Night sweats, insomnia, hot flashes, mood swings, brain fog—these are just a few of the symptoms people with ovaries may experience with menopause. While I teach medical students that the depletion of ovarian reserve and the decline in estrogen production in midlife are physiologic, I always emphasize that physiologic does not mean painless.

It now appears that, after decades of women suffering in silence, the topic of menopausal hormone therapy is back in public conversation—in a meaningful way.

Three years ago, in an editorial for the BCMJ [2023;65:76], I wrote “Menopause: Is the media going to set the record straight?” I was referring to the fear that followed the early termination of the Women’s Health Initiative (WHI) hormone therapy trials in 2002 and 2004.[1,2] As many will recall, the group of women assigned to combined oral conjugated equine estrogen (Premarin 0.625 mg/day) and oral medroxyprogesterone acetate (Provera 2.5 mg/day) for more than 5 years experienced a higher risk of invasive breast cancer, 8 cases per 10 000 woman-years in absolute risk terms. Yet it was the relative risk of 1.26 that dominated headlines and, alongside concerns about coronary heart disease, led to the conclusion that the risks outweighed the benefits.[3]

In the years since, there have been reanalyses of the WHI data, further research on hormone therapies, and meaningful shifts in prescribing trends, including a preference for transdermal estrogen. New therapeutic options have also emerged. In November 2025, the US Food and Drug Administration removed the black box warnings related to breast cancer, stroke, dementia, and cardiovascular disease.[4]

Current consensus holds that menopausal hormone therapy is the most effective treatment for vasomotor symptoms and genitourinary syndrome of menopause, with additional benefits for bone health. For most healthy symptomatic women younger than 60 years of age and within 10 years of menopause onset, the benefits outweigh the risks.[5]

We have exited the post-WHI fear era. Are clinicians keeping up?

Following the sharp decline in hormone therapy use after 2002, many physicians who trained during that period had limited exposure to prescribing it and little demand to build experience. The result is a persistent knowledge gap at a time when patient interest is resurging. This is an ideal moment to re-engage with the evidence. For a condition that will affect over 1 million women in our province, this is continuing medical education time well spent.[6]

There are many excellent resources to support clinicians who are updating their knowledge; a few of my favorites are listed in the Box.

A growing number of virtual menopause clinics have also emerged in recent years.[7,8] Their success—offering both private-pay and provincially covered visits—speaks to the unmet demand for timely menopause care in Canada. BC Women’s Hospital and Health Centre recently opened the Complex Menopause Clinic for patients whose needs cannot be met by community providers.[9]

BOX. Educational resources for physicians.

Menopause: The social movement

Menopause is no longer just a medical diagnosis; it is also a social movement. It is part of a broader cultural shift in which women are rejecting stigma and passivity in favor of openness and empowerment.[10] Increasingly, they are not waiting for physicians to come around. Instead, they are driving menopause into the mainstream themselves.

Consider Melani Sanders, a social media personality (@justbeingmelani on Instagram) and founder of the We Do Not Care Club, who has given voice to thousands of women navigating menopause and perimenopause. Her widely shared reflections—on everything from unmade beds to arm fat—capture a growing irreverence toward expectations that once kept women silent.[11]

Menopause may be having a moment, but for patients, access to informed, individualized, evidence-based care still lags. As physicians, we can close that gap by bringing the openness, curiosity, and confidence to menopause care that our patients are already demanding.
—Caitlin Dunne, MD

References

1.    Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321-333. https://doi.org/10.1001/jama.288.3.321.

2.    Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women’s Health Initiative randomized controlled trial. JAMA 2004;291:1701-1712. https://doi.org/10.1001/jama.291.14.1701.

3.    Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA 2013;310:1353-1368. https://doi.org/10.1001/jama.2013.278040.

4.    Bartz D, Tadikonda A, Manson JE. Opportunity for improved menopausal hormone therapy prescribing. JAMA 2026. https://doi.org/10.1001/jama.2026.1891.

5.    North American Menopause Society. The North American Menopause Society releases its 2022 hormone therapy position statement [news release]. 7 July 2022. Accessed 20 March 2026. https://menopause.org/wp-content/uploads/press-release/ht-position-statement-release.pdf.

6.    Statistics Canada. British Columbia—Population by five-year age groups and sex. Accessed 20 March 2026. www12.statcan.gc.ca/census-recensement/2011/as-sa/fogs-spg/charts/PR/LD-Chart-D-eng.cfm?Lang=Eng&TAB=4&GK=PR&GC=59.

7.    Blair Health. Accessed 20 March 2026. https://blairhealth.ca.

8.    Goldman B. The rise of paid menopause care. White Coat Black Art with Dr Brian Goldman. 30 January 2026. Accessed 20 March 2026. www.cbc.ca/listen/live-radio/1-75-white-coat-black-art/clip/16195087-the-rise-paid-menopause-care. 

9.    BC Women’s Hospital and Health Centre. Complex Menopause Clinic referral. Accessed 20 March 2026. www.bcwomens.ca/health-professionals/refer-a-patient/complex-menopause-clinic.

10.    Menopause Foundation of Canada. The silence and the stigma: Menopause in Canada. October 2022. Accessed 20 March 2026. https://menopausefoundationcanada.ca/wp-content/uploads/2023/01/MFC_The-Silence-and-the-Stigma_Menopause-in-Canada_Oct22_v2.pdf.

11.    Sanders M. Chin hair, laundry, your opinion: Women in menopause don’t care. The New York Times. 26 June 2025. Accessed 20 March 2026. www.nytimes.com/2025/06/24/well/menopause-melani-sanders-club.html.