A 228 per cent surge in hormone replacement therapy claims signals shifting attitudes towards menopause treatment, says Manulife’s Jennifer Foubert
Hormone replacement therapy (HRT) prescriptions among women aged 45 to 54 have surged 228 per cent since 2021, according to recent aggregate claims data from Manulife Canada's group benefits business.
Jennifer Foubert, head of product and growth of group benefits at Manulife Canada, believes this figure underscores both the scale of unmet need and the pressure mounting on plan sponsors to rethink how they support employees through menopause. She attributes the acceleration to several converging factors.
"There's a lot of misinformation historically around HRT. And a lot of that has improved in terms of our understanding and dispelling some of the concerns around access to HRT," Foubert said. “Menopause is being discussed more openly than ever before and really helping to reduce stigma and encouraging more women to seek care. We're certainly seeing a significant increase in claims over the past five years, which to us is suggesting that women are seeking treatment and support for menopause symptoms.”
Women are using HRT earlier
Foubert further outlined Manulife's analysis of its group benefits claims data that tracked HRT prescriptions, segmented by age band, among women aged 35 to 64 over a five-year period. The results showed an 80 per cent increase in the number of women using HRT across that cohort, with total prescriptions rising 113 per cent.
The steepest growth appeared among women aged 45 to 55, which Foubert noted as the period most closely associated with perimenopause, but the trend extended to younger members as well. Among women aged 35 to 44, hormone therapy users rose 33 per cent and prescriptions climbed 47 per cent.
"Women are educating themselves. They are becoming more empowered in understanding options that are available to them and proactively moving towards those solutions," she said, of the findings.
Foubert explained the distinction between menopause as a life stage and HRT as one treatment pathway within it. Perimenopause - the years of hormonal fluctuation leading to menopause - can bring a range of symptoms while hormone therapy, which is typically delivered through estrogen or progesterone, is an optional intervention designed to manage them.
According to Foubert, HRT isn’t just symptom relief but it can also act as preventative medicine. Beyond alleviating the discomforts of perimenopause and menopause, it can also reduce broader health risks including bone density loss, cardiovascular complications, sleep disruption, mood changes and cognitive function. She positions it as one option among several available to plan members rather than a default course of action.
“People are receiving more coordinated support earlier to help them rather than having these isolated interventions. A member may choose to access HRT, which will help them in addressing other health risks as well as managing symptoms,” said Foubert. “This earlier intervention is certainly going to benefit individuals, sponsor organizations, and the Canadian economy as a whole by helping to improve retention and career longevity.”
Why HRT coverage in the workplace matters
The coverage gap is as much a workplace issue as a health one, Foubert argues, given that menopause strikes during women's peak earning and career-building years. Symptoms ranging from poor sleep and fatigue to anxiety and difficulty concentrating erode day-to-day productivity and when left unmanaged, push women out of the labour force entirely. She points to the Menopause Foundation of Canada's estimate in its 2023 Menopause and Work in Canada report that unmanaged symptoms cost the Canadian economy $3.5 billion a year, which contributes to 10 per cent of women leaving the workforce due to menopausal symptoms, Foubert noted.
“This is why it's really important for employers to increasingly look at ways to better support employees through this stage of life,” she said. “Employers can certainly help by providing access to comprehensive health benefit plans, mental health resources, menopause-specific support, and care navigation. It's just as important as fostering a workplace culture where employees feel comfortable in accessing support when and where they need it.”
ROI signals retention and engagement
Foubert argues the return on investment for plan sponsors sits in retention, engagement and productivity rather than direct drug cost savings. She points to employee surveys and ERG groups as the most reliable sources of insight into what members need and whether existing programmes are meeting those needs across a diverse workforce.
“I would really encourage plan sponsors to take a look at their current plan design and to leverage surveys and insights and to really think about their plan as a continuous evolving document and strategy. In many instances, sponsors have robust plans that could use a bit of refresh through some guidance and support.”
