Shirley Weir has watched the conversation about perimenopause and menopause evolve since she was dubbed the “Menopause Chick” in the 2010s.Supplied
Shirley Weir became known as the “Menopause Chick” 13 years ago when she launched her website about progesterone and estrogen changes.
In her 40s, Ms. Weir, who is based in Port Moody, B.C., started to experience brain fog along with mood and sleep changes, and since then she’s been on a journey to increase awareness about perimenopause and menopause, including medical supports that are available.
At 48, she started taking progesterone and later introduced estrogen, which she said resulted in a boost in energy, along with cognitive clarity. She said she was originally dismissed in her pursuit of menopause care but later received the prescriptions through her family doctor.
“It felt like the most magical potion,” Ms. Weir said.
Earlier this week, the U.S. Food and Drug Administration announced it is initiating the removal of black-box warnings on hormone therapy products, removing a major barrier to women who could benefit from them in the same way Ms. Weir did. The warnings are used on products deemed to cause risk of injury or death. Removing the labels represents a sea change in how the therapy is viewed.
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Canadian menopause products contain similar health warnings. The Society of Obstetricians and Gynaecologists of Canada (SOGC) said it hoped the FDA’s announcement will encourage women to explore these options as a potential treatment based on consultations with physicians.
Much of the reluctance to pursue this course in Canada stems from a 2002 Women’s Health Initiative study that also led to the black-box warnings. That study found hormone therapy could raise the risk not only of breast and ovarian cancer but also of strokes and other serious conditions. Use of the treatment fell out of favour for decades.
But analysis found differences in clinical outcomes based on age and time since menopause began. It also found hormone therapy can be used safely when initiated in healthy women who are younger or who recently entered menopause and do not face an elevated risk of cardiovascular disease or breast cancer.
Menopause champions like Ms. Weir point to an uptick in public discussion about it in recent years. Celebrities, including Oprah and Halle Berry, are among those who have spoken out about their experiences with hormonal changes. In past decades, midlife women’s health issues were rarely discussed, including in Hollywood, at workplaces and among social circles, advocates say.
Still, Canadian patients and women’s health organizations say barriers remain for individuals who want to access timely and evidence-based medical care, including on hormonal and non-hormonal options. They say many family doctors are not well-versed in this area and are in need of continued education. As well, waiting times to see a menopause specialist often span months.
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Trish Barbato, the co-founder and director of the Menopause Foundation of Canada, said her organization hears repeatedly from women who cannot access care and treatment.
“It’s appalling and ridiculous,” she said.
Ms. Barbato said patients often go to see physicians, only to be prescribed antidepressants, anti-anxiety medication and/or sleeping pills. Additionally, she said there is a lack of knowledge among health care providers about the SOGC’s guidelines for hormone therapy, which say it can be safely initiated in women without conditions that put them at higher risk, who are less than 10 years post-menopause and younger than 60.
Lindsay Shirreff, a Toronto-based obstetrician and gynecologist who co-founded Blair Health, an online health platform for mid-life women, said fear and stigma around hormone therapy linger from the publication of the 2002 study. More education is needed among health providers, she said.
“Primary care providers are fantastic, but they are stretched so thin, and it can be very challenging for them to be able to manage perimenopause and menopause symptoms,” Dr. Shirreff said.
Dr. Shirreff also said medical schools should increase the amount of hours spent training students. She said continuing medical education courses should be offered for providers who lack menopause training.
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Wendy Wolfman, the director of the Menopause Clinic and the Premature Ovarian Insufficiency Clinic at Mount Sinai Hospital in Toronto, regarded as a trailblazer in menopause care in Canada, said a re-evaluation also conducted by the Women’s Health Initiative affirmed the use of hormone therapy for women between 50 and 59 is safe and found it offers some health benefits.
Dr. Wolfman, who works alongside Dr. Shirreff in a different capacity at Mount Sinai, said it was clear a long time ago that women’s lives are often not talked about and researched. She is now seeing change take hold.
“I’m very hopeful,” Dr. Wolfman said.
In B.C., Ms. Weir is hopeful too. She has watched the conversation about perimenopause and menopause evolve. But she suspects patients who will be eligible to receive publicly funded hormone therapy through the province’s pharmacare agreement, starting in March, 2026, will still encounter barriers to access.
She anticipates the same will be true for patients in Manitoba, the other province that includes hormone therapy in its public coverage plans.
Ms. Weir said while there are great health care providers who support individuals to make decisions about menopause, there is “a long way to go.”