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Dr. Omolayo Famuyide at her Winnipeg clinic on Sept. 25. Manitoba was the first province to create a billing code to compensate doctors specifically for menopause visits.Shannon VanRaes/The Globe and Mail
Family physicians in Nova Scotia who have recognized expertise in women’s health can now apply a dedicated code for compensation when they offer reproductive and sexual health services, including perimenopause care.
After Manitoba, Nova Scotia is the second province in the country to create a distinct billing code for specialized women’s health services, a change some health experts say is necessary to recognize the added time and expertise required to support patients navigating hormonal transitions.
Doctors do not require a certificate of added competence in family medicine to bill the code.
“Previously it wasn’t feasible, I think, financially to do the care, which is a huge problem in and of itself,” said Sarah Fraser, a family doctor based in Halifax. “Now it’s actually possible, and I think it’s encouraging.”
Doctors across Canada have traditionally used general assessment and consultation codes for perimenopause and menopause care, rather than a specific billing code.
But advocates say dedicated codes recognize that this kind of care often requires longer appointments to allow doctors to review patient history, address a wide range of symptoms and discuss a treatment plan.
“When we have a billing code, it allows us as physicians to be appropriately compensated but, more importantly, to be able to give women the time to ask their questions, and for us to be able to provide enough time to make them feel validated and heard,” said Shafeena Premji, a Calgary-based menopause specialist and medical advisory board member of the Menopause Foundation of Canada.
In Alberta, more than 300 physicians and menopause practitioners signed a petition last December calling for a menopause-specific billing code under the province’s public insurance plan. The petition described the absence of the code as a “major barrier” preventing equitable care access.
“This is a dire issue,” Dr. Premji said. “The sooner we do it, the sooner we’re going to be able to support half of our population.”
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Women typically reach perimenopause and menopause in their 40s and 50s. While these hormonal changes are considered a natural part of the aging process, some women struggle with debilitating symptoms – including hot flashes, mood disturbances and trouble sleeping – and face barriers when trying to obtain care.
The new code in Nova Scotia took effect in July. Previously, family physicians could apply a consult code for providing menopause care, but many felt the fee was not clearly defined, creating confusion about when it could be used.
In October 2023, Manitoba became the first Canadian jurisdiction to create a billing code to compensate doctors specifically for menopause visits. Since then, Doctors Manitoba says, tens of thousands of such appointments have been covered.
Physicians in Manitoba can claim $93.66 for each assessment and additional tests; follow-up care is also covered.
Doctors Manitoba says this coverage stands in contrast with the hundreds of dollars patients are often charged for assessments when they turn to health care providers outside the public system.
Omolayo Famuyide, a certified menopause practitioner who founded the Layo Clinic in Winnipeg, which offers women’s reproductive health care, described Manitoba’s menopause billing code as “groundbreaking,” saying it’s been beneficial for both doctors and patients.
Manitoba is also one of only two Canadian provinces, along with British Columbia, that publicly fund menopause hormone therapy.
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In Ontario, Sheila Wijayasinghe is among the family physicians who support creating a dedicated code.
“We can do comprehensive care in the public system. It’s just that we are often stretched for time,” said Dr. Wijayasinghe, who practices in Toronto.
“If you give us a designated code that allows us and acknowledges that it takes extra time, this could be very helpful.”
This sentiment was echoed by Aimee Debow, a Toronto-based menopause coach whose company, Menovate, works with corporations supporting employees through menopause.
She believes a dedicated menopause billing code could have been “life-changing” and spared her several years of suffering.
In her early 40s, she experienced perimenopause symptoms, including sleep challenges and brain fog, but felt dismissed by doctors. After countless medical appointments, she turned to the private system, which she knows many women cannot afford.
“It’s not just a code. It’s a code that actually gives the doctor enough time to help the person,” Ms. Debow said.