Gaps in menopause care push some Canadians to pay out of pocket

LISTEN | Why more Canadians are paying for menopause care:

White Coat Black Art26:30The rise of paid menopause care

Some Canadians are paying out of pocket for menopause care from a host of private practitioners opening clinics outside the public health-care system.

Aidan Brame, a 46-year-old woman from Nanaimo, B.C., is one of them.

“What drove me to seek help was frozen shoulder, but also hot flashes at night — just feeling really down and lethargic,” she told Dr. Brian Goldman, host of White Coat, Black Art.

Brame said she read an article in National Geographic linking frozen shoulder to menopause, but when she mentioned that to her family doctor, “it was dismissed completely.”

“He did order an ultrasound, which I still haven’t gotten yet,” said Brame. “It’s been almost a year.”

When she pushed for hormone replacement therapy, her doctor eventually prescribed estrogel, said Brame. He also referred her to a menopause specialist, “but that was a year’s wait to get to see that person.”

Physicians say lack of information and poor access to doctors who have received specialized training on menopause have left many without the tools they need to manage symptoms.

Advocates say access to good medical care for menopause symptoms within the public health-care system is insufficient everywhere in the country, but even more so in rural areas. (S_L/Shutterstock)

There isn’t a reliable source of data on the number of Canadians who seek menopause care privately. But a 2024 study of more than 2,100 women in B.C. ages 39 to 60 found that 43.5 per cent sought help for menopause symptoms from an extended health-care provider in the past year.

The most common among these were naturopaths, massage therapists, physiotherapists and mental health professionals. Respondents reported shelling out hundreds of dollars for these.

Brame said she researched various private providers and decided on the virtual clinic, Modern Menopause.

She paid $295 for an initial consultation that included a detailed medical questionnaire and review of that information followed by an appointment and then a 40-minute virtual consult. Followup appointments at that clinic are $170.

Brame said she was “blown away” by the experience.

The physician she saw, Dr. Eileen Wang, ordered a full blood panel, including the tests needed to check her hormone levels and her thyroid health, said Brame. Once those findings were in hand, she was prescribed progesterone to complement the estrogen therapy she was already receiving and help with her sleep. Her dose of estrogen was significantly reduced.

Brame said her symptoms, including her shoulder pain, have improved considerably, and she’s sleeping much better.

“I’m just a lot calmer, not as reactive and not as tearful. Yeah, it’s been a game-changer.”

WATCH | Which menopause products are helpful and which are all hype :

As menopause products boom, many don’t live up to the hype

Once a taboo topic, menopause is now being treated as a huge growth opportunity for some in the women’s wellness industry, but health experts warn some of these products promising relief are useless and possibly even harmful.

Buyer beware

But not all private operators advertising menopause services online are qualified to do so, warns Dr. Kelsey Mills, an obstetrician-gynecologist in Victoria. She’s a board member of the Menopause Foundation of Canada and has been a Menopause Society certified practitioner since 2013.

“There are a lot of people out there, maybe with the best of intentions, that aren’t medical providers, that are giving medical advice,” said Mills. “That’s a challenging, possibly dangerous situation to be in.”

A woman in medical scrubs — Dr. Kelsey Mills, an obstetrician-gynecologist in Victoria, says she worries not all of the organizations offering menopause health care online are qualified to do so. (Submitted by Kelsey Mills)

Mills said she’s worried that some may get taken advantage of financially.

“I’ve met people who have spent tens of thousands of dollars in one year on supplements and compounded medications over the internet and programs who still wind up in my office with their symptoms not well-controlled or issues or side-effects.”

Some of these operators promote frequent hormone testing, which generally isn’t clinically useful, especially in perimenopause, when hormones can fluctuate so much, according to the Menopause Foundation of Canada.

Others prescribe unregulated, custom-made hormone products or supplements that aren’t approved by Health Canada. Some promote treatments or lifestyle fixes that they say are essential or they’re curative, even when they’re not supported by guidelines.

Mills said she does, however, understand how this happens given that her own waitlists are 18 to 24 months long.

The public system often can’t provide menopause care quickly or with enough depth, and even when doctors do offer it, they aren’t paid adequately, she says.

So far Manitoba is the only province in Canada that has a specific billing code for menopause that allows for an extended visit with compensation to match, says Mills, though she adds that the Menopause Foundation is advocating for other provinces to follow suit.

How private menopause clinics operate

Some private menopause clinics charge by structuring care in the form of membership fees or bundle services that include access to allied health professionals whose services aren’t covered by provincial health insurance.

Others rely on nurse practitioners (NPs), who — while some hold salaried positions in publicly funded institutions — can’t yet bill provincial health systems for their services. (Changes to the Canada Health Act Services Policy announced last year mean NPs will be able to bill provincial and territorial health plans starting in April).

And then there are providers who serve clients exclusively outside their home province through virtual appointments, getting around rules that — in most jurisdictions — don’t allow doctors to charge privately for services that are covered by their own provincial health system.

A woman with glasses and a white blouse. — Family physician Dr. Eileen Wang founded private clinic Modern Menopause to provide care to those struggling to access menopause care, especially in rural parts of Canada. (Submitted by Eileen Wang)

But, said Dr. Eileen Wang, founder of Modern Menopause, these clinics have sprouted up in response to an unfilled need.

“Honestly, as a doctor, I encountered so many women who would tell me very similar stories of how, you know, they’re getting dismissed, ignored, denied care for menopause,” said Wang, a family physician who lives in the Toronto area.

She said a lot of the clinic’s patients live in areas where access to health care for anything, let alone the more specialized area of menopause care, is limited.

“A lot of our patients are actually in very rural places where there’s no walk-in clinics. I’ve had a patient, just a few days ago, tell me that her only option is going to the ER.”

Modern Menopause operates in nine provinces and employs 20 nurse practitioners.

In Nanaimo, Aidan Brame said paying out of pocket for health care that should be covered by the public system is “a hard pill to swallow.” Those who are simply struggling to put food on the table for their kids, she said, just won’t even be able to consider it.

Still, though she describes herself as “not independently wealthy,” Brame said she’s glad she parted with that cash.

“For 300 bucks, I got my life back.”