The Senate inquiry has made sensible recommendations, but recommendations alone won’t change things.
On 10 September the Senate Community Affairs Reference Committee released a report featuring 25 consensus recommendations on menopause and perimenopause.
They took into account the voices of individuals with lived experience, clinicians, advocates, and industry representatives, gathered through 285 submissions and seven public hearings.
As a GP, menopause education advocate, and perimenopausal woman who submitted two written contributions and gave verbal evidence at the Senate inquiry in Sydney, I was thrilled to see my “ABC” of policy changes reflected in the report.
(Note: I use the term “women” below to encompass all individuals who were born with ovaries and assigned female at birth.)
A is for Awareness (recommendations 2-5,7):
A government-led national awareness campaign on perimenopause and menopause, designed in consultation with experts and people with lived experience can empower and educate everyone. The narrative has been for too long focused on hot flashes, ignoring the diversity of symptoms that women can experience, notably those originating in the brain, such as depression, anxiety, and brain fog.
Express referencing of menopause in the school curriculum of health and physical education learning can teach our young people how hormones impact the entirety of their health, which not only improves an understanding of perimenopause and menopause but also provides a foundation of knowledge to understand the entire female life cycle.
With 3.3 million women aged 45-64 in the workforce (ABS 2021), the workplace is perfectly suited to deliver more detailed menopause education, which is simply sex education for grown-ups.
Menopause leave was a hotly contested subject, with one hearing being suspended due to heated discussions, so agreement was instead reached for gender inclusive reproductive leave. Those of us who work in menopause care are very aware of the potential menopause impact on workplace performance, with many women reducing hours or leaving the workforce[1],[2]. But we would counter the need for leave as so many of our patients say, “I’ve got myself back” when given the correct hormones, which dare I say it, often includes testosterone.
Related
B is for Better education of ALL clinicians (recommendations 9-12):
The majority of, if not all, clinicians look after women, yet only a small minority of us were taught about sex as a biological variable of disease. Ovarian hormones are a key determinant of female physiology and therefore how that physiology differs from male. These hormones impact every system in the body shaping the patterns, presentations, prevention, and treatment of disease.
Including menopause in medical school education from the get-go offers a pivotal opportunity to reframe women’s health (traditionally limited to reproductive health) to the health of the whole woman. Funding the delivery of that education is also going to be open to tender, which will hopefully ensure that this CPD is designed to meet the needs of real-world clinicians.
C is for Cheap (or at least affordable) Care including better funding for GPs, and body-identical hormone therapy for those who wish to use it (recommendations 13-19):
There are already too many demands on GPs to be experts in everything, so the recommendation to financially incentivise a workforce that is already stretched thin and burning out is particularly welcome.
Perimenopause and menopause care is not fast medicine; indeed, these are the most complex of all my consultations. Dealing with what is often a multitude of symptoms, excluding other causes, checking screening is up to date, debunking myths about hormones, giving important advice on nutrition, exercise, sleep, alcohol and relationships as well as discussing how to use hormones, is never a 15-minute appointment.
Expansion of the 45-49 health check (currently funded for those at increased risk chronic disease – menopause transition is at least equivalent to smoking in terms of increasing cardiovascular risk[3]) should be a simple change with the potential to save our healthcare system and the greater economy billions.
Using practice nurses and nurse practitioners is invaluable to improve delivery, especially in rural and remote areas. Nurse practitioners already form a vital part of menopause delivery in the UK and the US.
Though I am not optimistic about the government’s ability to improve supply chains, ensuring that gold standard body identical hormones including micronised progesterone (and testosterone) are PBS-listed would remove the current socio-economic discrimination that exists. It is frustrating that it seems impossible to access Australian prescribing data to truly see how stark this gap is (and that most prescribing data seems limited to PBS medications), but we know from UK data that it is likely to be unpleasant reading[4].
Body-identical hormones should absolutely be considered in a class of their own. Estradiol, progesterone, and testosterone demonstrate both treatment effect and future health benefits that no other medicine can even aspire to. With solid evidence for preventing osteoporosis[5], [6] and reducing risk of cardiovascular disease[6] and emerging evidence of neurocognitive benefits[7],[8],[9] this could save unnecessary suffering, premature death, and billions in healthcare costs (osteoporotic hip fractures alone costing Australia $475 million per year, according to the AIHW).
What’s Next?
There’s so much to gain for society, beyond just women, by implementing these recommendations, which I consider to be a no-brainer. However, it’s now been two years since the UK all-party working group on menopause delivered its report, and progress has been disappointingly slow. It’s clear that having recommendations on paper is not enough.
As outlined in recommendation 25, if Australia is to lead in menopause and perimenopause care, it’s crucial for all of us involved to take action, whether that means supporting a friend, educating colleagues, or spearheading a national awareness campaign.
Doctors specialising in menopause have been aware of these issues for a long time. This inspired me, along with fellow GP colleagues, to create Healthy Hormones: an online community dedicated to enhancing menopause awareness and improving care across Australia. We provide a platform for health professionals and the public to deepen their understanding of menopause, while offering a supportive space for asking questions, sharing experiences, and connecting with like-minded individuals.
Through evidence-based guides and resources, we’re simplifying what can often seem like overwhelmingly complex issues. By focusing on the ABCs – raising Awareness, providing Better education for clinicians, and advocating for Cheap Care – we aim to empower all women to thrive in the second half of their lives.
If you’d like to learn more about peri/menopause and feel more confident prescribing hormone therapy, or if you’re looking for somewhere to direct patients for support and reliable information, visit healthyhormones.au.
References:
1 Faubion SS, Enders F, Hedges MS, Chaudhry R, Kling JM, Shufelt CL, Saadedine M, Mara K, Griffin JM, Kapoor E. Impact of Menopause Symptoms on Women in the Workplace. Mayo Clin Proc. 2023 Jun;98(6):833-845. doi: 10.1016/j.mayocp.2023.02.025. Epub 2023 Apr 26. PMID: 37115119.
2 D’Angelo S, Bevilacqua G, Hammond J, Zaballa E, Dennison EM, Walker-Bone K. Impact of Menopausal Symptoms on Work: Findings from Women in the Health and Employment after Fifty (HEAF) Study. Int J Environ Res Public Health. 2022 Dec 24;20(1):295. doi: 10.3390/ijerph20010295. PMID: 36612616; PMCID: PMC9819903.
3 Uddenberg ER, Safwan N, Saadedine M, Hurtado MD, Faubion SS, Shufelt CL. Menopause transition and cardiovascular disease risk. Maturitas. 2024 Jul;185:107974. doi: 10.1016/j.maturitas.2024.107974. Epub 2024 Mar 22. PMID: 38555760.
4 Iacobucci G. Menopause: Government must tackle “postcode lottery” of treatment, says report BMJ Oct 2022
5 Gosset A, Pouillès JM, Trémollieres F. Menopausal hormone therapy for the management of osteoporosis. Best Pract Res Clin Endocrinol Metab. 2021 Dec;35(6):101551. doi: 10.1016/j.beem.2021.101551. Epub 2021 Jun 2. PMID: 34119418.
6 Barrett-Connor E, Young R, Notelovitz M, Sullivan J, Wiita B, Yang HM, Nolan J. A two-year, double-blind comparison of estrogen-androgen and conjugated estrogens in surgically menopausal women. Effects on bone mineral density, symptoms and lipid profiles. J Reprod Med. 1999 Dec;44(12):1012-20. PMID: 10649811.
7 Hodis HN, Mack WJ. Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease: It Is About Time and Timing. Cancer J. 2022 May-Jun 01;28(3):208-223. doi: 10.1097/PPO.0000000000000591. PMID: 35594469; PMCID: PMC9178928.
8 Rueda Beltz C, Muñoz Vargas BA, Davila Neri I, Diaz Quijano DM. Neuroprotective effect of hormone replacement therapy: a review of the literature. Climacteric. 2024 Aug;27(4):351-356. doi: 10.1080/13697137.2024.2354759. Epub 2024 Jun 11. PMID: 38863238.
9 Kim YJ, Soto M, Branigan GL, Rodgers K, Brinton RD. Association between menopausal hormone therapy and risk of neurodegenerative diseases: Implications for precision hormone therapy. Alzheimers Dement (N Y). 2021 May 13;7(1):e12174. doi: 10.1002/trc2.12174. PMID: 34027024; PMCID: PMC8118114.
10 Gordon JL, Rubinow DR, Eisenlohr-Moul TA, Xia K, Schmidt PJ, Girdler SS. Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause Transition: A Randomized Clinical Trial. JAMA Psychiatry. 2018 Feb 1;75(2):149-157. doi: 10.1001/jamapsychiatry.2017.3998. PMID: 29322164; PMCID: PMC5838629.
11 Lambrinoudaki I, Mili N, Augoulea A, Armeni E, Vlahos N, Mikos T, Grimbizis G, Rodolakis A, Athanasiou S. The LADY study: epidemiological characteristics of prevalent and new genitourinary syndrome of menopause cases in Greece. Climacteric. 2024 Jun;27(3):289-295. doi: 10.1080/13697137.2024.2314504. Epub 2024 Feb 28. PMID: 38415685.
12 Tan-Kim J, Shah NM, Do D, Menefee SA. Efficacy of vaginal estrogen for recurrent urinary tract infection prevention in hypoestrogenic women. Am J Obstet Gynecol. 2023 Aug;229(2):143.e1-143.e9. doi: 10.1016/j.ajog.2023.05.002. Epub 2023 May 11. PMID: 37178856.
13 Dadgostar P. Antimicrobial Resistance: Implications and Costs. Infect Drug Resist. 2019 Dec 20;12:3903-3910. doi: 10.2147/IDR.S234610. PMID: 31908502; PMCID: PMC6929930.
