Status of Women Committee on June 16th, 2026

[Sylvie Demers]

It's actually very simple. We find the cause, and then we treat it.

Let us take the example of men who are treated for andropause. I'll just illustrate the kind of disparity that exists. Men will often have a decrease in testosterone levels, around two or three times lower, and that's when they will be treated. It's an indication for treatment. There's no time limit. They can start at any age, and they can continue treatment for the rest of their lives. It's their decision. They will be given a dosage of bioidentical hormones.

When it comes to women, it becomes very complicated. There's a discussion, and then there's another discussion to determine whether it's appropriate to treat them. For women, though, their hormonal levels don't decrease by two or three times; it's in the order of 20 times lower. That means that the consequences are much more severe for women than for men. In the same way as with men, women can receive their own hormones, bioidentical hormones, which can be measured out. It's very simple. It's just too simple. That's what needs to be understood.

I'm pleased, because in 2025, the United Kingdom had a great study based on the same approach, with very few differences. It's something I was unfamiliar with. I think it was a group of frontline physicians who published an article in Menopause about this. They arrived at results similar to mine. They came to just about the same conclusions. We know that when it comes to validity in science, everything starts with observation. The results have to be replicable. I have been providing training for a long time. I have trained hundreds of doctors and hundreds of nurse practitioners. It can be seen. It's easy to treat.

When it comes to transgender women, the recommendations we have received are straightforward. Transgender women are still prescribed 17ß‑estradiol. This has been done for a long time. Conjugated estrogens would never be prescribed. According to the protocol currently in place in Toronto, all transgender women over 40 years old are told that they're going to get estradiol through transdermal patches, because it's safer. Here, there's still a dispute.

In addition, if there are cardiovascular risk factors in a woman under 40 years old, she is given transdermal doses. The dosage will be determined. The dosage will be determined in transgender women. The dosage will be determined in transgender men. The dosage will be determined in men, but when it comes to women, all of a sudden, it becomes very complicated. Why?

[Juanita Nathan, Liberal, Pickering—Brooklin, ON]

Thank you.

You teach other physicians right now, and as a woman, you would have the perspectives to offer to them when you're teaching.

[Sylvie Demers]

I can offer them a lot of perspectives.

[Juanita Nathan, Liberal, Pickering—Brooklin, ON]

Normally, when physicians go through school, is this taught to all of them?

[Sylvie Demers]

No.

[Juanita Nathan, Liberal, Pickering—Brooklin, ON]

A lot of men are physicians, like my doctor. I know some of my colleagues inquired about this. Is it taught at all, or is it just a one-day lecture and they move on? How do they manage to teach this?

[Sylvie Demers]

In July 2002, the Women's Health Initiative study was published. I remember it all. I was in my office, and I had been prescribing transdermal 17ß‑estradiol and progesterone for a year already, based on the evidence. Many researchers found that women were not being prescribed the right type of hormone therapy. This is nothing new. It was even found to be safer.

When that study came in, everything really stopped overnight. All of a sudden, fear took hold. There was no more progress. It was a loss of collective memory. Really, what we knew, we no longer knew. That's what happened, and we're starting to, once again—

[The Chair, Conservative, Dominique Vien]

Thank you, Dr. Demers.

You'll probably have a chance to say a bit more about that study later.

Mrs. Roberts, you have the floor for five minutes.

[Anna Roberts, Conservative, King—Vaughan, ON]

Thank you.

[The Chair, Conservative, Dominique Vien]

Pardon me, Mrs. Roberts, it isn't your turn. I'm sorry.

Ms. Larouche, you have the floor for two and a half minutes. How could I forget you?

[Andréanne Larouche, Bloc, Shefford, QC]

That's fine, Madam Chair.

Thank you again, ladies, for being here today.

Dr. Demers, you mentioned a study conducted in the United Kingdom.

Are there other studies elsewhere?

Are there other places in the world that we could keep in mind, other studies that could inspire us here?

[Sylvie Demers]

There are many studies on bioidentical hormones.

I'm a pioneer in the serum dosage of estradiol and progesterone. I have been doing that since January 2005. I was my own teacher. There was nothing on the subject. It was always said that measuring female hormones was pointless. I went to read the literature, I checked the journals, and there was nothing on it.

There was a lot of small-scale research, though. For example, in cardiology, it was observed that when middle-aged women had a certain dosage in perimenopause, they began to suffer from hypoestrogenism and osteoporosis.

There have been small studies on high blood pressure, depression and so on. There have also been many studies on osteoporosis, particularly about protective factors. With all of that put together, many doctors around the world are now adjusting doses for hormone therapy.

The study I was talking about was a major study published in the United Kingdom that came to more or less the same conclusions as mine.

[Andréanne Larouche, Bloc, Shefford, QC]

We have talked a lot about health.

I have just over a minute left, so I'll be quick.

This question is for both witnesses, because you both touched on the issue of economic consequences in the workplace. I'd like to come back to that. Please answer in 30 seconds each.

What measures could we suggest?

Should we add anything specific, such as employment insurance reform?

Should we make sure that women have support, training in the workplace?

What do we need to do to limit the economic impact?

Dr. O'Hearn, you can start.

[Shawna O'Hearn]

That's an important question. I would say that definitely workplace education is critical as a starting point, and the evidence shows—

[The Chair, Conservative, Dominique Vien]

I'm sorry to interrupt you, Dr. O'Hearn.

There's no interpretation.

It has been fixed, you may continue, Dr. O'Hearn.

[Shawna O'Hearn]

Workplace education is critical, as are the support groups that I talked about within the workplace.

Australia and the U.K. are two places to look at where really great work has been happening in research on the labour force impact of menopause. I will send some of those studies to you. They are quite advanced in thinking about the conversation around menopause in the workplace, through legislation as well as through specific programming.

[The Chair, Conservative, Dominique Vien]

Thank you very much, Dr. O'Hearn.

Mrs. Roberts, you have the floor.

[Anna Roberts, Conservative, King—Vaughan, ON]

Thank you, Madam Chair.

I know there are a lot of symptoms with menopause: hot flashes, night sweats, cold flashes and insomnia. There is also brain fog, weight gain, joint and muscle pain and thinning of the hair. Would this hormone treatment help prevent some of those ailments?

[Sylvie Demers]

In fact, even though I advocate for hormone therapy, it isn't a magic solution. There are still symptoms that I think are due to other factors. I'm speculating. However, for many women, it will indeed prevent many issues.

We also have to talk about joint pain and muscle pain. It's now official. There's a musculoskeletal syndrome linked to perimenopause and menopause. There have been studies on this. We know that it happens long before menopause. We're currently talking about perimenopause, but we actually should also be talking about premenopause. I see it when women are still having regular menstrual cycles. Typically, the musculoskeletal symptoms include shoulder tendonitis.

There can be preventive aspects related to hormone therapy, then. It isn't perfect, because there are still alterations and changes that will remain. However, if we recognize that and, from the start, work with what I think the data shows to be the best type of hormone therapy we can prescribe to women, while tailoring the dose to each individual, we can try to improve everything.

Yes, there are preventive aspects for women who start treatment early. The earlier they start, the more preventive it is.

[Anna Roberts, Conservative, King—Vaughan, ON]

If a woman has to have a hysterectomy because of endometriosis and other issues, would that trigger early menopause?

[Sylvie Demers]

This issue has been debated among obstetricians and gynaecologists for years, and they're now saying that it does tend to precipitate menopause by a few years. However, it's definitely still on a case-by-case basis. Take female smokers, for example.

To answer your question, it could indeed lead to early menopause, because there's slightly less vascularization in the ovaries once the uterus has been removed. However, once again, that's on a case-by-case basis.

[Anna Roberts, Conservative, King—Vaughan, ON]

We talked about muscle pains, and I kind of laugh about this because I was an athlete my whole life and played in joint men-women sports because I was a little aggressive with my sports. My son said to me the other day, “Well, you know, women aren't as strong as men, and as you get older you just don't have the same strength.” Well, believe it or not, I proved him wrong. I got him to get the glove. We went out, played baseball and came in with a red hand. Wow, so I didn't lose that muscle. Did I slow down? Yes. Did I lose the strength? Not as much. Was I a little weaker? Probably.

If those hormone medications had been offered to me, would they have helped?

[Sylvie Demers]

Yes, that could have helped you. A healthy lifestyle is definitely important. I always say that the basis of preventive medicine is a good hormonal balance and good lifestyle habits. Taking hormones certainly isn't a magic solution. When we were younger, we had all our hormones, and we could still have health problems. We could feel tired. It's certain that adopting good lifestyle habits continues to be important throughout our lives.

Indeed, it's also a matter of quality. We now know that estrogens and progesterone—we aren't talking about testosterone here—play a role in all musculoskeletal structures, be they bones, muscles, joints or tendons. They play a role throughout the organism, in fact.

[Anna Roberts, Conservative, King—Vaughan, ON]

Is it important as well that a doctor, male or female, understands the importance of the drug? Sometimes I hear comments like, “Oh, she's going through menopause”, “Oh, she's moody because of menopause”. I don't necessarily believe that is the case. I think there are other aspects in life to cause those feelings. Do we need to educate more doctors, especially family doctors, to understand the benefits of the medication? I've never heard the positive side of it, I'll be quite honest. This is good news for me to hear. Would it be beneficial to educate the doctors when they're going through medical school?

[Sylvie Demers]

I would say that this is being done in Quebec. More and more doctors are being trained, and I personally train doctors every month. There's a real movement in that direction. These doctors and nurse practitioners also provide training. There really is a movement taking hold.

I would say that there's a revolution under way in Quebec, and that's probably also true in the United Kingdom. It's happening right now. There's a reason you're conducting a study. Women are expressing dissatisfaction that they didn't express before.