Wait times of 2 or more years, difficulty recognizing menopausal symptoms, dismissive doctors, and lack of workplace support are among the hurdles menopausal women in Canada encounter, a survey revealed.

“This research shows how difficult it can be to know where to go, be taken seriously, and get effective treatment [for menopause],” Mandy Mail, executive vice president of GreenShield Cares, said in a press release. “When access breaks down, the consequences extend beyond health, affecting careers, workplaces, and equity.”

The survey, conducted online in February by Ipsos on behalf of the nonprofit healthcare and insurance organization GreenShield, was published online on March 26 on the Ipsos website.

Key Findings

The survey of a representative sample of 1000 Canadian women aged 35-60 years showed that “too many women are forced to navigate menopause without clear pathways to care or timely support,” Mail said. Key findings included the following points:

• One third of respondents (33%) waited for more than 2 years after first noticing symptoms to receive effective treatment, whereas nearly half (46%) waited for at least 1 year.
• The most common symptoms, which affected day-to-day functioning, included fatigue (74%), hot flashes (68%), mood swings (65%), weight gain (58%), and brain fog (53%).
• Nearly 40% of respondents said they did not know where to seek menopause or hormonal healthcare, whereas 26% did not initially recognize their symptoms as part of a hormonal transition.
• Half of the respondents said they had experienced symptoms they associated with perimenopause or menopause, and another 24% believed they may have, but only 48% had discussed their symptoms with a healthcare professional.
• Nearly two thirds of the respondents (64%) said that menopause symptoms affected their job performance, and more than half (54%) said the time spent seeking care has disrupted their work. Workplace consequences among those who spent time seeking menopause care included reduced productivity (16%), needing time off (8%), needing to take a short-term leave (6%), or considering leaving their job due to their symptoms (6%).
• Only 13% of women said their employer provided adequate menopause or hormonal health benefits. This included 15% of women working in education and childcare, and 24% in healthcare, highlighting that even in sectors where women make up most of the workforce, support remained limited.

‘Reflect Reality’

“Unfortunately, these findings are reflective of the realities in Canada.” Iliana Lega, MD, an endocrinologist and menopause specialist at Women’s College Hospital, Toronto, told Medscape News Canada. “While there is increased awareness among primary care providers, with more and more providing this care, there are still many who are not comfortable prescribing menopausal treatments.”

This situation leads to referrals to menopause clinics, of which few are covered by the Ontario Health Insurance Plan, most of which are in large, urban centers, said Lega. “At these specialty clinics, wait times are very long, up to 1-2 years, which is not reasonable, given the severity of symptoms that some women experience.”

“The critical piece is that women themselves need to be adequately informed about menopausal symptoms so that they know when to go to their provider to seek treatment,” she added. Workplace policies are key to ensuring that employees have drug insurance that covers the cost of menopausal treatments.

‘Not a Healthcare Provider Failure’

“The findings overall seem in keeping with similar surveys that have been done globally,” said Janet Ko, cofounder and president of the nonprofit advocacy organization Menopause Foundation of Canada (MFC).

Importantly, she told Medscape News Canada, the fact that millions of women in Canada struggle to access quality menopause care “is not a failure of individual healthcare providers: physicians, nurse practitioners, pharmacists, and specialists are working within an already overextended system.

“The challenge is systemic,” said Ko. “Most clinicians receive limited formal education on menopause during their training, and many are left to rely on outdated or inconsistent information. As a result, even experienced providers may lack the knowledge and confidence to deliver evidence-based menopause care.”

At the same time, current remuneration models do not adequately reflect the time and complexity of menopause management, she added. This discrepancy makes it difficult to provide the level of care that patients need within existing practice constraints.

Menopause intersects with a “critical career stage” during which most women are taking on greater leadership roles, Ko continued. “Unmanaged symptoms of menopause cost the Canadian economy $3.5 billion dollars annually, including missed days of work and lost productivity. Women need solutions to manage their symptoms to enable them to thrive in the workplace. We are failing half the population with the current state of menopause care in Canada.”

What’s Needed Now

Clinicians need to understand that menopause is a natural physiologic transition that will affect all their female patients (that is, those born with ovaries), Lega noted. “It is a common process, such as puberty or pregnancy, that clinicians need to have at least a baseline understanding of. Therefore, clinicians should seek out educational opportunities to further their knowledge of this prevalent life condition.”

Organizations must support clinicians who are seeking this knowledge and promote the use of tools that can facilitate the care of menopausal patients, such as online decision aids, she said. “Medical schools and societies need to keep promoting educational opportunities that meet the needs of students and practicing physicians alike to narrow the knowledge gap.”

“Menopause is a significant health transition, associated with more than 30 symptoms and important implications for bone, cardiovascular, and brain health,” Ko added. “It should be recognized as a core component of comprehensive midlife women’s health.”

Organizations need to support clinicians “with accessible, evidence-based continuing medical education, and encourage engagement with trusted resources such as the Society of Obstetricians and Gynaecologists of Canada and the Canadian Menopause Society,” she said.

For employers, MFC has an ongoing Menopause Works Here campaign and provides a free Menopause Inclusive Workplace Playbook with a five-step action plan and practical tools to help employers retain talent and improve well-being across teams.

“The good news is there has been a big shift over the last 5-10 years among medical schools, training programs, medical societies, and individual providers about the importance of treating menopausal symptoms,” and multiple educational initiatives are underway for trainers and providers, Lega noted.

“The system is responding to the needs of women, and with a little more time, I think this gap in care will become addressed,” she said. “Hopefully, by the time our children are menopausal, these struggles will all be in the past, menopause care will be normalized, and everyone will have access to this care.”

The survey was funded by GreenShield. MFC has received unrestricted educational grants from Pfizer, Bayer, Astellas, Organon, Lupin, and Searchlight, but Ko did not receive any funds directly and reported having no relevant financial relationships. Lega also reported having no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDEdge, The Lancet (where she was a contributing editor), and Reuters Health.