May 31, 2023

Helping mature women thrive: Correcting 20 years of menopause misinformation

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Female medical practitioner reassuring a female patient

Periods, pregnancy and many other realities of being a woman* have become normalized topics in today’s public discourse, yet menopause remains largely taboo. This shroud of secrecy around menopause means that far too many women do not know what to expect when they reach this natural transitionary period: in fact, research by the Menopause Foundation of Canada found that more than two thirds of women lacked knowledge of common menopausal symptoms, and almost half of Canadian women aged 40 to 60 feel unprepared for this stage of life. How can an experience that impacts almost half of our population remain such an enigma?

These knowledge gaps aren’t exclusive to patients—many physicians are misinformed about menopausal care in part due to a landmark study published over two decades ago.

In 2002, the Women’s Health Initiative (WHI) found that the use of combined estrogen and progestin hormone therapy among post-menopausal women had an increased risk for breast cancer and cardiovascular disease, concluding that the health risks of using combined hormone therapy exceeded health benefits. However, since then, that data has been re-evaluated and numerous studies have shown that the use of menopausal hormone therapy in younger or early post-menopausal women can have beneficial effects on the cardiovascular system. Despite new evidence supporting the safe use of menopausal hormone therapy, the conclusions of the 2002 WHI study had lasting impacts that still affect the care that women receive today.

Dr. Goldstein, an assistant professor at the University of Toronto Department of Family and Community Medicine (DFCM), explains.

“After this study, there was a domino effect that created the huge knowledge gap in menopausal care that we have today. Many physicians believed hormone therapy was dangerous and as a result, they felt that there wasn’t anything they could do to support women going through menopause. And because they felt there wasn’t anything they could do, they naturally didn’t ask about it. So, we find ourselves years later with very limited curriculum around menopausal care, and doctors—including newly graduated doctors—are afraid to treat women for menopause based on old information.”

But it is high time that this changes. With the number of Canadian women around menopause age reaching over 5 million by 2025, we need to ensure that they can access the care and support they need during this phase of life. To address the knowledge gaps among healthcare providers and encourage the provision of menopausal care, Dr. Goldstein developed the MQ6 Menopausal Management Tools website. The Menopause Quick 6 (MQ6) assessment tool and accompanying MQ6 treatment algorithm/decision tool can be found on the site along with other resources for both healthcare providers and patients.

Through six simple questions, the MQ6 assessment tool allows both healthcare providers and patients to efficiently screen for common and treatable menopausal symptoms—symptoms that many patients may not bring up on their own.

“The tool is used to assess for the presence of symptoms, but it’s also used to get the conversation going. Data shows that patients will not open the conversation on their own and will suffer instead of seeking care. But the tool allows for a quick screen and facilitates that conversation,” says Dr. Goldstein, who is a community-based family doctor and a North American Menopause Society (NAMS) certified menopause practitioner.

The answers to the MQ6 assessment tool can then inform the  MQ6 treatment algorithm, which has been developed into an online interactive treatment tool to help healthcare providers develop personalized menopausal treatment plans for their patients. This decision tool provides up-to-date evidence-based recommendations to guide treatment choices. The website also provides a counselling tool, Canadian product tables and information that addresses some of the common difficulties and questions that clinicians have when prescribing for menopause, as well as health promotion information for patients to learn more about menopause and what to expect. Important recommendations on how to maintain brain, bone and heart health through the menopause and into women’s mature years are also included.

Of course, there are still symptoms of menopause that can’t be treated, and some individuals may not be appropriate candidates for certain treatments. Regardless, physicians can still screen their patients and provide counselling around lifestyle interventions that can help mature women thrive.

“A large percentage of our patient population will be menopausal in the upcoming years, so it is an important time to counsel and prepare women to optimize their health for the second half of their adult lives. After all, if women live to be 85, they will spend—on average—half of their adult lives post-menopause. So, physicians need to be comfortable with addressing menopausal concerns to support this large cohort,” says Dr. Goldstein. “I encourage physicians to reflect on their own comfort and knowledge base in treating menopause and address any knowledge gaps in the same way they would for any other condition that we treat.”

The MQ6 assessment tool and treatment algorithm can be found at

*The term “woman/women” is used throughout this article, however, the conversation around menopause applies to all individuals who can experience menopause.