After years of ignoring them, Quebec is facilitating access to two bio-identical hormones. This resounding victory, the women owe it in large part to the pugnacity of Véronique Cloutier. Rising to the front in order to understand the upheavals that have beset her since menopause came into her life, the facilitator has rallied an army of 260,000 women sharing the same arid countryside. The Minister of Health, Christian Dubé, gave up the day of the broadcast of the last part of his documentary series Loto-Meno. A symbol that nonetheless leaves one wondering: is this really how we want women’s health to advance, with documentaries, petitions and stardom?
Let’s not forget that before Vero’s victory, there was Julie’s. It was in 2010. Host and producer Julie Snyder had moved all of Quebec with her fight for universal access, for all infertile couples, to in vitro fertilization. Of course, Quebec is not standing apart in resorting to spectacle health to burst a ripe abscess. The most eloquent example remains that of breast cancer, which has gone from poor relation to ultra-privileged thanks to unprecedented mobilization and a pink ribbon which has become a school in various parts of the globe.
The path to awareness turns out to be more tortuous for perimenopause and menopause, taboo periods that mark the end of ovulation and menstruation at the cost of a variety of symptoms that are sometimes benign, sometimes disabling. How many cries for help were lost, how many holy angers were swept away before the dike gave way here under the impulse of an extraordinary televisual showdown?
In the UK these days, access to hormone therapy is generating heated debates just like ours. There, some menopause warriors want to make “the silence surrounding menopause” “a cacophony”. Their muse is Lorraine Kelly, one of the most popular presenters on the British small screen. Their Véronique Cloutier is called Davina McCall. His documentary Sex, Myths and the Menopause created a huge shock in British homes. As big as Loto-Meno in Quebec salons. And like here, the political and medical establishment is shaking.
We wish our British colleagues a victory as decisive as that of Mrs.me Cloutier. Because yes, access to estradiol-17B in the form of a topical gel and to micronized progesterone is a major advance, warmly welcomed by the Association of Obstetricians and Gynecologists of Quebec. It puts an end to two decades of misery for those who would have benefited from these treatments, which almost disappeared from practices after the publication of a major misinterpreted study in 2002. Result: in 20 years, the number of Quebec women who take hormones has dropped by 45%, while the number of women of child-bearing age increased by 43%, calculated Investigation.
Last March, Radio-Canada’s flagship program went back on the beaten track Loto-Meno over a journalistic investigation that led to the same conclusions. Not only is female hormone therapy largely under-prescribed in Quebec, but all the care surrounding these upheavals is deficient. Minister Dubé took note of this. It has mandated the National Institute of Excellence in Health and Social Services to produce a guide promoting better management of menopause by health professionals. Very good.
There remains the elephant in the room: the treatment reserved for menopause is only the visible part of a poorly documented problem that affects several spheres of women’s physical and psychological health. This is true in practices and hospitals, where women’s ailments are more likely to be minimized. This is also true in clinical studies, where they are beginning to be more present again, after having been driven out for years because of the thalidomide scandal, even though science knew very well that the two sexes metabolize certain drugs differently.
Diagnostic methods are also sometimes to their disadvantage. For example, certain coronary diseases present such different clinical portraits in men and women that the latter more often escaped the radar. The reason is simple: many doctors had been trained to recognize the warning signs only in the first. Things tend to change, but the delay in this area has not yet been made up. And while the majority of studies now focus on women, few make comparisons between the sexes.
And it is not the robustness of our public system that shields Canada from these inequalities. According to a study conducted by Hologic, the country ranked 43e out of 116 countries and territories in terms of women’s health in 2020. For example, the southern neighbour, though far from posing as a paragon of virtue, arrives at an enviable 26e rank. As long as we do not make this issue a public health priority assumed as such, with targeted and universal action strategies, we cannot, alas, aspire to better. Unless a star decides to carry this torch…