We have spent generations treating the ovary as a reproductive organ. We have removed it to treat women’s distress, excluded women from research because they might become pregnant and argued over who should control their reproductive choices. We have been, however, much slower to organize health care around what ovarian hormones do throughout women’s lives.
That history matters when we consider what is happening in Alberta and across the country, as rising demand has driven the growth of specialized private and virtual clinics for comprehensive perimenopause and menopause care. Women seeking help through the reproductive transition can now find private clinics offering the time, attention and expertise they have struggled to obtain elsewhere. It may look like progress. But if access depends on paying for an appointment, we have created another barrier for women who cannot afford one.
As a nurse, epidemiologist and women’s cardiovascular health researcher, I believe we need to ask a more basic question: Why is care for a predictable transition affecting roughly half the population still so difficult to obtain within our public system?
Part of the answer lies in how we got here.
In the 19th century, physicians performed Battey’s operation, removing ovaries to treat conditions labelled hysteria. A historical review identified 94 published cases involving neuropsychiatric symptoms. The authors suggest that a few may have involved ovarian tumors associated with encephalitis, potentially explaining some apparent successes. Those possibilities do not justify the broader assumption that removing reproductive organs was an appropriate response to poorly understood distress.
The ovary was important enough to blame. Understanding the woman living with it was another matter.
Under the Nazi regime, reproductive control became an instrument of persecution. At Auschwitz, radiation experiments targeted prisoners’ reproductive organs, including women’s ovaries. Carl Clauberg used chemical irritants to obstruct women’s fallopian tubes. These crimes belong to a profoundly different historical context from today’s failures of care but they remain part of the history of institutions claiming authority over reproduction while denying the people affected any meaningful autonomy.
Control also took a quieter form in modern science. In 1977, the U.S. Food and Drug Administration recommended excluding women of childbearing potential from Phase I and early Phase II drug trials, largely out of concern about fetal harm. The policy left a lasting gap in knowledge about how drugs affected women themselves. Women’s biology became a reason to exclude them from research, even though that biology was precisely what needed to be studied.
In 1993, the U.S. National Institutes of Health’s (NIH) Revitalization Act made women’s inclusion in NIH-funded clinical research a legal requirement. Yet more than three decades later, women still account for only about 25–30 per cent of participants in many areas of cardiovascular research. Requiring inclusion has not ensured adequate representation in the evidence guiding women’s care, and Canadian health care draws on that same international evidence base.
These gaps have consequences for women’s ability to make informed decisions about their bodies. Women have fought for the right to make decisions about their bodies, but exercising that right requires reliable knowledge about their health and access to services that respond to their needs. Autonomy depends on care informed by women’s biology and lived experiences, and on publicly funded services that enable them to act on their choices. The right to decide must be accompanied by the knowledge and care that make those decisions possible.
Ovaries produce hormones that act well beyond the reproductive tract. Estrogen helps regulate vascular, neurologic, kidney and bone function. Across the late reproductive stage that starts in a woman’s late 30s and the menopausal transition. Changing ovarian function is relevant to health long before a woman reaches her final menstrual period.
The American Heart Association’s scientific statement on the menopausal transition describes changes in cholesterol, body composition and vascular health that cannot be explained by chronological aging alone. This offers an opportunity for prevention: a time to connect menstrual history, reproductive history and symptoms with cardiovascular risk assessment and follow-up.
Recognizing women’s distinct biology does not mean attributing every symptom to hormones. Blood pressure, diabetes, smoking, sleep, caregiving demands and access to care also matter. Instead, it means that the reproductive stage belongs in the assessment alongside those other influences.
Nor does understanding estrogen’s role establish that prescribing it will prevent heart attacks. The 2022 hormone therapy position statement supports individualized treatment for appropriate indications, including vascular symptoms (hot flashes and night sweats) and prevention of bone loss, while stating that hormone therapy is not approved for primary or secondary cardio protection. Women deserve a clear discussion of benefits, risks and alternatives. Cardiovascular prevention must also be available to women who do not need, want or qualify for hormone therapy.
Canada has already acknowledged the larger problem. The House of Commons report Women’s Health in Canada describes a health and research system that has traditionally treated the male body as the default. Witnesses also described the tendency to reduce women’s health to maternal health. That leaves care through the reproductive transition too easily treated as an additional interest rather than a core responsibility.
Private menopause clinics are emerging within that gap. The Menopause Foundation of Canada has published guidance for navigating the growing number of virtual and private clinics. In Alberta, publicly posted fees show what access can cost: A clinic in Calgary advertises consultations at $440 an hour; in Edmonton, a clinic lists a nurse practitioner hormone-health consultation at $374 for 30 minutes, with a separate preliminary consultation fee.
These services may offer valuable care, and women cannot be faulted for paying when they need help. Clinicians working in these settings may be responding to the same gaps that concern me. The policy question is whether the ability to pay should determine who gets that time and expertise.
Women’s health is public health. Its consequences extend into families, workplaces and communities. Treating reproductive transition care as an individual purchase leaves women to solve a population-wide health need through their own resources.
There are other choices. In April, Manitoba announced a $5.2-million investment in a menopause clinic, with an interdisciplinary model and access to specialties including cardiology and sleep medicine. Its planned opening in fall 2027 will not resolve today’s needs, but the commitment recognizes a public responsibility to organize this care.
In Alberta, our Cycles to Cessation (C2C) clinic, supported by an Alberta Health Innovations and Primary Care Grant, was built around that same public responsibility. Nurse practitioners provide virtual menopausal transition assessment, education and treatment planning without requiring women to have a family physician. Uptake has demonstrated substantial demand: in its first seven months, a single full-time-equivalent nurse practitioner served more than 500 patients across more than 1,200 appointments. Early patient-reported outcomes are encouraging: 95 per cent reported confidence in their care plan, and 80 per cent reported meaningful symptom improvement within eight weeks. These preliminary findings warrant continued evaluation, but they demonstrate that women are seeking and engaging with publicly funded care. Although virtual care cannot meet every need, C2C offers a practical way to expand access without asking women to pay for the consultation.
Publicly funded teams need the time to take a full history, assess symptoms and follow treatment over time. Medical and nursing education should prepare clinicians to connect reproductive aging with cardiovascular and broader health. Research MUST identify the reproductive stage rather than assuming women of the same age are biologically interchangeable. These are practical changes governments, educators and funders can make.
For generations, institutions have exercised authority over women’s reproductive biology while leaving women without adequate explanations of their own health. We should not repeat that imbalance by finally offering answers primarily to those who can purchase them.
The ovary’s importance does not end with fertility. A woman’s access to care should not depend on her credit card.
