments (which damage the ovaries) for certain types of cancer. Women who experience induced menopause at a younger age experience more severe symptoms due to the very sudden drop in estrogen levels and are at higher risk for diseases related to low estrogen levels, like osteoporosis, dementia, and heart disease.

Brain Fog Is Real

In perimenopause, the years leading up to menopause, they work unpredictably.  Your sexual hormones, estrogen and progesterone, fluctuate and you may experience many physical, cognitive, and emotional changes, including brain fog. 

Working through perimenopause can be dreadful if you experience:

  • fatigue
  • insomnia
  • hot flashes and/or night sweats
  • irritability
  • mood swings
  • palpitations
  • anxiety and worry
  • memory loss, problems with recall and/or brain fog
  • reduced concentration
  • loss of confidence

Brain fog can be a consequence of simply getting older, in both men and women.

For midlife women, fluctuating hormones during the menopause transition can cause brain fog.

In midlife you are at the peak of your career and the demands on your cognitive function—from work, family, older parents, and others—are very high. 

What can you do to decrease brain fog?

  • Menopause symptoms, such as poor sleep, may exacerbate brain fog. If night sweats, which are hot flashes that happen at night, wake you up frequently, night after night, month after month, that’s going to affect your cognition, your brain function. You feel and function worse. But night sweats should be treated. Call me and find out how.
  • Mood swings are common in menopause. If you’ve had depression in the past, check with your doctor if you’re feeling depressed to ensure it gets treated.
  • Eat well. The Mediterranean diet lowers the risk of pre-clinical Alzheimer’s disease (this benefit was been shown in a large randomized trial!). Read more about the Mediterranean diet on my blog.
  • Engage in various types of exercise—cardio, strength training, and balance—for better heart, brain, and bone health. You don’t have to walk 10,000 steps/day. Just 15 minutes/day of brisk walking improves your cognitive function.
  • Manage your stress in whatever way works for you: baths, reading, meditation, slow breathing, listening to music, waking in nature, talking with a friend. Be mindful, live in the present moment.

Breast Cancer Treatments May Induce Menopause

Menopause is the end of ovulation, menstruation, and fertility, and it usually happens between 45 and 55 years of age. Breast cancer treatments such as some chemotherapies and radiation treatments for breast cancer can damage the ovaries and cause induced menopause – women receiving such treatments may go through menopause earlier. Moreover, medications used to treat and prevent breast cancer (tamoxifen and aromatase inhibitors) further decrease estrogen levels. 

Estrogen is the predominant female sexual hormone – it has an effect in many cells, tissues, and organs of your body. When it decreases rapidly, as in induced menopause, you may notice rapid changes and bothersome symptoms to varying degrees, such as: 

  • Vasomotor symptoms (VMS) – hot flashes and night sweats (hot flashes that happen during sleep)
  • Brain fog (memory and concentration changes)
  • Changes in metabolism and fat distribution – weight gain and change in body-shape
  • Difficulty sleeping
  • Fatigue and lack of energy
  • Headache
  • Dry, itchy, crawling skin
  • Mood swings
  • Irritability
  • Sadness and tearfulness
  • Depressed mood
  • Anxiety and worry
  • Decreased self-esteem and self-confidence
  • Self-doubt
  • Panic
  • Palpitations
  • Anger
  • Vaginal dryness, discomfort and pain with sex, itching, burning, soreness, urinary problems such as incontinence and urinary tract infections (UTIs), and decreased sex drive.

 If these symptoms negatively affect your quality of life then you should seek treatment. 

If your breast cancer was estrogen-sensitive then you may not be a candidate for menopause hormone therapy (MHT), aka HRT, the most effective treatment for menopause symptoms. But there are other treatment options such as:

  • cognitive behaviour therapy (CBT)
  • selective serotonin reuptake inhibitors (SSRIs)
  • gabapentinoids
  • oxybutynin
  • herbals
  • supplements 

Estrogen has a protective effect on the heart, bones, and brain. When estrogen levels fall, as in menopause, you’re at increased risk of diseases such as osteoporosis, heart attacks, strokes, and dementia.

Lifestyle interventions—such as eating a healthy diet, engaging in regular exercise (at least 5 days a week, 30 minutes a day), sleeping properly, non-smoking, low consumption of alcohol, and consuming calcium and vitamin D supplementation—may help decrease disease risk.

You’ve probably heard this before: “you must be your own best advocate”. Many healthcare providers are not trained in menopause. Unless they work in this space, they may not have the best up-to-date information on how to help women with induced menopause.

Menopause Hormone Therapy (MHT)

 Menopausal Hormone Therapy (MHT) is the most effective treatment for menopause challenges but many women opt not to take it or are denied it by their healthcare professionals. This article will give you a good understanding of what MHT is and why you shouldn’t fear it.

Menopause is the end of ovarian function, confirmed when a woman hasn’t had a period for 12 consecutive months.

The most common symptoms of menopause—hot flashes and night sweats—can bother 8 in 10 women, often beginning in perimenopause and lasting on average 7.4 years, with ethnic differences.

 Lesser-known changes include sleep disturbances, fatigue, mood changes, irritability, anxiety, brain fog, decreased self-esteem and self-confidence, vaginal dryness, and pain with sex.

 Bothersome menopause can reduce a woman’s quality of life and contribute to poorer health since hot flashes can be linked to cardiovascular, bone, and cognitive risks.

Menopausal Hormone Therapy (MHT) —formerly known as Hormone Replacement Therapy (HRT)—is the most effective treatment for hot flashes and night sweats.  Estrogen relieves hot flashes and improves sleep, mood, and cognition and, in some women, joint aches and pains. But estrogen stimulates growth of the endometrium, the lining of the uterus.  Adding progestogen protects the endometrium and decreases the risk of endometrial cancer.

The Women’s Health Initiative (WHI) trial results published in 2002 led to significant fear of MHT.  Many women avoid MHT for fear of breast cancer, but many factors affect breast cancer risk:  different formulations of estrogen therapy, different progestogens, dose, duration of use, regimen, how it is administered (orally, transdermally, or vaginally), and prior MHT use.

 Newer observational data and reanalysis of older studies, including the WHI, suggest that the benefits of menopause hormone therapy outweigh its risks for healthy women younger than 60 or within 10 years of menopause.

 MHT must be individualized considering personal and family health history, risk factors, expectations, needs, preferences, and values.

 In the WHI trial, risk was greater for women with a uterus who had to take a progestogen along with the estrogen for uterine protection than for women with no uterus who took only estrogen.

 The breast cancer risk increases with longer-term use.  For women who had to take the progestogen along with estrogen in the WHI trial, the risk of breast cancer did not increase until the fourth year.  Researchers found very little risk in those who took menopause hormone therapy for less than one year.

 For women who have only localized vaginal symptoms such as vaginal dryness, itching, burning, and/or pain with sex, locally-applied low-dose vaginal estrogen rather than systemic estrogen is recommended. Due to minimal systemic absorption, a progestogen is generally not indicated and there should be very little increase in the risk of invasive breast cancer.

List of books recommended by Teresa Isabel Dias Bsc Pharm NCMP 

  • Menopause – The Change For The Better by Deborah Garlick
  • Managing Hot Flushes & Night Sweats. A Cognitive Behavioural Self-Help Guide To The Menopause by prof Myra Hunter and psychologist Melanie Smith
  • The XX Brain by Dr. Lisa Mosconi
  • A Woman’s Guide to Healthy Aging: 7 Proven Ways to Keep You Vibrant, Happy & Strong, by Vivien Brown, MD
  • Moody Bitches: The Truth About The Drugs You’re Taking, The Sleep You’re Missing, The Sex You’re Not Having, And What’s Really Making You Crazy by Dr Julie Holland (for all women still ovulating!)
  • Sleep After Menopause by Maria J. Sunseri, MD
  • The Joy of Movement -How Exercise Helps Us Find Happiness, Hope, Connection, and Courage by psychologist Kelly McGonigal
  • Better Sex Through Mindfulness – How Women Can Cultivate Desire by Lori A. Brotto, PhD
  • Menopocalypse: How I Learned to Thrive During Menopause and How You Can Too
  • The Menopause Manifesto: Own Your Health With Facts And Feminism by Dr. Jen Gunter

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