Her first acting job came at the age of nine, when she landed a spot in a commercial for Bell Canada. She was directed to make an impudent gesture out of a school bus window like sticking out her tongue - but ended up making a rather obscene and adult gesture instead.

She quickly found steady work in Canada, appearing in a few TV series such as Matt and Jenny, The Mating Season, The Baxters and The Littlest Hobo, in which she guest-starred with her entire family in a two-part episode. She also starred in the short film "Boys and Girls" (1983), which won an Academy Award for Best Short Subject.

Follows' breakthrough occurred when she was cast as Anne Shirley in the miniseries Anne of Green Gables, and subsequently appeared in the two sequels that followed. The part of "Anne" was a coveted role that she won over 3,000 other young girls when director, producer and writer Kevin Sullivan chose her despite early worries during the audition process that she might be too old for the part.

The miniseries, wholly produced in Canada, became successful around the world and remains to this day the highest-rated drama in Canadian television history.

Follows gained a substantial fan following for her portrayal of the popular literary character. Her performances earned her two Gemini awards as best actress for the first two miniseries, Anne of Green Gables and Anne of Green Gables: The Sequel, and a Gemini nomination for the third Anne installment, Anne of Green Gables: The Continuing Story.

Follows has made a number of appearances on both Canadian and American television. In 1995, Follows (as Megan Porter Follows) starred in The Outer Limits episode "The Choice" along with Thora Birch.[6] In Canada, she appeared in a popular made-for-TV movie, Hockey Night, around the time she appeared in Anne of Green Gables. She played the lead role of Cathy, a young girl who played hockey on a previously all-male team. Other Canadian television appearances include leading roles in the period drama Under the Piano and police drama Major Crime, which starred fellow Canadians Michael Moriarty and Nicholas Campbell.

In 2005, she guest-starred in the Canadian ensemble drama Robson Arms as one of the tenants of the Robson Arms apartment complex. She also appeared in the hospital drama Open Heart as a nurse fighting a physician of malpractice and in Shania: A Life in Eight Albums, as the mother of famous Canadian singer Shania Twain. Most recently, she has starred as Booky's mother in the three movie adaptations of Bernice Thurman Hunter's "Booky" series, Booky Makes Her Mark, Booky and the Secret Santa and Booky's Crush.

Among the earliest American television appearances were roles in The Facts of Life (as a cousin of Jo Polniaczek in an episode that was intended as a backdoor pilot for a proposed spin-off) in 1982, and in the short-lived series Domestic Life as Martin Mull's TV daughter in 1984. She also appeared alongside a young Dermot Mulroney in two TV movies, Sin of Innocence and Shattered...If Your Kid's On Drugs, in 1986. In 1987, she played the French wife of Hugh Grant in the historically accurate Champagne Charlie series that was later repackaged into a 3 hour movie format. In 1993-94, Follows was part of the ensemble in a short-lived CBS television series Second Chances with a then-unknown Jennifer Lopez. Since 2000, Follows has appeared on numerous longstanding television series, such as Law & Order, ER, The X Files, CSI: Crime Scene Investigation, CSI: Miami, Cold Case, and Lie to Me. Follows also appeared in the Canadian hit series, Heartland, for three consecutive episodes.

In 2004, Follows was also part of the ensemble cast of the Hallmark movie Plainsong, which included Aidan Quinn, Rachel Griffiths and America Ferrera. In 2009, she guest-starred in the ABC drama, Brothers and Sisters. In 2011, she had a guest role on the Fox network series, House. In 2012, she played Beth in Hollywood Heights. Beth is the sister of drug-addicted Lisa.

Follows will be a cast member on Reign, an historical drama TV series based on the early life of Mary, Queen of Scots which was commissioned in May 2013 for broadcast on The CW beginning in the 2013-2014 season.

Although Follows has been more prolific in television appearances, she has appeared in a number of feature films. She co-starred with Corey Haim and Gary Busey in the 1985 film adaptation of Stephen King's novella Silver Bullet. Following the success of Anne, she appeared in Termini Station, which reunited her with Anne of Green Gables co-star Colleen Dewhurst. A rarely recognized role played by Follows was Clara in the movie The Nutcracker Prince starring Kiefer Sutherland, in which she sings a song. In 1998, she appeared in the Canadian movie Reluctant Angel. Her most recent film credits include Christmas Child, A Foreign Affair (2003) released on DVD as Two Brothers and a Bride, and a cameo in Laurie Lynd's Breakfast with Scot starring fellow Canadian Tom Cavanagh. She was also the narrator of Heather Connell's 2008 documentary Small Voices: Stories of Cambodia's Children.

Recent years have seen the return of Follows on stage as a regular of the Toronto-based Soulpepper Theatre Company. In 2005, she had the leading role of May in their production of Fool for Love by Sam Shepard.[2] The following year, she took on the role of Annie in Tom Stoppard's The Real Thing which ran at Ottawa's National Arts Centre as a coproduction between Soulpepper and NAC English Theatre. Following this run, the play also made its way to Toronto as part of Soulpepper's 2006 season at the Young Centre for the Performing Arts. In 2007, she played the role of Marlene in the summer production of Caryl Churchill's Top Girls, again with the Soulpepper Theatre Company. Following this, she starred in Soulpepper's 2007 production of Anton Chekhov's Three Sisters. Soulpepper's 2008 season, marking the company's 10-year anniversary, signaled the continuation of Megan's prolific theatre career. Just like the past season, she appeared in two productions.

The first was Marsha Norman's 1983 Pulitzer Prize for Drama 'night, Mother, which she co-starred with her real-life mother, Dawn Greenhalgh. The second was Soulpepper's remount of its critically acclaimed 2007 production of Caryl Churchill's Top Girls, which featured the same cast and director.

Taking a short break in 2009, Megan returned to the stage in 2010 in Mirvish Productions's revival of Caryl Churchill's classic 1979 play Cloud 9. The play was directed by her Top Girls and 'Night, Mother director, Alisa Palmer, and featured an all-star Canadian cast, including Ann-Marie MacDonald and Yanna McIntosh.

In 2011, she returned to the stage to star in the Canadian premiere of Melissa James Gibson's This at the Vancouver Playhouse directed by Amiel Gladstone and, in 2012, she stars in the lead role of Penelope in the Nightwood Theatre's production of The Penelopiad playing at Toronto's Buddies in Bad Times Theatre.

Follows has served as a spokeswoman for the relief organization World Vision Canada. She traveled to both Rwanda and Tanzania as a spokeswoman and a photographer. She also participated in the 2005 benefit concert Canada for Asia held to support the relief efforts for Asia after the 2004 Indian Ocean earthquake.

Most recently, she travelled to Cambodia in 2007 with friend and director Heather Connell to film Small Voices: Stories of Cambodia's Children, a documentary about how the children of Cambodia living on the street and garbage dumps face their living conditions amidst poverty and abuse and how they view their own future.

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