Canada and the United States have faced each other in the gold medal game of six of seven Olympics, 22 of 23 IIHF Women's World Championships and 21 of 23 4 Nations Cups since the beginning of international play.

After an American victory over Canada at the 1998 Nagano Olympics, the Canadian Olympic team won the next four gold medals over the U.S. (the exception being 2006 where Canada defeated Sweden for gold and U.S. defeated Finland for bronze) until 2018, when the U.S. ended a 20-year gold medal drought defeating Canada in a shootout.

At the 4 Nations Cup, Canada and the U.S. have faced each other in every gold medal game (except 2001 when the U.S. withdrew due to the September 11 attacks and 2013 where Canada won gold defeating Finland and the U.S. won bronze defeating Sweden).

The Canadian streak lasting from 1998 to 2002, was broken by U.S.'s Gold at the 2003 4 Nations Cup.

The American streak lasting from 2015 to 2019, was broken by Canada's Gold at the 2021 World Championship.