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Ontario Health’s Menopause quality standard addresses care for women and gender-diverse people who are experiencing perimenopause or menopause (and postmenopause), including early or surgically induced menopause. The quality standard focuses on the identification, assessment, and management of symptoms at any stage and in all health care settings.

Menopause refers to the health transition from reproductive to nonreproductive status. During this time, women and gender-diverse people should receive high-quality care based on the best available evidence. However, among Canadians who took part in a survey about menopause in 2022, 46% said that they felt unprepared for this life transition. Clinicians’ varying levels of knowledge about and comfort with menopause management means that menopause-associated symptoms are often mistakenly attributed to other conditions; this can lead to incorrect treatment and delays in receiving both preventative care and evidence-based treatment options. Although recent clinical practice guidelines recommend menopausal hormone therapy as first-line treatment for vasomotor symptoms, many clinicians report hesitation in prescribing it. Further, primary care clinicians’ lack of knowledge and comfort in providing perimenopause and menopause care leads to unnecessary and inappropriate referrals for specialty care, contributing to long wait times.

To improve care for people experiencing perimenopause or menopause, Ontario Health assembled an advisory committee consisting of clinical leaders and people with lived experience to develop the Menopause quality standard. Drawing from clinical guidelines and expert consensus, the quality standard includes 6 evidence-based opportunities to improve perimenopause and menopause care, including clinician knowledge and skills; identification and assessment of perimenopause and menopause; evidence-based information for people experiencing perimenopause or menopause; management of vasomotor symptoms; management of non-vasomotor symptoms; and appropriate referral to a clinician with expertise in menopause.

Below are some tools and resources that may help you implement the Menopause quality statements in your practice, organized by purpose. Many of these tools can be used to support multiple quality statements.

This list is not exhaustive, and these resources may have shortcomings. Are there other tools or resources you use? Do you have experience using these or other tools? If so, please share your thoughts in the comments section below.

Educational Resources for Clinicians

Mentoring/Community of Practice

• Menopause Quality Standard Community of Practice (CoP): An online community of practice for health care teams and clinicians to support the implementation of the Menopause quality standard. Members will share implementation challenges and strategies, resources, data, and problem-solve together to facilitate the uptake and implementation of the Menopause quality standard.
• OTN eConsult (Ontario Health): A secure, web-based tool that allows primary care clinicians to connect with menopause specialists for advice on patient care.
• Champlaine Consult BASE: A secure, web-based platform under the Ontario eConsult program that allows primary care clinicians in the Champlain region to connect with menopause specialists for advice on patient care.

Training/Courses

• Academic Detailing Service for Menopause: The Centre for Effective Practice’s academic detailing service for menopause delivers free, one-on-one, evidence-based education to Ontario-based primary care clinicians through personalized visits with a trained pharmacist detailer.
• International Menopause Society Professional Activity for Refresher Training (IMPART): Comprehensive online training for clinicians in managing acute menopausal symptoms and the long-term consequences of the changes that occur at menopause. Topics include the benefits and risks of menopausal hormone therapy; currently available options for menopausal hormone therapy; the efficacy and safety of complementary therapies for menopause; and guidance on midlife preventative health care, bone loss and osteoporosis, cardiovascular disease, gynecological cancers, and poor psychological well-being.
• Pause for Menopause: An Accredited Self-Assessment Program from the Society of Obstetricians and Gynaecologists of Canada to support clinicians in implementing the Society’s 2021 menopause guidelines.

Clinician Education Websites and Publications

• Menopause Hub: A comprehensive online resource for clinicians from the Society of Obstetricians and Gynaecologists of Canada and the Canadian Menopause Society. It addresses the menopause definition and stages, impact, symptoms, and diagnosis and management. It provides links to clinical practice guidelines, patient resources, publications and tools, and education and training.
• Pocket Guide Menopause Management: A Practical Tool for Healthcare Professionals: A concise PDF summary of current guidelines and evidence-based treatment options to help clinicians make quick decisions about managing menopausal symptoms; from the Canadian Menopause Society.
• The Menopause Society: Professional Resources: A source of up-to-date information for clinicians, including publications, position statements, slide decks on menopause and midlife women’s health, practice pearls, and more. Membership is required to access all resources.
• Menopause in Ethnic Minority Women: A 4-page resource from the British Menopause Society that details racial or ethnic differences in the menopause experience with the goal of delivering culturally appropriate care to increase quality of life for all women in midlife.
• Menopause and Indigenous Women in Canada: The State of Current Research: A publication by the National Collaborating Centre for Aboriginal Health that summarizes existing research on Indigenous women’s experience of menopause and suggests how research can be applied in practice when providing menopause care to Indigenous women.

Tools and Resources to Support Clinical Practice

• Menopause Management: A digital tool from the Centre for Effective Practice is designed to support primary care clinicians in effectively implementing tailored treatment plans for people across the menopause journey. The tool provides evidence-based guidance on assessment and the full range of treatment options, including information about specific population considerations and follow-up care.
• MQ6: An Approach to Menopause Management: A website for clinicians and people experiencing perimenopause that includes many useful resources for clinical practice, including the following:
  • The Menopause Quick 6 (MQ6) Menopause Assessment Tool: A 6-question assessment designed to help patients and clinicians discuss menopausal symptoms and determine the need for treatment. The assessment is available as a fillable PDF or for mobile devices and can be shared with patients in advance of their appointment.
  • Interactive Treatment Algorithm: A decision tool that allows clinicians to use a patient’s answers to the MQ6 as a starting point for developing a personalized menopausal treatment plan; also available as a digital tool.
  • Menopause Therapies: Detailed information about prescribing menopausal hormone therapy, understanding the associated risks, pharmacological and nonpharmacological treatment options, and medication tables.
  • Counselling Patients About Menopausal Hormone Therapy: A counselling script clinicians can follow when initiating menopausal hormone therapy for appropriately selected patients.
• HRT and the Likelihood of Some Medical Conditions: A Discussion Aid for Healthcare Professionals and Patients: A discussion aid from the National Institute for Health and Care Excellence (NICE) that outlines the impact of menopausal hormone therapy on the risk of developing breast, endometrial, or ovarian cancer; coronary heart disease; dementia; osteoporosis; or stroke.
• Ontario Ministry of Health Diagnostic Codes: Diagnostic code 627 “Other Disorders of Female Genital Tract: Menopause, postmenopausal bleed” may be used to bill for menopause-related care.

Tools and Resources to Support Women and Gender-Diverse People Experiencing Perimenopause or Menopause

Clinicians are encouraged to share the following resources with people experiencing perimenopause and menopause and support them in making informed decisions about their care.

Patient Self-Assessments and Symptom Trackers

• MQ6 Tool PDF for Women: People experiencing menopause-related symptoms can complete the 6-question assessment independently to support conversations with their clinicians and determine the need for treatment.
• MenoPause Symptom Tracker: A free, downloadable tool from the Menopause Foundation of Canada designed to help women record 35 menopause-related symptoms, which they can then share with their clinician for more informed conversations about care and treatment. Note: The tracker can be downloaded by signing up for the Menopause Foundation of Canada’s mailing list.

Patient Education Websites

• Menopause Hub: A patient education website from the Canadian Menopause Society in collaboration with the Society of Obstetricians and Gynaecologists of Canada. Includes a range of publications and videos on common menopause symptoms and treatments.
• Complete Guide to Menopause: A Canadian initiative by the Gynaecology Quality Improvement Collaboration that offers comprehensive information for patients on perimenopause and menopause.
• Menopause Education for Patients: A patient education website from the Menopause Society with information, videos, and podcasts on menopause and perimenopause topics.
• Menopause and U: A patient education website from the Society of Obstetricians and Gynaecologists of Canada that provides facts on perimenopause, menopause, therapies, and menopause-related health concerns.

Patient Handouts

• Patient Handout Project: Menopause: Succinct, visually appealing patient handouts from the Gynaecology Quality Improvement Collaboration that clinicians can email directly to patients. Some menopause-related topics include the following:
  • Vasomotor Symptoms of Menopause: A 2-page infographic summarizing the vasomotor symptoms of menopause, pharmacological and nonpharmacological treatment options, and contraindications to menopausal hormone therapy.
  • Genitourinary Syndrome of Menopause: A 3-page infographic outlining the genital, sexual, and urinary symptoms that are commonly experienced during perimenopause and menopause, as well as nonpharmacological treatment options and pharmacological treatments, including menopausal hormone therapy.
  • Menopause Hormone Therapy: A 3-page infographic outlining systemic and local menopausal hormone therapy options, indications, contraindications, types, and the risks of systemic therapy.
  • Systemic Menopause Hormonal Therapy Basics: A 2-page infographic explaining systemic options for menopausal hormone therapy, how the dosage and duration of treatment are determined, and the main risks associated with menopausal hormone therapy.
  • Local Hormone Therapy Basics: A 2-page infographic explaining local hormone therapy options available in Canada to treat genitourinary syndrome of menopause, including common side effects.
• Menopause Info is a patient information website from the International Menopause Society that offers fact sheets on menopause-related topics, including the following:
  • Menopause FAQ: A patient resource that answers frequently asked questions about menopause, such as its impact on mood, memory, and sex; the risk of breast cancer, heart attack, stroke, or blood clots associated with menopausal hormone therapy; the effectiveness of complementary therapies; and more.
  • 9 Myths and Misunderstandings About Menopausal Hormone Therapy: A patient resource discussing common misconceptions about menopausal hormone therapy related to breast cancer risk, weight gain, complementary therapies, compounded bioidentical hormone therapy, and more.
  • Vaginal Dryness: A patient resource on vaginal dryness, symptoms, treatments, and tips for talking with one’s doctor.
  • Vaginal Atrophy: A patient resource on vaginal atrophy, symptoms, treatments, and tips for talking with one’s doctor.
  • Incontinence: A patient resource that outlines different types of urinary incontinence, their causes, and management.
  • Sleep: A patient resource on menopause and insomnia, causes, treatment options, and tips for improving sleep long-term.
  • Sex: A patient resource on the impact of menopause on sex, including treatment options.
  • Hair Loss: A patient resource on menopausal hair loss, causes, and strategies that may slow or reverse hair loss for some people.
  • Bioidentical Hormone Therapy: A patient resource addressing myths about compounded bioidentical hormone therapy.
• MenoNotes: A webpage by the Menopause Society with free information sheets written by experts on menopause-related topics, including the following:
  • Midlife Weight Gain: A 2-page information sheet on the causes, health risks, and management of midlife weight gain.
  • Menopause and Depression: A 2-page information sheet on the connection between menopause and depressive symptoms, and on recognizing and treating depression.
  • Menopause and the Workplace: A 2-page information sheet on menopause symptoms that may affect work productivity, and what employers and people experiencing menopause symptoms can do to improve their menopause experience in the workplace.
  • Nonhormone Treatments for Hot Flashes and Night Sweats: A 2-page information sheet that outlines non-hormone treatments for hot flashes and night sweats, such as clinical hypnosis, cognitive-behavioural therapy, and non-hormone medications.

Patient Handouts for Specific Populations

• Power in the Pause: A webpage from the Black Women’s Health Imperative with resources on perimenopause and menopause to address myths and advance the health of Black women.
• Menopause Fact Sheet: A 4-page patient fact sheet by the Native Women’s Association of Canada that explains what perimenopause and menopause are, describes their symptoms and treatments, and compares Western social and cultural constructs with Indigenous views of menopause.
• Autism and Menopause: A 3-page patient handout by the UK National Autistic Society that provides an overview of menopause, how menopause may impact people with autism, tips on making menopause easier, and treatment options.
• MenoPoz & You: A Guide for Women Living With HIV: A resource from the Canadian AIDS Treatment Information Exchange for people with HIV that provides information on menopause, treatment options, symptom tracking, and differentiating menopause symptoms from HIV symptoms.