HRT claims among Canadian working women surge 228% in five years: what's driving the shift?

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

What happened

Hormone replacement therapy (HRT) claims filed by Canadian women aged 45 to 54 through Manulife group benefits plans rose 228% over five years, according to data the insurer published on September 2, 2026. The increase was not confined to one age group: claims among women aged 35 to 44 climbed 46%, and those among women aged 55 to 64 rose 66%. Manulife noted the sharpest acceleration happened in the most recent two years of the five-year window.

For a hormone-care patient in Canada, this signals a concrete shift in how the country's employer-sponsored drug plans are being used. If you have group benefits through work, HRT is increasingly likely to be a covered line item, though coverage terms vary by plan and province. Women without employer coverage face a patchwork of provincial pharmacare options, and out-of-pocket costs for common formulations can range from roughly $30 to $120 CAD per month depending on the product and the dispensing province.

What this means in Canada

HRT is a treatment that replaces hormones, primarily estrogen and progesterone, that the ovaries produce less of as women approach and pass menopause. Formulations approved by Health Canada include estrogen-only products and combined estrogen-progestogen products, available as oral tablets, transdermal patches, gels, and vaginal preparations. Common Canadian brand names include estradiol (sold as Estrace in oral form and Estradot as a patch), and conjugated estrogens (Premarin). Combined products include norethindrone acetate with estradiol (Activelle) and medroxyprogesterone acetate with conjugated estrogens (Premplus).

Health Canada has approved these products for the management of moderate to severe vasomotor symptoms (hot flashes, night sweats) and vulvovaginal atrophy associated with menopause, and for the prevention of postmenopausal osteoporosis in select patients. Health Canada has not issued a new overarching menopause guidance document in recent years, though its product monographs for individual HRT drugs are updated periodically.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) published a menopause guideline in 2021 that took a more permissive stance than earlier iterations, stating that for healthy women under 60 or within 10 years of menopause onset, the benefits of HRT generally outweigh the risks for symptom management. The SOGC has not yet issued a position statement specifically addressing the Manulife claims data or the broader workplace-menopause policy question.

On provincial pharmacare, coverage is uneven. Ontario's OHIP drug benefit (ODB) covers some HRT formulations for seniors and social assistance recipients, but not for most working-age women. British Columbia's PharmaCare covers select estrogen products under its regular benefits plan with a deductible. Quebec's RAMQ lists several HRT drugs on its formulaire, including oral estradiol and certain patches. Alberta's AHCIP does not include a general outpatient drug benefit for working-age adults, so most Albertans rely on employer plans or pay out of pocket. Prince Edward Island and the Atlantic provinces have limited public coverage for this age group outside of social assistance programs. Canada's national pharmacare framework, still being phased in as of 2026, has not yet designated HRT as a priority drug class.

For Canadians without employer benefits, virtual menopause care is available through platforms including Cleo (a Canadian women's-health platform), Felix (a Canadian telehealth service), Maple (a Canadian virtual care provider), and Science & Humans (scienceandhumans.com), a Canadian platform that offers hormone therapy assessment and prescribing. US-based platforms such as Midi Health, Hone Health, and Winona do not serve Canadian patients and cannot prescribe under Canadian law.

Why this matters

The 228% figure is large, but it comes from a single insurer's claims database, not a population-level registry. Manulife is Canada's largest group benefits insurer, so the data cover a substantial slice of employed Canadians, but they capture only people with Manulife group plans who filed a drug claim. Women who pay out of pocket, use provincial pharmacare, or see a naturopath for compounded hormones are not counted.

The clinical backdrop matters here. For roughly two decades after the 2002 Women's Health Initiative (WHI) trial published results linking combined HRT to elevated breast cancer and cardiovascular risk, prescribing rates dropped sharply across North America. Subsequent re-analysis of that data, including work published in journals such as Menopause (the journal of the Menopause Society, formerly the North American Menopause Society), showed the original trial enrolled older women, many of whom were more than 10 years past menopause, and that the risk profile for younger, recently menopausal women was materially different. The Menopause Society's 2022 position statement concluded that HRT is appropriate for most healthy women under 60 who have bothersome symptoms and no contraindications.

Dr. Farzana Haq, physician lead of Women's Health at Cleveland Clinic Canada (which acts as medical director for Manulife Canada's Group Benefits business), said in the Manulife release that the evidence base supporting HRT's safety and effectiveness for many menopausal women is now considerably stronger than it was when caution dominated clinical practice.

Workplace awareness is also a factor. Several large Canadian employers have added menopause support to their benefits packages in the past three years, including dedicated nurse practitioner consultations and expanded drug formularies. That structural change makes it easier for women to seek and fill prescriptions without navigating a GP waitlist.

What Canadian patients should know

Menopause is the point 12 months after a woman's final menstrual period, typically between ages 45 and 55. Perimenopause is the multi-year transition before menopause when hormone levels fluctuate unpredictably and symptoms including hot flashes, sleep disruption, mood changes, irregular periods, and vaginal dryness can begin. HRT can address many of these symptoms, but it is not appropriate for everyone. Women with a personal history of estrogen-receptor-positive breast cancer, active cardiovascular disease, unexplained vaginal bleeding, or active liver disease are generally not candidates.

If you have employer group benefits, check your plan's drug formulaire or call your benefits administrator to confirm which HRT products are listed. Transdermal estradiol patches and gels are often preferred by clinicians for women with cardiovascular risk factors because they bypass first-pass liver metabolism, but coverage varies by plan.

If you do not have employer coverage, ask your family doctor or gynecologist whether a provincial pharmacare plan covers your prescribed formulation. In provinces with limited public coverage, some generic oral estradiol products cost under $40 CAD per month at pharmacy.

Virtual care options have shortened wait times for many women. Canadian platforms including Cleo, Felix, Maple, and Science & Humans can connect patients with physicians or nurse practitioners who can assess suitability and prescribe Health Canada-approved HRT products, typically within days rather than the weeks or months that GP referral to a gynecologist can take in many provinces.

Limitations and open questions

The Manulife data are claims data, not clinical outcomes data. A rise in claims tells us more women are filling HRT prescriptions through employer plans; it does not tell us whether those prescriptions are clinically appropriate, whether women are staying on therapy, or whether symptom control is improving.

The data also cannot distinguish between women who are newly starting HRT and those who switched from out-of-pocket payment to employer-plan coverage as formularies expanded. Some portion of the 228% increase may reflect a billing shift rather than a true increase in the number of women using HRT.

Health Canada has not issued updated population-level guidance on HRT prescribing since the post-WHI period, and the SOGC's 2021 guideline, while more permissive than earlier versions, predates the current surge in prescribing. Whether Canadian regulators will respond with updated labelling, new safety communications, or revised clinical guidance is not yet known.

Long-term safety data for transdermal formulations in younger perimenopausal women remain thinner than for oral combined HRT, and the optimal duration of therapy is still debated in the clinical literature. The Canadian Cancer Society notes that combined estrogen-progestogen HRT is associated with a small increase in breast cancer risk with longer-term use, a consideration that should be part of any shared decision-making conversation with a clinician.