Gaps in Menopause Education - Presentation -

1. Gaps in Menopause Education- Presentation - - May 2007 -

2. Agenda • Methodology Detailed Results • Impact on Quality of Life • Symptoms • Women & Physicians • Knowledge and Discussions • Treatments and Therapies • Communication and Education • Information on Menopause • Women’s Attitudes on Age, Health and Menopause Use header or footer to name study. Example: Ad Campaign Post-Test Use header or footer to name study. Example: Ad Campaign Post-Test

3. Methodology Women • A total of 2,049 Canadian women aged 41 and older who have never had breast cancer or a hysterectomy, answered an online survey between January 18, 2007 and February 2, 2007 • Data was weighted according to age within region for women over the age of 41. Results from a sample of this size can be considered accurate to within 2.16%, 19 times out of 20 Physicians • A total of 125 general practitioners who have at least 50 per cent female patients and have either an equal number of patients over and under the age of 35, or a majority over the age of 35, answered a telephone survey between January 20, 2007 and February 1, 2007 • Data was weighted to reflect the natural gender composition of Canadian general practitioners, which is approximately 67% male and 33% female. Results from a sample of this size can be considered accurate to 8.8%, 19 times out of 20 Use header or footer to name study. Example: Ad Campaign Post-Test Use header or footer to name study. Example: Ad Campaign Post-Test

4. Impact on Quality of Life

5. 1 in 4 Menopausal Women Say the Symptoms of Menopause Have Had an Impact on Their Everyday Life • Over 6 in 10 menopausal women say they have experienced at least the same or more sleepless nights due to menopause as they did with pregnancy, work stress , or relationship problems • 1 in 4 women say the symptoms of menopause have had an impact on their everyday life, and women in Quebec are more likely than other Canadian women to say so (33% vs. ROC: 20%) Q16. All things considered, on a scale of 1 to 10, how much of an impact have the symptoms of menopause, including hot flashes had on your everyday life? For this question, 1 means no impact at all and 10 means a very big impact. Q15. If you’ve experienced sleepless nights or difficulty sleeping as a result of menopausal symptoms, would you say that you experienced more, less or about the same amount as the following events in your life?

6. Over Half of Working Professional Women Say Experiencing a Hot Flash Has Interfered With Their Work at Some Point • Over 2 in 5 menopausal women say colleagues or clients have witnessed them having a hot flash with post-menopausal women being more likely than peri-menopausal women to say so (45% vs. 38%) • Interestingly however, 7 in 10 say the individual understood it was related to menopause and not performance Q13. To the best of your knowledge, have colleagues or clients ever witnessed you having a hot flash? Interfered: 55% Q12. If you are a working professional, how often has experiencing a hot flash, or the apprehension of experiencing a hot flash, interfered with your work (i.e. Giving a presentation, leading a meeting, interviewing, etc.)? Q14. What did you perceive their reaction to be? (n=600)

7. Nearly 3 in 10 Women Say Menopause Has Negatively Affected Their Relationship with Their Spouse • Most commonly, women say their spouse or partner and friends are understanding in regards to their menopausal symptoms, while children have had no reaction at all • 1 in 5 women, however, say their spouse does not understand, but is supportive and just over 1 in 10 say their spouse think/acts like the symptoms are trivial Q32. How has experiencing symptoms of menopause affected your relationships with your…? Q33A/B/C. Which of the following best describes how your spouse or partner/children/friendshave reacted to your menopausal symptoms?

8. 1 in 3 Menopausal Women Consider Menopause to Have the Same or More Impact On their Daily Life as Other Major Life Milestones • 1 in 3 menopausal women say menopause has the same or more significant impact on their daily life as their first job, marriage, and retirement • 3 in 10 women say menopause has had the same or more of a significant impact on their daily life as child bearing, their career obligations or raising children Q34. Compared with the following milestones in a woman’s life, how significant an impact does menopause have on your daily life?

9. Symptoms

10. Pre-Menopausal Women are the Least Aware of Many Menopausal Symptoms • Peri-menopausal women are the most aware of mood swings, and post-menopausal women are the most aware of insomnia, difficulty with sleep and vaginal dryness • Pre-menopausal women are the least aware of weight gain, fatigue, decreased libido, heavy menstrual period, headaches, short term-memory problems and joint pain Q5. Are you aware of the following symptoms of menopause?

11. Pre-Menopausal Women are Most Concerned About Experiencing Weight Gain • Pre-menopausal women are the most concerned about experiencing weight gain, with 3 in 5 saying so • An additional half of all pre-menopausal women are concerned about difficulty with sleep and frequent awakenings, short-term memory problems and hot flashes • Pre-menopausal women are the least concerned with experiencing an irregular menstrual period Q7. What symptoms of menopause are you most concerned about experiencing? (Select all that apply)

12. 3 in 5 Regularly Experience Difficulty with Sleep and Frequent Awakenings as a Result of Menopause… Frequency of Experiencing Menopausal Symptoms Q8. How often have you experienced the following symptoms of menopause?

13. 4 in 10 Women Say they Feel Frustrated When Experiencing a Hot Flash • While frustration is the most common feeling associated with experiencing a hot flash, post-menopausal women are more likely than peri-menopausal women to say they felt embarrassed (20% vs. 13%) • On the other hand, peri-menopausal women are more likely than post-menopausal to say they felt surprised (15% vs. 10%) or worried (8% vs. 4%) • Regionally, women in the Maritimes and Alberta are the most likely to say they feel frustrated (53% each vs. ROC: 36%), while women in Quebec are the most likely to say they feel nervous (25% vs. ROC: 11%) Q9.How did you feel or how do you feel when you experience hot flashes? (Select all that apply)

14. More Than Half of Women Said That They Experience Hot Flashes, and When Asked to Describe their Worst Hot Flash, Women Said… “My husband said it was cold in the house and I said I was sweating, that I could literally lay down in the snow and go to sleep in our backyard.” “Being dipped in hot, boiling oil.” “Overpowering heat that is totally uncontrollable and extremely uncomfortable. You turn red and flushed and break out in a sweat.” “I was sitting in front of the TV and then I was just hot and wet all over. It only took a few seconds for it to come on.” “The skin on my arms started tingling and I broke out in a sweat from head to tow. My clothes clung to me and the sweat dripped off my chin.” “Someone opened the door to a steel making oven.” Q10. Please describe, in your own words, what your worst hot flash felt like.

15. 7 in 10 Menopausal Women Have Lost Sleep or Sleep Badly Because of Hot Flashes • Nearly half of all peri and post menopausal women say that they have had to significantly increase the number of baths or showers they take, especially post-menopausal women (16% vs. peri: 10%), and an additional 2 in 5 say they have had to significantly increase the number of times they change or wash their clothing • 1 in 4 menopausal women say that as a result of hot flashes, they have had anxiety in their workplace setting Q11. How much does each of the following statements describe your experiences with the effects of hot flashes?.

16. Women & Physicians- Knowledge and Discussions -

17. Satisfied: 61% Dissatisfied: 39% Only 6 in 10 Physicians and Half of Women Say They Are Satisfied With The Treatment Options for Menopause • 6 in 10 physicians say they are satisfied with the current treatment options for menopause, but only half of women who have used treatments say the same Q21. Overall, on a scale of 1 to 10, how satisfied have you been with the therapies or treatments you have used for the symptoms of menopause? Q11. How satisfied are you with current treatment options for menopause?

18. Physicians Do Not Rate Women’s Knowledge of Menopause as Highly as Women Themselves Do • While over 7 in 10 women consider themselves knowledgeable on this topic, only half of physicians consider their female patients to be knowledgeable about menopause • Furthermore, 3 in 10 women consider their knowledge to be very good while less than 1 in 10 physicians would say the same of their female patients Very good/ Good: 50% Very good/ Good: 72% Fair/Poor: 50% Fair/ Poor: 27% Q3. How would you rate your knowledge on menopause and its symptoms? Q9. How would you rate your patients’ initial knowledge on menopause and its symptoms?

19. 1 in 4 Women Do Not Realize that If Their Period Stops for a Whole Year, They Have Reached Menopause • Peri-menopausal women are the most likely to agree that “mood swings and irritability are symptoms of menopause” (85% vs. pre: 77% and post: 78%) and more likely than pre-menopausal women to agree that “menopause can have a profound affect on a woman’s quality of life” (87% vs. 78%) • Regionally, women in Quebec disagree the most that “each woman experiences the symptoms of menopause differently” (7% vs. ROC: 2%) and “mood swings and irritability are symptoms of menopause” (28% vs. ROC: 15%) Q4. How much do you agree or disagree with the following statements?

20. Proactively Discussing Menopause – Nearly All Doctors Say they Do, but Less than Half of Women Say this is True for Them • While nearly 100% of Physicians say they proactively discuss menopause with patients over the age of 40, less than half of women say their doctor has done so Proactively Discuss: 99% Q42. Has your physician proactively spoken to you about menopause and its symptoms? Q1. How often do you proactively discuss menopause and its symptoms with women patients over the age of 40?

21. Physicians Generally Initiate Discussions About Menopause with Female Patients Between Age 41 to 50 • Physicians say they most commonly initiate discussions about menopause with female patients between the age of 41 to 45 (44% vs. women: 25%), but women are most likely to say their physician did so slightly later, at age 46 to 50 (37% vs. physicians: 35%) • Women are also more likely than physicians to say their doctor proactively discussed menopause with them before the age of 41 (12% vs. physicians: 7%) or after age 50 (25% vs. physicians: 14%) Q2. At what age do you initiate discussions about menopause and its symptoms with your patients? Q43. At what age did your physician initiate this discussion with you?

22. Women Generally Initiate Discussions About Menopause with Physicians Between Age 41 to 50 • Both women and physicians are in agreement that women generally discuss menopause with their doctor between the age of 41 to 50 (women: 64% and physicians: 81%) • Women, however, are more likely than physicians to say they spoke with their doctor before the age of 41 (13% vs. physicians: 8%) or after age 50 (23% vs. 11%) Q45. At what age did you speak with your physician about menopause? Q3. At what age do women start asking you questions about menopause?

23. Primary Reason Women Initiate Discussions About Menopause - Women and Physicians Differ • Differences appear in what women say is and what physicians believe is the primary reason women initiate discussions • An overwhelming 3 in 4 physicians say to the best of their knowledge, the primary reason women bring up the topic of menopause is their concern about managing symptoms. However, only one quarter of women who have proactively spoken to their physician say this was the reason • Women’s reasons vary, but they most commonly say it was because they were experiencing irregular periods (36% vs. physicians: 17%) Q46. What was the primary reason you initiated the discussion with your physician? Q4. To the best of your knowledge, what is the primary reason that women bring up the topic of menopause?

24. Women & Physicians- Treatments & Therapies -

25. Only Half of All women who Have Used A Therapy or Treatment for their Menopausal Symptoms Have Been Satisfied With It • On average, women rate their satisfaction with the therapies or treatments they have used a 6.4 out of 10 (on a 10 point scale where 10 is very satisfied) • Just over half, say they are satisfied with the therapies or treatments they have used • Women who have used Hormone Replacement Therapy appear to be the most satisfied, as 6 in 10 say so Q21. Overall, on a scale of 1 to 10, how satisfied have you been with the therapies or treatments you have used for the symptoms of menopause? *Note: Small base n, interpret with caution

26. Hormone Replacement Therapy Is the Most Commonly Known Treatment • An additional 6 in 10 women have heard of diet and exercise and natural and herbal remedies and half have heard of vaginal lubricants/moisturizers • Pre-menopausal women, however, are the least aware of: • Diet and exercise (56% vs. peri: 68% and post: 70%) • Vaginal lubricants or moisturizers (38% vs. peri: 52% and post: 60%) • Reducing stress (29% vs. peri: 43% and post: 40%) • Antidepressants or anti-anxiety drugs (26% vs. peri: 41% and post: 42%) Q17. What therapies or treatments have you heard of which help to alleviate the symptoms of menopause? (Select all that apply)

27. 2 in 10 Physicians Say the Biggest Gap in Treatment Options Available for Menopause is a Need for Effective Treatment with No Side Effects • While opinions vary as to what physicians believe the biggest gap in treatment options is, 2 in 10 say it is a need for treatments that are both effective and have no side effects • The next three most common mentioned gaps are: • Need for more quality research • HRT without risks or side effects • Need for more effective non-hormonal options • Less than 1 in 10 physicians say not enough treatment options/alternative therapies, the need for an effective treatment for hot flashes, and safety are the biggest gaps in treatment options available for menopause Q19. What would you identify as the biggest gap in treatment options that are available for menopause?

28. Both Women and Physicians Site a Need for Safer Alternatives as the Most Common Reason for More Non-Hormonal Therapies • While female physicians gave “women are reluctant to take HRT” as the top reason for needing to have more proven non-hormonal therapies, male physicians said that there is a need for “more alternatives and options with fewer risks” Q30A. Why do you think there is a need to have more proven non-hormonal therapies? Q17A. Why do you think there is a need to have more proven non-hormonal therapies?

29. 3 in 4 Physicians Recommend HRT to Patients, But Less than 1 in 7 Women Would Recommend HRT to Another Woman • The treatments or therapies physicians most often recommend to menopausal women are different from what women recommend to other women • While 3 in 4 physicians recommend HRT to patients, less than 1 in 7 women would recommend HRT to another woman • Rather, the most common treatment or therapy women recommend to other women, with over half saying so, is diet and exercise (53% vs. physicians: 19%) Q31. What treatments or therapies do you recommend to other women? (Select all that apply) Q12. What therapies or treatments do you recommend most often to women who are going through menopause?

30. Physicians Appear to be Uninformed as to What Therapies or Treatments Women Most Often Recommend • Physicians do not appear to be aware of the types of treatments or therapies women recommend to other women as nearly half of all physicians said HRT or natural or herbal remedies, when in fact, women recommend diet and exercise most often Q31. What treatments or therapies do you recommend to other women? (Select all that apply) Q16. What therapies or treatments do women most often recommend to their friends?

31. Half of All Physicians Whose Patients Request a Treatment or Therapy Recommended by a Friend, Say Women Recommend Natural or Herbal Remedies the Most to Friends • 3 in 5 physicians say women often come in requesting a treatment or therapy recommended by a friend, with half of these physicians saying women most often recommend natural or herbal remedies to their friends • An additional 2 in 5 physicians say women recommend Hormone Replacement Therapy the most often, with male physicians (53% vs. female: 20%) and those in eastern Canada (58% vs. central Canada: 28%) saying so the most Q15. Do women often come in requesting a treatment or therapy that was recommended by a friend of theirs? Q16. What therapies or treatments do women most often recommend to their friends?

32. 2 in 5 Post-Menopausal Women Have Been on a Treatment They Have Stopped • 1 in 3 women have been on a treatment that they have stopped, with post-menopausal women saying so more than those who are peri-menopausal • 3 in 10 women say they stopped the treatment because their doctor took them off of it, with women in Quebec more likely than those in Ontario, the Prairies and Alberta to say so (49% vs. 26%, 15% and 9%, respectively) Q27. Have you been on a treatment that you have stopped? Q28. What influenced you to stop the treatment? Q29. What did you do after you stopped the treatment?

33. 2 in 5 Women Who Say Menopause Has Had an Impact on Their Daily Life Are Willing to Pay as Much as They Need For a Treatment That Alleviates Their Symptoms • While only 2 in 10 women say they would pay as much as they need in order to get a treatment or therapy that alleviates their symptoms, 2 in 5 women who say menopause has an impact on their daily life, would do so • Post-menopausal women are also more likely than peri-menopausal women to say they will pay as much as they need in order to get a treatment or therapy that alleviates their symptoms, while pre-menopausal women are more likely to say they would compare prices of different treatments and therapies prior to purchasing one Q19. Which one of the following statements best describes the way you have selected or would select treatments or therapies relative to their cost?

34. Communication and Education

35. Physicians Appear to Think Gender Plays a Larger Role in Woman’s Comfort in Speaking About Menopause • While 6 in 10 women say gender does not matter to them when speaking to a doctor about menopause, the majority of doctors think that women are more comfortable speaking to a female doctor about menopause (45% do not think gender plays a role) Q47. Do you prefer to speak with a male doctor or a female doctor about menopause? Q5. Do you think that women are more comfortable speaking with a female doctor or a male doctor about menopause?

36. Physicians are Aware of Women’s Comfort Levels in Speaking About The Physical Effects of Menopause • Over 1 in 3 of women say they are not completely comfortable in speaking with their physician about the physical effects of menopause and physicians agree Uncomfortable: 35% Uncomfortable: 36% Q48A. How comfortable are you in speaking with your physician about the physical effects of menopause (i.e. hot flashes, irregular period, weight gain etc.)? Q7A. How comfortable do you think your patients are with discussing the physical effects of menopause with you (i.e. hot flashes, irregular period, and weight gain)? Are they…

37. 4 in 10 Of the Women Who are Uncomfortable Speaking With Their Physician about the Physical Effects of Menopause, Say It Is Because Their Physician is Male Q48B. Why are you not comfortable speaking with your physician about the physical effects of menopause?

38. Physicians are Also Aware of Women’s Comfort Levels Around Speaking About The Emotional Effects of Menopause • More than 4 in 10 (42%) women say they are not completely comfortable with discussing the emotional effects of menopause with their physician. Almost half (49%) of physicians realize that. Uncomfortable: 49% Uncomfortable: 42% Q8A. How comfortable do you think they are with discussing the emotional effects of menopause with you (i.e. mood swings)? Are they… Q49A. How comfortable are you in speaking with your physician about the emotional effects of menopause (i.e. mood swings)?

39. 4 in 10 Of the Women Who are Uncomfortable Speaking With Their Physician about the Emotional Effects of Menoapuse Say That It Is a Very Personal/Private Matter Q49B. Why are you not comfortable speaking with your physician about the emotional effects of menopause?

40. 3 in 10 Physicians Say they Have Not Been Provided With Enough Counsel and Treatment Options on the Issue of Menopause To Adequately Provide Alternatives to Patients • While 7 in 10 physicians agree with the statement “You have been provided with enough council and treatment options on the issue of menopause to adequately provide alternative to patients”, 3 in 10 say they have not • Male physicians are more likely than female physicians to somewhat disagree (30% vs. 12%) Agree: 70% Disagree: 30% Q18. How much do you agree or disagree with the following statement: “You have been provided with enough council and treatment options on the issue of menopause to adequately provide alternatives to patients.”

41. Information on Menopause

42. 5 in 10 Women Have Looked for Information on Menopause • 4 in 10 women say that if they were to look for information on menopause, they would look for information on symptoms, especially pre-menopausal women (51% vs. peri: 36% and post: 34%) • While an additional 1 in 5 say they would look for information on treatments, 3 in 10 say they do not know what information they would look for • While half say they have looked for information on menopause, its symptoms and treatments, pre-menopausal women are the least likely to have done so (22% vs. peri: 61% and post: 57%) Q36. If you were to look for information on menopause, what type of information would you look for? Q37. Have you looked for any information on menopause, its symptoms or treatments?

43. Women Who Have Looked For Information On Menopause, Have Looked to The Internet the Most • 8 in 10 women say they have looked to the internet for information on menopause • While women in Quebec are the least likely to have looked on the internet they are more likely than those in Ontario, Alberta and British Columbia to have turned to television for menopausal information • An additional 3 in 5 women say they turned to healthcare professionals or books, especially those who are post-menopausal • Women in Alberta are also more likely than those in the Maritimes, Ontario or British Columbia to have turned to healthcare professionals • 4 in 10 women have also turned to Magazines and Friends Q38. Where did you look for this information? (Select all that apply)

44. 3 in 10 Women are NOT Confident With Menopause Information Provided to Them By Friends • 3 in 10 women, are not confident with information provided by friends, with post-menopausal saying so the most • Post-menopausal women are also the most likely to say they are not confident in information provided to them by books and more likely than pre-menopausal women to say they are not confident in information provided by healthcare professionals, magazines and TV • While women in the Prairies and BC are more confident in the internet, women in Quebec are more likely than women in Ontario or out west to be confident in TV • 8 in 10 women say it was easy for them to find information about menopause that they trusted Q39. How confident are you with information that is provided about menopause from…? Q40. Was it easy for you to go find information about menopause that you trusted?

45. The Majority of Women are Not Interested in a Forum to Speak with Other Women About Menopause and the Experiences Associated with It • Women appear to be the least interested in a forum to speak with other women about menopause and the experiences associated with it, as the majority say they are not interested • While women in BC are the most interested in a Canada specific online resource on menopause, women in the Maritimes are the most interested in a forum to speak with other women about menopause • Women in Quebec are more interested than those in the Maritimes, Ontario or the Prairies in having brochures about menopause and its effects available at their doctor’s office • Post-menopausal women appear to be the least interested in all of these sources of information: • Brochures about menopause • A Canada specific online resource on menopause • Articles about menopause and its effects in women’s magazines • (800) line to discuss menopause • A forum to speak with other women about menopause Q51. How interested would you be in the following?

46. Women Turn to the Internet the Most for Information on Menopause • It appears women tell their doctor they use the internet the most for information as physicians say women tell them they use the internet more than any other source • While friends is the second most common source of information doctors say women tell them about, women say they turn to healthcare professionals, books and magazines more than friends Q38. Where did you look for this information? (Select all that apply) Q24. What sources do women tell you they use to get information about menopause?

47. While Only 2 Per Cent of Physicians Encourage Women to Seek Information Through Friends, Over 4 in 10 say Women Get Their Information from Friends • 6 in 10 physicians encourage women going through menopause to seek information on the internet, and just as many say women tell them they use the internet to get information about menopause • Half of male physicians say women tell them they get information from magazines while only 1 in 5 female physicians say the same Q23. Where do you encourage women going through menopause to seek information? Q24. What sources do women tell you they use to get information about menopause?

48. Most Women are Aware of the Society of Obstetricians and Gynaecologists and the Canadian Women’s Health Network • 5 in 10 women have heard of the Society of Obstetricians and Gynaecologists and the Canadian Women’s Health Network, but only 5 per cent have heard of the North American Menopause Society and 3 per cent have heard of A Friend Indeed • While women in Ontario are the most likely to be familiar with the Society of Obstetricians and Gynaecologists, women in Quebec are the most likely to have not heard of any of these organizations • Post-menopausal women, however are more aware than pre-menopausal women of all of these organizations, with the exception of a Friend Indeed Q41. Which of the following organizations have you heard of? (Select all that apply)

49. Women’s Attitudes on Age, Health and Menopause

50. 3 in 4 Women Agree “50 is the New 40” • Over 50 per cent of women say they “see menopause as the beginning of an exciting phase of my life” • While post-menopausal women are the most likely to agree with this statement, pre-menopausal women are the most likely to disagree • Similarly, post-menopausal women are the most likely to say that “I am (was) looking forward to menopause because I will no longer have to worry about birth control”, while pre-menopausal women are the most likely to disagree • Post-menopausal women, however, are the most likely to disagree that: • “I am afraid that menopause will bring lower energy levels and impact my efficiency at work” • “I am always afraid of when my symptoms may strike” • “I am worried about the long term impact of menopause on my overall health” Q35. How much do you agree with each of the following statements?