Middle-aged British women really lucked out earlier this year when the National Health Service (NHS) introduced menopause screenings into routine health exams for women aged 40 to 74. 

These appointments (part of the country’s Health Check program – a free half-hour checkup for adults designed to spot early signs of illnesses like heart disease, diabetes and dementia) now include candid conversations and useful advice about dealing with perimenopause and menopause symptoms. Healthcare providers will ask patients a set of tailored questions not just about hot flashes and night sweats, but also about how their symptoms impact their daily life, work and mental wellbeing and treatments they could benefit from (including hormone therapy and non-hormonal alternatives).  

The goal is simple – to improve access and identify physical and mental issues for women before they enter this stage. It’s a landmark step in women’s healthcare. Not only does it raise awareness of symptoms, but it also reduces stigma and boosts patients’ confidence when it comes to aging. “Women have been suffering in silence for far too long and haven’t been encouraged to open up about the symptoms they’re experiencing. This often means they’re left to navigate menopause alone, with very little support,” Wes Streeting, the U.K.’s health and social care secretary, said in a press release. “The government is overhauling women’s healthcare and giving those experiencing menopause and perimenopause the visibility and support they have long been asking for.” 

Bringing hot flashes, brain fog, mood swings, vaginal dryness, night sweats and sleep disturbances into the mainstream seems like an obvious move, yet Canada doesn’t offer a similar program for the estimated 5.5 million women between the ages of 40 and 70 who might benefit from it. While we’re quick to tout proactive care for a slew of other health issues, menopause isn’t on the list, even though the Menopause Foundation of Canada says nearly half of Canadian women feel unprepared for this stage of life, and a third say they’ve waited more than two years to find care. 

Dr. Alison Shea, an obstetrician and gynaecologist, and menopause and reproductive mental health specialist in Hamilton, Ont., says the current landscape in menopause care here in Canada is something to be desired. “We have a lot of work to do, and I think it’s excellent that the U.K. is incorporating screening because, right now, unless you bring a concern to your doctor, perimenopause and menopause symptoms often aren’t identified,” she says. “For example, a lot of women don’t know that their joints start to hurt and that could be associated with hormone changes. Or they’re waking up in the middle of the night and can’t get back to sleep and that could also be hormonal. Not doing screenings is a missed opportunity to educate.” 

For Dr. Wendy Wolfman, a professor in the department of obstetrics and gynaecology at the University of Toronto and the director of the Menopause Clinic at Mount Sinai Hospital, education is exactly what’s lagging here. “It starts in medical schools and even in our residencies. Aging women’s health really didn’t start to be researched until the 1990s,” she explains. “Now, there’s been an explosion of interest in the topic. Women are vociferous about it and social media is publicizing symptoms and information. Women are becoming more validated in how they’re feeling.” 

Dr. Wolfman, who started one of the first fellowship programs in mature women’s health and runs a yearly course in the topic, says the statistics – 70 to 80 percent of women have symptoms, and women spend up to 40 percent of their lives after menopause – have changed the discussion about the importance of this part of life.

“We’ve also recognized that women are not just reproductive creatures – our lives don’t stop when we become menopausal.” 

While new clinics are popping up to help women in bigger cities (like the Menopause Clinic at Women’s College Hospital in Toronto, which caters to those 40 to 60 years old), the experts agree that overall, we’re not doing enough to support women in midlife. A good start, says Dr. Shea, would be for the government to amend the way family doctors bill for menopause-related appointments. Manitoba recently became the only Canadian province with a specific billing code GPs can use for menopause assessment and care. (In other provinces, GPs must bill using standard consultation or assessment fee codes.) “Family doctors are underpaid and overworked, but if there was a special code that gave them the opportunity to bill more time and spend more time with patients who specifically booked a midlife health assessment, that would be huge,” she says.  

While many experts would like to see Canada replicate the screening program offered in the U.K., a good place to start would be to arm every family doctor with a Canadian tool already at our disposal. The Menopause Quick 6 (or the MQ6) was developed by Dr. Susan Goldstein in 2017, is an assessment tool with six key questions – about changes in periods, hot flashes, vaginal dryness, bladder issues, sleep and mood – for women and healthcare professionals to assess the need for treatment. The Canadian Menopause Society is working to validate it against other approved questionnaires.

“It takes a village,” says Dr. Wolfman. “Universities are starting to get on board when it comes to training, and more physicians are talking about the need for the dedicated fee code, so I think we’re getting there. With so many women in our community demanding care and advocating to the government, I’m excited about the potential for change.”