Bring back BEACH, check the historical misogyny and consider local manufacture of vital therapies.
It’s time to “grasp the nettle” and address the misogyny facing women’s healthcare, the Senate committee into menopause heard today.
Addressing the committee hearing, AMA president Professor Steve Robson emphasised the complexity of perimenopausal and menopausal care, necessitating a “whole person multi system approach” to care.
“Our GPs in particular want to provide good quality health care, and [the AMA] believes it’s a matter of urgency that [we produce] an action plan that enables our doctors more time for their female patients to support complex, quality menopause care, and that should be a priority,” he said.
“We believe the current MBS structure can present some barriers for GPs spending more time with their patients, time that’s required to provide the necessary care.”
The association flagged the need for adequately compensated longer appointments and clarity around referral pathways.
Amid ongoing menopausal national medication shortages, the AMA is regularly engaging with the TGA, said Professor Robson.
But, he added, “there is without doubt an element of misogyny” in the treatment of women’s health and supply of medication.
“There’s no doubt that historically a large amount of medical practice was based on research in middle aged male patients and it has excluded women, it’s excluded pregnant women, and it’s left us with a dearth of evidence to guide practice.
“That’s something that absolutely has to be dealt with.
“But also, if we look across different dimensions of practice, if we look at the MBS for example, there is a relative undervaluing of women’s health care.
“In fact, it’s not even relative, it’s quite stark. Something that would require a similar amount of therapeutic effort in a woman is rebated to that woman less than for a man, and I think this is so systematic that a lot of people don’t even think about it.
“It’s a total mistake to accept that.”
According to Professor Robson, “we need to grasp the nettle” and tackle misogyny within the healthcare system.
“Virtually every woman will go through menopause and yet we have these extraordinary situations where people can’t get safe medications that are not complicated and not even expensive,” he said.
“We should make them available and deal with that misogyny.”
Professor Robson said Australia may need to rethink how we stock vital medication.
“I can get Viagra online, should I be so inclined, like that,” Professor Robson said with a click of his fingers.
“But for women having significant issues that affect their work-life relationships and emotional status, having to run around to different pharmacies … sends a terrible message about how we value women’s health.”
Professor Robson said that, unfortunately, menopausal medication may not be a top priority for manufacturers.
“There’s a set amount of manufacturing capacity and sometimes, unfortunately, I suspect menopausal hormone treatment may be a fair way down the pecking order in priority for some manufacturers,” he told the Senate.
Professor Robson added Australia has unique logistical challenges and may need to consider sovereign manufacture and national stockpiling of important medications.
When asked about whether extending scripts may improve access, Professor Robson said, “in general practice, prescription of menopausal hormone treatment is also an opportunity for a broader health check”.
AMA vice president and GP Dr Danielle McMullen said the question of perpetual scripts cropped up “time and time again”.
“There is more to a script than signing a prescription paper, particularly in something like MHT where it is a careful balance of symptom burden versus the risks and benefits of medications,” she told the Senate.
“It’s a continual update about how long it is appropriate to remain on these medications.
“Clinically these are safer for a briefer period of treatment and for relatively younger ages.”
Dr McMullen said the association was supportive of the recent move to allow two-month prescriptions for some drugs, “but it really is about getting that clinical balance right”.
The AMA, RACGP and the RDAA all agreed that the return of a modernised, BEACH-like general practice-based research initiative would benefit a number of conditions, including perimenopause and menopause.
“We did lose quite a lot of very valuable general practice primary care data with the loss of BEACH,” said RACGP sexual health special interest group chair Dr Sara Whitburn.
Dr Whitburn said GPs would need to be supported to input data and patients would need to be reassured that the data was stored safely.
“The best thing about BEACH was that you would fill it in while you were there with the patient, so you’d be getting that real time information,” she said.
Dr Whitburn said the real time data meant that time-poor GPs could provide data on the go and would not need to leave their busy community practices for education.
Senator for New South Wales Hollie Hughes suggested a “tick box” tool, similar to those for children regarding developmental milestones, that are provided to all women in their 40s onwards to investigate perimenopausal and menopausal symptoms.
According to Dr Whitburn, there are two checklists already in existence: one produced by the Australasian Menopause Society and another by women’s health provider Jean Hailes.
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Dr Whitburn suggested linking them to MyHealth Record.
RDAA representative Dr Louise Manning said that addressing menopause care was not only important for patients, but also healthcare workers.
“A lot of our general practice workforce is staffed by women,” she told the Senate.
“So not only [does menopause care] affect the patient, but also the female doctors working in these communities.
“We don’t wish to over-medicalise menopause, but we need to ensure that everybody has access to care and doesn’t feel stigmatised in achieving that and asking for that access to care and ensuring that women are able to maintain their physical, mental and emotional health as they age.”
The menopause committee is set to report to the Senate on 17 September.
