How Much Would You Pay For Better Menopause Care?
In fall 2023, Lauren Pisa just couldn’t get a good night’s rest. At the same time, the 45-year old’s periods became erratic and she started experiencing brain fog. She felt more emotional, too, with heightened anxiety. Getting through the day was a struggle.
A few months later, Pisa—who lives in Toronto—went to her doctor, suspecting that she was in perimenopause. He was attentive and concerned, Pisa says, ordering an internal ultrasound and an abdominal exam, as well as other tests. But everything came back normal.
Meanwhile, Pisa started researching her symptoms online. She learned that menopause hormone therapy (or MHT, also known as hormone therapy) might help alleviate her symptoms. But her doctor wouldn’t prescribe it because she wasn’t in menopause yet—meaning it hadn’t been one year since her last period. (Current guidelines state that hormone therapy can be prescribed during perimenopause, but some health care practitioners are reluctant to do so.) Instead, he offered her a sleep aid and anti-anxiety medication. “It was demoralizing,” she says. She knew there had to be a better option.
Pisa is far from the only Canadian woman experiencing underwhelming menopause care. This is due in part to a huge gap in menopause education and training—even in women’s health-specific specializations, says Dr. Shafeena Premji, a Calgary-based family physician. “Midlife and menopause were never discussed as part of my medical training,” says Premji, who graduated from medical school in 2010 and then did a fellowship in women’s health. She completed part of her fellowship at The Shirley E. Greenberg Women’s Health Centre (part of The Ottawa Hospital), and the experience sparked her interest in menopause care. In 2015 she became a Menopause Society Certified Practitioner—a designation awarded after completing a competency examination by the U.S.-based Menopause Society, an independent, evidence-based menopause resource for healthcare professionals and the public. And in 2024, she opened Milestone Menopause Centre as part of her family practice.
Premji’s menopause patients are often desperate. “They’ll say, ‘My family doctor is fantastic, but they didn’t have the training or experience to help me. They did not understand what I was experiencing. They dismissed my symptoms,’” she says. Demand for her menopause services, which are covered under Alberta’s provincial health care plan, was fast and furious. Wait lists ballooned from eight weeks to three months for urgent referrals, while the wait for routine referrals grew from six months to 18 months. “In July 2025, I actually had to stop routine referrals because I just couldn’t manage the demand,” Premji says. That’s set to change: earlier this year, her menopause clinic moved into a new, dedicated 3,200-square-foot space staffed by multiple doctors offering care under the public health system, as well as a team of other practitioners providing out-of-pocket care.
When women can’t get adequate support from public clinics like Premji’s, they’re increasingly turning elsewhere. The menopause business is booming: Market research company Grand View Horizon predicts that the menopause market in Canada, which includes sales of hormonal and non-hormonal therapies, will reach US $784.9 million by 2030. And in the past 10 years, a slew of virtual healthcare startups like Felix, Science & Humans and Hims & Hers have sprung up alongside smaller private clinics to make it easier to access MHT.
MHT is the evidence-based gold standard treatment for hot flashes, and women who take it also report alleviation of other symptoms related to menopause, like mood and sleep disturbances, weight gain, joint pain, hair loss and low libido. But some doctors are still apprehensive about prescribing it thanks to a 2002 American study (which was strongly criticized and later reappraised) that claimed hormone therapy was dangerous and caused an increased risk of breast cancer, stroke and heart attack. “Women would tell me that their doctor didn’t think [hormone therapy] was safe,” Premji says.
In fact, MHT is now considered safe and effective, and may help reduce the risk of heart disease in some women—but it’s not a one-size-fits-all solution. Premji says a lack of education is still leaving family doctors hesitant and ill-equipped to prescribe it. “Hormone therapy is very personalized,” she says. “You need to know how to do a proper risk assessment to determine the exact dose, formulation and regimen that is safest and most effective for your patient.”
This knowledge gap is driving women who can afford it to seek out private care. Dr. Michelle Jacobson, a Toronto-based ob-gyn and menopause specialist, decided to start her own private clinic in July 2025 after seeing high demand for care in her public practice, which had a waitlist of two-and-a-half years. She was also alarmed by the quality of some of the private clinics she saw popping up, because it seemed like they weren’t providing evidence-based care.
Her clinic, Coven Women’s Health, offers virtual menopause care, including hormone therapy prescribed by a nurse practitioner with oversight from Jacobson; the clinic team also includes a dietitian, a social worker and a registered nurse. Appointments start at $299 for a basic menopause assessment with a nurse practitioner (including lab work and a hormone therapy prescription, if required) and max out at $1,399 for a six-month package involving multiple practitioners.
Jacobson encourages women seeking private care to do their research first. “[Find out] who the medical director is,” says Jacobson. “Their training and experience is important.” Look for a Menopause Society Certified Practitioner or someone who has completed a menopause fellowship or the International Menopause Society Professional Activity for Refresher Training. Also check out the Menopause Foundation of Canada’s guide for assessing virtual and private menopause care options, which Jacobson helped create.
Aside from practitioners with no menopause-specific training, certain types of treatments and tests offered at private clinics can also be red flags. “Does the clinic prescribe compounded bioidentical therapy [which is not evidence-based and not approved by Health Canada] or is it providing pharmaceutical-grade, evidence-based, Health Canada-approved treatments?” Jacobson asks. “Are they offering for-pay [hormone] testing like saliva or hair or urine testing, which doesn’t have any evidence [behind] it?”
While private clinics attempt to fill the gaps in menopause care, some progress is being made on the public front. Aside from Premji’s Calgary clinic expansion, Alberta’s new Virtual Clinic for Post-Reproductive Care is set to open this year, and will offer access to nurse practitioners for peri- and menopause care. Last year, the BC Women’s Hospital + Health Centre opened its Complex Menopause Clinic in Vancouver, while Toronto’s Sinai Health received a $25-million donation to build a dedicated physical space for its Centre for Mature Women’s Health. Also in 2025, Nova Scotia’s health ministry announced it was working on a plan to open a Menopause Centre of Excellence that would be the first of its kind in Atlantic Canada. And overall interest in menopause care has spiked, with the number of Menopause Society Certified Practitioners in Canada increasing from 22 in 2015 to 715 in 2025. (Aside from doctors, these practitioners include nurses, pharmacists and other licensed healthcare professionals.)
Unfortunately, this progress is still too slow for many women. After developing constant breast tenderness in addition to the fatigue, brain fog and anxiety, Pisa booked a virtual appointment with a nurse practitioner through Science & Humans. “I shopped around a little, but it was like the Wild West,” she says. “Science & Humans had good reviews, and they were less expensive than other quotes I had gotten.” At the time, it cost $30 to register as a patient and $200 for a consultation with a nurse practitioner, which must occur every three months to renew hormone prescriptions.
The NP ordered blood tests that showed low progesterone and high estrogen levels. “She said I had sensitive breasts because I was estrogen-dominant,” says Pisa. The NP prescribed progesterone and Pisa’s breast tenderness disappeared. After six weeks, her quality of sleep improved too, which in turn alleviated her brain fog and anxiety.
Aside from the relief, Pisa experienced validation. “I felt heard for the first time,” she says. She has no regrets about going private—she just wishes she didn’t have to. “To be listened to,” Pisa says, “and to be prescribed without limitations or trepidation should not come at a price in Canada.”
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Andrea Yu is a Toronto-based freelance journalist who writes about everything from business to design, women's health, food, travel and real estate. Aside from Chatelaine, you can also find her work in Toronto Life, the Globe and Mail, Cottage Life and Maclean's.
