By Annie Tuba
Dr. Sheila Wijayasinghe believes Canadians need to have better conversations about menopause. As a family doctor working in the Women’s College Hospital in Toronto, she explains that menopause treatment plans are less accessible to low-income and racialized women.
Menopause is a stage in life which affects an immense number of women across the world. To gain more insight on this subject, The Leveller interviewed Dr. Wijayasinghe as a professional of the subject.
Menopause has not been a part of the medical field for a long time as it was first medicalized in the 1970s. The National Institute of Aging (NIA) described menopause in 2024 as the transition to a woman losing her menstrual period permanently with symptoms lasting two to eight years.
Hormonal therapy is an option for women to take during menopause when the body stops producing estrogen and progesterone, according to the Canadian Cancer Society. It acts as a replacement for what is being lost. With its recent attention in the healthcare system, misinformation surrounding hormonal therapy has surfaced.
The idea that estrogen is dangerous has been a leading factor of fear mongering surrounding hormonal therapy since the Women’s Health Initiative – “a long-term study focused on the prevention of heart disease, cancer, and osteoporosis in postmenopausal women” – was first published in 2002. This study argued that the health risks of hormonal therapy with estrogen and progestin were higher than the benefits in healthy postmenopausal women. The same study also heavily impacted menopausal care, with prescriptions for hormonal therapy plummeting, reported a study by Bush & colleagues in 2007.
According to Heather Hirsch, a consultant for AMAG Pharmaceuticals, residency training is not equipped to adequately train new physicians to feel comfortable prescribing hormonal treatment by graduation. Indeed, they explain that of 177 medical practitioners, only 12 – a mere 6.8% – reported feeling properly prepared to manage menopausal complaints.
I found myself having suicidal ideations during menopause, I did not feel like myself.
Symptoms from menopause can include problems with memory, loss of sense of self and mood swings, according to the National Institute on Aging. During the Always Discreet Menopause Panel hosted by Melissa Grelo in Toronto back in April 2024, Amanda Thebe, a menopause coach, described the symptoms of her own menopause as the following: “I found myself having suicidal ideations during menopause, I did not feel like myself.”
Janet Ko, the founder of The Menopause Foundation of Canada (MFC), was also present at the same panel as Thebe. In 2022, Ko released a study titled The Silence and the Stigma: Menopause in Canada which asked Canadian women how informed they were about menopause. In the study, they found that less than 25% of women understand menopause. 72% felt that the conversations about menopause they had with their healthcare practitioners were unhelpful, according to the study.
It is estimated that 41% of medical schools in Canada do not include any education on menopause in their undergrad curriculum, according to Canadian Primary Care Today.
“It’s our responsibility to be knowledgeable about this and it’s on us to do the training, to get the extra training,” said Wijayasinghe.
When asked about this statement at Grelo’s panel, Ko said that we cannot blame our healthcare providers because, “they have had very little education.”
Ko explained that the solution is for women to educate themselves, such as tracking their symptoms to understand what is going on in their body and to prepare to advocate for themselves at doctors appointments.
Thebe said she was left feeling lost when trying to access menopausal care, “I spent two years in the Canadian healthcare system with doctors who wanted to help me, but they don’t know what they don’t know,” she said.
Due to the lack of education in the public healthcare sector, more women are accessing private clinics to get adequate menopausal care, said Wijayasinghe.
The [healthcare] system can be a cruel and unsafe place for people.
On their website, MFC recommends people to visit private healthcare practices to get properly taken care of not just during menopause, but perimenopause too. At these clinics, women are able to be prescribed hormonal therapy treatment and other medications to deal with their symptoms.
Although, access to proper medications depends on their healthcare coverage, Wijayasinghe explained. People who have private healthcare plans may have coverage for transferal estrogen products, which is the safest option for hormonal therapy. However, for those who do not have coverage or are on assistance, the transdermal patch is not covered, she explained.
People who cannot afford transdermal estrogen products, which help reduce symptoms from menopause, are provided with topical progesterone. This treatment can come with an increased risk of endometrial cancer, according to a 2010 study. Wijayasinghe said this treatment should be avoided because it is “not as safe.”
As a doctor who works in the public healthcare sector, Wijayasinghe tries to send in requests for her patients on social assistance to get proper menopausal medication. According to Maytree, in 2022-2023, over 880,000 Ontarians are on social assistance.
Despite trying to write and apply for her patients to have transdermal medications, her requests do not get accepted by Ontario Works. “There’s an issue of inequity in the safe options,” explained Wijayasinghe.
A study in 2022 published in New Trends in Qualitative Research found that women on social assistance described going to their doctors as “Nobody listens, nobody wants to hear you.” All women in the study found their financial situations stopped them from getting adequate healthcare. With the increase in inflation, a rising amount of clients are unable to access private insurance. Indeed, rising inflation has made private care, including access to transdermal estrogen, increasingly unaffordable for many women, explained Wijayasinghe. Those without insurance often have to delay or skip treatment, or even forgo it all together, “leading to unmanaged symptoms that disrupt both their personal well-being and work life.”
A study released in 2022 called Menopause and the Workplace found that one in ten women leave their jobs because of menopause symptoms.
Without a family doctor, these barriers become increasingly hard, having access to menopausal treatment products becomes increasingly hard, and women have to face more barriers and have to rely on walk-in clinics, Wijayasinghe explained. Right now 6.5 million Canadians do not have a family doctor, according to Statistics Canada.
Specific barriers women face accessing transdermal estrogen products include high costs, product shortages and limited public insurance coverage, Wijayasinghe explained. “Systemic inequities mean that racialized women are less likely to receive hormonal therapy,” she said.
A study by Oxford University found that 93.8% of Asian and 94.8% of Black female patients were not on hormonal therapy in comparison to 76.7% of white women.
Wijayasinghe herself has seen her family struggle through the Canadian healthcare system in accessing adequate menopausal care.
“The [healthcare] system can be a cruel and unsafe place for people,” said Wijayasinghe. “We need expanded insurance coverage for all forms of hormonal therapy to ensure women have access to the best options.”
Despite many efforts by the MFC, such as recommending not only doctors but also online resources, the healthcare sector continues to lack proper education on menopause.
Menopause is the subject of a lot of misinformation that continues to be widely misunderstood because of the lack of education in the healthcare field. Low-income and women of colour continue to be left out of safe and adequate hormonal treatment options.
Wijayasinghe states that many women continue to be left out of the menopause conversation. Meanwhile menopause conversations themselves are already spare in the broader context of healthcare.
