Manulife says only 13.1 per cent of women aged 45 to 65 made a claim for menopausal hormone therapy drugs in 2023.CHRIS WATTIE/Reuters
Earlier this week, on March 1, British Columbia began offering menopausal hormone therapy at no cost.
Manitoba made a similar change, with little fanfare, on April 15, 2025.
So what are the other provinces and territories waiting for?
As B.C. Health Minister Josie Osborne said: “This is a game changer for people who will now be able to access vital medications without worrying about how much they cost.”
The process is simple, too. A woman need only bring her prescription and health card to the pharmacy, and there will be no charge. No registration required, no paperwork, no reimbursement claims.
Mind you, in a country where there is a crisis in access to primary care, finding a family physician or nurse practitioner to write the prescription for menopausal hormone therapy is a whole other matter.
Most women reach menopause – the stage in a woman’s life when she stops having menstrual periods – between age 45 and 55. Stated another way, the average woman will spend almost half her life in a menopausal state: perimenopause, menopause or postmenopause.
There are more than 30 symptoms associated with the transition to and from menopause, including lack of energy, brain fog, depression, insomnia, night sweats, incontinence, vaginal dryness and more. The drop in estrogen production also increases the risk of cardiovascular disease and osteoporosis.
About one in four suffer severe, often debilitating, symptoms. One in 10 stop working due to unmanaged symptoms.
Far too many suffer in silence, resigned to their fate.
There are more than 10 million women over the age of 40 in Canada. Roughly 2.7 million are aged 40 to 50, when perimenopause symptoms typically begin. Another 2.5 million women are 50 to 60, almost all of whom are in menopause. Another five million are older than 60, and largely postmenopausal.
According to the Menopause Foundation of Canada, three in four women experience symptoms that interfere with their daily lives.
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The majority could benefit from symptom relief courtesy of menopausal hormone therapy, but it can be financially out of reach.
“Every woman deserves access to publicly funded menopause care,” says Janet Ko, the foundation’s president and co-founder.
Yet, therapies like estrogen patches, gels and pills can be costly – roughly $240 to $1,800 annually, depending on the severity of symptoms.
As with most prescription drugs, Canadians depend on private insurance for coverage. Only 13.1 per cent of women aged 45 to 65 made a claim for menopausal hormone therapy drugs in 2023, according to the insurer Manulife.
In recent years, the federal government has made modest efforts to expand pharmacare, offering provinces money to cover some diabetes drugs and oral contraceptives.
So far only three provinces and one territory have signed deals with Ottawa. Given that it already publicly covered contraceptives, B.C. decided to use the new money to cover menopausal hormone therapy. Manitoba opted to cover both birth control and MHT.
The timing is good because, in recent years, there has been a resurgence in interest in MHT. In the U.S., prescriptions rose 86 per cent between 2021 and 2025, with rates returning close to what they were in the late 1990s.
There is still a lot of unwarranted fear of menopausal hormone therapy, a lingering effect of a blockbuster 2002 study, the Women’s Health Initiative, that wrongly left the impression MHT increased the risk of cardiovascular disease and breast cancer.
A more careful reading of the data showed that, for most women, the benefits of menopausal hormone therapy greatly outweighed the risks, especially for those under the age of 60.
At the time, 27 per cent of women in the U.S. took MHT, and that number plummeted to 2 per cent. (There is no good data for Canada, but rates are assumed to be roughly similar.)
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Now, perimenopause and menopause are being talked about much more openly and candidly in popular culture, such as TV shows like Baroness von Sketch, and by celebrities like Oprah and Brooke Shields.
In other words, stigma is dissipating, and discussion of symptoms of perimenopause and menopause is more commonplace in the media and in the workplace.
Manulife makes some sound recommendations to employers to better support women experiencing perimenopause and menopause, including normalizing conversation about these common issues, providing autonomy and flexibility in work schedules of employees with symptoms, offering comprehensive drug coverage, training and educating managers, and cultivating a culture of caring.
They’re all suggestions that policy makers and politicians overseeing the publicly funded health care system across the country would also do well to embrace.