‘Giving women agency over their health’: How innovative solutions are filling the gaps in Canadian menopause care

According to data released by Statistics Canada in September, this country is home to nearly four million women between the ages of 40 and 55, the window during which “natural” menopause takes effect. In a 2022 survey conducted by Leger Canada for the Menopause Foundation of Canada (MFC), about 46 per cent of women said they don’t feel prepared for menopause, even though they know it’s coming. Additional research shows three-quarters of them will experience symptoms that disrupt their daily lives. This means nearly two million Canadians could be struggling unnecessarily.
Additionally, an analysis by the MFC found that menopause costs Canadian women $3.3 billion each year in lost wages as a result of unmanaged symptoms that affect their ability to fulfill professional obligations.
The onset of menopause can be accompanied by more than 30 possible symptoms, from brain fog, hot flashes and sleep disturbances to mood swings, vaginal dryness and weight gain. But some experts say those experiences are greatly exacerbated by one overarching failure: a lack of effective health care for Canadian women. For professionals like Dr. Michelle Jacobson, an assistant professor at the University of Toronto and menopause specialist at Women’s College Hospital and Mount Sinai Hospital, it’s difficult not to wonder whether this would be the case if men were suffering through a similar midlife transition.
“We would have a lot more information, research, products, more lenient indications, we would talk about it more, care about it more, and I think we’d have more doctors (treating it),” says Jacobson, who also sits on the boards of the Canadian Menopause Society and the MFC. What those experiencing menopause need most, Jacobson believes, is “access to quality education and counselling that is evidence-based, non-predatory, and individualized.”
Dr. Michelle Jacobson is an assistant professor at the University of Toronto and menopause specialist at Women’s College Hospital and Mount Sinai Hospital.
At a time when tech-savvy millennials are starting their menopausal journeys, some tech entrepreneurs are stepping up with potential solutions to long-standing health-care deficiencies.
Menopause, while potentially challenging to live through, is typically easy to diagnose. Generally, if 12 consecutive months have passed without a period or spotting, menopause has officially begun. On average, Canadian women hit that milestone at age 51, according to the MFC.
Perimenopause — the six to eight years leading up to menopause, during which a woman experiences the final reproductive cycles — is a lot harder to pinpoint, says Jacobson, who describes this period as “a time of major confusion.”
That’s because there’s no single test or sign that can confirm that a woman’s hormones have started to fluctuate, sometimes chaotically, Jacobson says. This can trigger commonly identified symptoms, including menstrual changes (periods can be longer or shorter, with a heavier or lighter flow), night sweats and hot flashes. The 2022 survey conducted by Leger Canada also found that 60 per cent of Canadian women didn’t know that body aches, migraines, headaches, anxiety, depression and memory issues are all symptoms of perimenopause and menopause, and only 18 per cent considered themselves very knowledgeable about perimenopause.
Fibra was created with the intention of capturing information about a woman’s personal reproductive health and delivering it in a way that allows them to make informed decisions, says Parnian Majd, founder and CEO of the Toronto-based startup. Although Fibra’s primary application is as a tool for fertility — to help women identify when they’re most likely to conceive — Majd envisions a product evolution that will serve women at the end of their fertile years by identifying the onset of perimenopause.
Fibra underwear has sensors that monitor heart rate, skin temperature, and bodily fluids, with data demonstrated in an app.
The “smart” underwear has embedded sensors that monitor biophysical parameters, like heart rate and skin temperature, and biochemical parameters, such as pH and volume of body fluids. That data is captured and served up in an app. The product is in a series of pilot tests and expected to launch in 2025.
For those in the menopause transition, Fibra’s data on body temperature, sleep disruption and other variables could provide concrete insights about what’s happening to their bodies in real time, Majd says. By monitoring changes in biochemical and biophysical parameters related to discharge, for instance — which reflect hormonal fluctuations — the tool will be able to help women determine if they’re experiencing certain symptoms as a result of perimenopause.
“I attended an event at Women’s College Hospital a couple of months ago, and they talked about how many patients they see every day who are worried about symptoms they’re experiencing and don’t know that they’re normal perimenopausal symptoms,” says Majd. Because there’s a lack of easily accessible education and resources about perimenopause and menopause, many women are unable to make the connection between what’s happening in their bodies and the natural shifts that occur during this stage of life, she says.
Parnian Majd is founder and CEO of the Toronto-based startup Fibra.
It can be helpful to remember that menopause is a perfectly normal transition — bestselling author and obstetrician/gynecologist Dr. Jen Gunter has said it can be thought of as puberty in reverse. But that doesn’t mean you need to white-knuckle your way through it. The Canada-born, San Francisco-based doctor maintains that it is crucial to be equipped with facts and feminism and an understanding of the wide array of effective, science-backed treatments to ease symptoms like hot flashes, mood swings and sleep disturbances.
One treatment option known as menopausal hormone therapy (MHT) involves treating the symptoms of menopause by replacing lost hormones. In recent years, studies on MHT have demonstrated that its benefits in treating menopause symptoms outweigh its risks for most patients. One study published in the medical journal JAMA earlier this year shows MHT is capable of treating symptoms such as hot flashes and night sweats with limited risk of adverse events like stroke or breast cancer, particularly among those under the age of 60. Previous concerns around hormone therapy have been downgraded — and experts believe this option should be offered to more women.
A number of studies have presented vaginal estrogen as the “gold standard” for treating genitourinary symptoms of menopause, which are specific physical changes (such as UTIs, irritation and dryness in the vulvar and vaginal area) that result from decreasing estrogen levels during this period. Studies have also shown options such as cognitive behavioural therapy, exercise and reducing your caffeine and alcohol consumption can improve certain symptoms without medication.
But before landing on a treatment, women need to consider their personal menopause experience in the context of established guidelines to understand which options best suit their needs, says Hoda Soboh, co-founder of Nyah Health, a tool she hopes can address this issue.
One in five Canadians don’t have a family physician or nurse practitioner that they see regularly, according to research compiled by the Canadian Medical Association. And, even if they’re lucky enough to have a family doctor, that medical professional might not be equipped to help treat the symptoms of menopause. That’s because as many as 41 per cent of Canadian medical schools don’t include menopause in their undergraduate curricula, according to an article published in the peer-reviewed Canadian Primary Care Today journal in 2023.
While some programs, such as one offered at the University of Toronto, are seeking to address the problem, many obstetrician and gynecologist residencies across the country don’t cover menopause at all or enough to prepare their graduates to address their midlife patients’ needs, according to research compiled by the MFC.
In 2021, Soboh and her friend Dr. Nese Yuksel, a pharmacologist and leading researcher in women’s health who is currently the dean of the faculty of pharmacy and pharmacological sciences at the University of Alberta and president of the Canadian Menopause Society, were discussing their frustrations with women’s limited access to the care they need. And then they thought, “Wouldn’t it be great if we did something about it?”
Hoda Soboh is the co-founder of Nyah Health.
The fruit of their labours is Nyah, a virtual health platform that will allow Canadian women going through this transitional phase to access frontline medical care provided by regulated menopause practitioners, in accordance with evidence-based protocols developed by accredited sources.
“People like us, who are looking for solutions, are being dismissed, gaslit, diminished,” says Soboh, the company’s CEO and co-founder. “It’s not like women are going to their doctors, not getting answers, and then just going back and suffering. Women are being sold solutions that don’t have demonstrated, evidence-based efficacy, (and) in some cases, can be harmful.”
After rigorous development and testing, Nyah will soft-launch later this year. Those who sign up for the service will be led through a process of education — called “Menopause 101” — and complete a comprehensive intake to provide data on their general health, family history, symptoms, and priorities. From there, data is analyzed based on established guidelines and provided to a designated health practitioner, who then conducts an hour-long consult involving an assessment, recommendations, and an in-depth written report that can be shared with other care providers.
Soboh says the assessment, which includes a follow-up appointment, will cost about $500. Nyah is one example of an expanding market for femtech entrepreneurs, focused on using technology to address women’s health issues. These entrepreneurs are aware of the shortcomings within the health-care system today — and attuned to the ways digital resources can fill gaps in access.
Ensuring privacy is a vital issue for health tech entrepreneurs and their customers, says Soboh.
“That is paramount for me. We’re compliant with all of the regulations in terms of protection of information so that we’re doing everything we need to do so that our systems don’t get breached,” says Soboh. Canadian health data is subject to a growing number of cyberattacks, according to a 2023 article published in the Canadian Medical Association Journal, with hospitals and health-care systems becoming major targets across the country, spurring action on the part of provincial health departments, such as the one in Nova Scotia.
“Today you’ve got almost a million women in Canada who are experiencing debilitating symptoms and 10 per cent of them are actually leaving the workforce,” says Soboh, referring to research compiled by the MFC. “What has stuck with me through my own health struggles, and in rolling out this service, is the importance of giving women back agency over their health.”
If menopause has a hallmark, it’s hot flashes (a.k.a. “hot blooms”). Up to 80 per cent of women will experience a rapid onset of heat in the upper body that lasts anywhere between one and five minutes, according to research from The Menopause Society in the United States. Hot flashes can occur daily and persist for seven to 10 years among women experiencing menopause.
While mild hot flashes may present tolerable discomfort, severe flashes can be debilitating and night sweats (hot flashes experienced at night) can interfere with required rest. MHT is considered a first-line therapy for hot flashes but there are plenty of other medical and lifestyle interventions that can provide effective results, such as increased exercise and yoga.
Other methods of cooling down as fast as possible can also help. In the absence of a fully portable personalized HVAC system, entrepreneurs have devised solutions to provide immediate (and convenient) ways for women experiencing menopause to chill out.
The Menopod, the brainchild of a Canadian startup featured on CBC’s Dragon’s Den, is a computer-mouse-shaped device that provides up to 12 cycles of cooling courtesy of its copper plate that drops to 5 C within seconds and can be applied to the neck with the flick of a switch. In a clinical trial conducted with Queen’s University, the Menopod provided symptomatic relief to 70 per cent of women experiencing hot flashes.
Although it is not yet commercially available, the Grace wristband applies the same principle as the Menopod in an automated, elaborately designed package. Currently being developed by U.K. femtech startup Astinno, the app-connected device aims to track and manage hot flashes 24–7. It contains a sensor that will detect a spike in body temperature and activate a cooling patch on the wrist, with the intention of managing rising body temperatures.
And for any woman who has flapped their overheated shirt and stared up at the cosmos hoping for a solution, space has delivered an answer: temperature-stabilizing fabric fit for an astronaut. Originally developed in the 1980s with NASA funding, the fabric now known as Outlast was created to line spacesuit gloves and provide heating and cooling. A patent has since been acquired and used in multiple products, including a line of menopause-friendly clothing by Fifty One Apparel, which sells temperature-regulating daywear and pyjamas.
Given existing gaps in the current health-care system, novel solutions can help provide agency (and much needed relief) to Canadian women as they navigate the challenges of their menopause transition. Jacobson is heartened by the emergence of platforms that promise to help bring evidence-based information to the masses — without forcing patients to seek out a menopause specialist in person.
“What I worry about are the gimmicks, the snake oil, the supplements or compounded therapies that are being recommended to women,” she says. “Nothing is going to actually be the fountain of youth.”
As Jacobson points out, if something seems too good to be true, it probably is.
Dominique Ritter writes about technology for MaRS. CTVNews.ca has partnered with MaRS to highlight Canadian innovations in health care.