innovation in menopause treatment combines evidence-based care and technology
“nearly 50 per cent of canadians will go through menopause, yet access to informed, evidence-based care remains limited and women are no longer willing to wait months to years for care," says menopause expert dr. lindsay shirreff.
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dr. lindsay shirreff is a menopause specialist in toronto working to improve access to care and treatment for mid-life women across the country. she is chief medical officer and co-founder of blair health, a new virtual care platform.
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dr. lindsay shirreff works with women in some of their most vulnerable moments—childbirth, painful sex, and the insomnia, mood swings and hot flashes of menopause that can go on for more than a decade. as an obstetrician and gynecologist in toronto, she’s made mature women’s health a focus of her work, committed to meeting the growing need for treatment of a group that is, as she calls it, “deeply underserved.”
“nearly 50 per cent of canadians will go through menopause, yet access to informed, evidence-based care remains limited and women are no longer willing to wait months to years for care,” she says.
“i have seen, over and over again, patients coming into my office having waited too long to have their symptoms treated and have struggled for years before being able to get appropriate evidence-based care.”
women in menopause have an unmet need for evidence-based care
she repeats the term “evidence-based care” several more times during the interview, for a reason. there’s an onslaught of products on the market for women in the 50-plus age range of menopause—the life transition stage when menstruation stops and key hormones like estrogen and progesterone fluctuate. there are promising fixes in serums to firm skin, powders and supplements that claim to eliminate night sweats, and “treat trunks” with snacks to boost your mood.
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while there’s some science behind product development, the evidence just isn’t there to support shelling out a lot of money for long-term symptom relief. shirreff says the proven treatments she and other physicians offer in clinics are highly effective and worth considering. but there are hurdles to accessing medical care, including few certified menopause professionals who have the extensive training like herself (patients can wait 18 to 24 months to see a menopause specialist) and a lack of understanding about the therapies available.
“typically, what someone does if they’re suffering from these symptoms, they would seek care from their healthcare provider. perhaps it’s a nurse practitioner or a family doctor,” she says. “but if they’re seeing a provider who may not be as comfortable treating these symptoms, they may be sent away without treatment or be told that it’s just a normal part of aging.”
menopause symptoms often dismissed and misunderstood
symptoms like sleep disruption and brain fog can also be dismissed in a doctor’s office or misattributed to some other cause. part of the problem is that family doctors receive little or no formal menopause training, which is the case even in obstetrics and gynecology and general residency, shirreff explains.
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as a result, menopause is often overlooked in routine care, and patients are left to self-advocate or rely on online sources.
“access is even worse in rural and underserved areas, so there’s a gap in care and unmet need. it leads to a delay in diagnosis and treatment for a lot of women who are left to suffer unnecessarily from treatable symptoms.”
she also emphasizes that this is a time in people’s lives when they are at the height of their career while dealing with common symptoms like hot flashes and night sweats.
the menopause foundation of canada reports that 10 per cent of women will stop working because of unmanaged symptoms. others reduce their hours or pay, so life and livelihood are derailed by something that could be treated effectively. as well, unmanaged symptoms cost the canadian economy $3.5 billion.
shirreff, however, has seen positive change in attitudes and clinical innovation in treatment options.
“we used to have a stigma around menopause, and there is a lot of misinformation out there that is now being tackled. we’re getting over the stigma, and so there are so many women who are now informed and looking for care.”
women, for the most part, don’t want to just accept and live with symptoms that are undermining their lives.
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tainted legacy of hormone replacement therapy
she wants to see women self-advocate for care and consider the treatment options like traditional hormone replacement therapy that replaces estrogen and progesterone during and after menopause, when levels of those hormones drop and fluctuate. use of the therapy plummeted after 2002 with the release of the women’s health initiative (whi) report, a federally funded, randomized controlled trial that remains the largest, longest trial of menopausal hormone therapy.
the whi was stopped early because of increased risk of heart attack, stroke, blood clots and breast cancer. newer research, though, has shown that the original study’s findings were flawed and hormone replacement therapy is now considered safe, depending on a woman’s unique health history.
shirreff says even the terminology has changed to menopausal hormone therapy.
“the literature has shifted with respect to safety, and we know for women who are healthy, less than the age of 60 and within 10 years of a final menstrual period, typically the benefits of menopause hormone therapy outweigh risks for most people.”
virtual care and new medications for menopause
she’s most excited by the new medications that are coming to market for people who can’t take menopause hormone therapy because they have a personal history of breast cancer, heart attack or blood clots—or they prefer not to take the treatment but are open to other options. these drugs are safe and effective, particularly for hot flashes and night sweats. among the most recent is veozah, fezolinetant film-coated tablets, which is a non-hormonal treatment approved by health canada last december.
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shirreff is also closing the care gap as chief medical officer and co-founder of blair health, a virtual platform launched in june to lead access to care for mid-life women navigating menopause. the aim is to help women across the country assess their menopause stage and receive tailored recommendations.
“we combine clinical expertise with digital tools to deliver evidence-based personalized care,” she says.
women create a free account, fill out health assessments on menopause and medical history, and then get a personalized treatment plan. they can book a virtual appointment with a healthcare provider, a physician or nurse practitioner, and have prescriptions filled by their pharmacy.
“on our platform, you can do that within minutes to days. you are no longer waiting 18 months to two years,” she notes. the platform also offers an app for women to continue their therapeutic relationship with their provider, a validated symptom tracker for monitoring and personalized education.
“it’s really comprehensive support for patients navigating this life stage who don’t want to wait or don’t want to sit in waiting rooms,” she says, proud to offer this model of care that has more than 500 women already participating. “i’ve always dreamed that a platform like this could be built.”
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