Overview

Menopause is not an illness, and neither is it a medical condition: it is a normal component of the female life cycle; however, it is a women’s health issue with social and economic consequences.

From reproductive health to menopause, women’s experiences are too often ignored and their concerns easily dismissed. Previous inquiries by this committee have highlighted the substandard level of care that some women may experience in their health journey.

To date, menopause, despite being a natural transition for over 51 per cent of the population, has remained an area in women’s health where women’s voices and pain have been ignored or poorly understood. Menopause continues to be a topic that is rarely discussed and is stigmatised.

Every woman’s experience of menopause is unique. For some women with debilitating symptoms, this can have a significant impact on their relationships, workforce participation and many other aspects of their lives. Other women will experience few negative impacts.

1,4 Evidence indicates that the level of awareness in the community is very low. There is limited information available, and women experience significant barriers in accessing diagnosis and treatment.

1.5 It is in this context that the committee embarked on this inquiry, seeking to explore the multitude of issues related to perimenopause and menopause in Australia and consider measures to adequately support women during this phase of their lives.

1.6 During the inquiry, the committee listened to the stories of hundreds of women, heard from academics, clinicians, businesses, public health bodies and government departments. The evidence told a compelling story that in Australia, women do not always receive adequate support to manage their symptoms, both in the health system and in their workplaces.

Senate menopause inquiry called

Members of the Upper House agreed to set up a Parliamentay Committee to look into the impact of perimenopause and menopause . The inquiry involve looking into the health and economic effect of perimenopause and menopause, focusing on the impacts menopause and perimenopause on women, their financial security, relationships and their workplaces.

The Greens Leader in the Senate, Senator Larissa Waters moved a motion on Monday (6 November) to refer the issue to the Community Affairs References Committee for an inquiry and report. Co-sponsored by Labor Senator for South Australia Marielle Smith, the motion called for an inquiry to consider the mental, physical, and economic effects of menopause and perimenopause. It also called for an investigation into the awareness among medical professionals and patients of symptoms and treatments, including their affordability and availability.

‘Menopause often occurs at a time when a lot is going on in women’s lives - adolescent or young adult children, or ageing parents and a demanding job.When women are struggling it can be difficult to tease out what is an effect of menopause and what is related to other facto

Menopause can also be a turning point in a patient’s health trajectory, and she believes patients should have access to a comprehensive assessment around the time of menopause. This should include attention to risk factors for future cardiovascular disease, osteoporosis, dementia and cancers, and checking to see whether they are up to date with screening.

Medical Journal of Australia suggested that 85% of symptomatic Australian women are not receiving effective, approved menopausal hormone therapy (MHT) or non‐hormonal interventions. Longer general practice consultations needed for appropriate menopause care are also not encouraged by the way Medicare operates, she believes.

Better education about menopause for doctors and other health professionals is another area for improvement according to Dr Magraith, including both at undergraduate and postgraduate levels.

More education of the general public ‘to reduce stigma and help women make informed choices about their health’

Who made submissions?

The inquiry heard submissions from women, health professionals, employers and other experts.

Issues related to menopause and perimenopause, with particular reference to:

a. the economic consequences of menopause and perimenopause, including but not limited to, reduced workforce participation, productivity and retirement planning;

b. the physical health impacts, including menopausal and perimenopausal symptoms, associated medical conditions such as menorrhagia, and access to healthcare services;

c. the mental and emotional well-being of individuals experiencing menopause and perimenopause, considering issues like mental health, self-esteem, and social support;

d. the impact of menopause and perimenopause on caregiving responsibilities, family dynamics, and relationships;

e. the cultural and societal factors influencing perceptions and attitudes toward menopause and perimenopause, including specifically considering culturally and linguistically diverse communities and women’s business in First Nations communities;

f. the level of awareness amongst medical professionals and patients of the symptoms of menopause and perimenopause and the treatments, including the affordability and availability of treatments;

g. the level of awareness amongst employers and workers of the symptoms of menopause and perimenopause, and the awareness, availability and usage of workplace supports;

h. existing Commonwealth, state and territory government policies, programs, and healthcare initiatives addressing menopause and perimenopause;

i. how other jurisdictions support individuals experiencing menopause and perimenopause from a health and workplace policy perspective; and any other related matter.

The Report

For a copy of the full report please refer below:

https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Menopause/Report

The Recommendations

List of recommendations

The committee recommends that the Department of Health and Aged Care commission research to establish a comprehensive evidence base about the impacts of menopause and perimenopause on women in Australia, including:

Menopause differentiated from midlife stressors;

Mental health impacts of menopause; and

Early menopause.

The research should also establish an understanding of experiences for:

Culturally and linguistically diverse women;

First Nations women;

LGBTQIA+ individuals; and

Women living with a disability.

The committee recommends that the Australian Government launch a national menopause and perimenopause awareness campaign, providing information and resources for women and communities across Australia. This awareness campaign should be designed in consultation with experts and people with lived experience.

The committee recommends that, in the next review of the Australian Curriculum, the Australian Curriculum, Assessment and Reporting Authority (ACARA) consider how menopause can be expressly referenced in the menstrual health and reproductive cycles content within the Health and Physical Education learning area.

The committee recommends that the Australian Government commission research to undertake a comprehensive study to assess the economic impacts of menopause which clearly delineates the impact of symptoms of menopause on women’s workforce participation, income, superannuation, and age of retirement.

The committee recommends that the Australian Government introduce reforms to allow the Workplace Gender Equality Agency (WGEA) to re-commence data collection on the supports employers are providing, and their usage, for employees experiencing menopause and perimenopause, including specific workplace policies.

The committee recommends that the Australian Government consider amendments to Section 65 of the Fair Work Act 2009, to ensure women can access flexible working arrangements during menopause.

The committee encourages Australian workplaces develop perimenopause and menopause workplace policies in consultation with their employees.

The committee recommends that the Australian Government task the Department of Employment and Workplace Relations to undertake further research on the impact and effectiveness of sexual and reproductive health leave where it has been implemented in Australia and overseas, while giving consideration to introducing paid gender-inclusive reproductive leave in the National Employment Standards (NES) and modern awards.

The committee recommends that the Australian Government encourage the Australian Medical Council to consider explicitly including menopause and perimenopause in the Graduate Outcome Statements of the Standards for Assessment and Accreditation of Primary Medical Programs. The committee further recommends that menopause and perimenopause be included in graduate outcomes for other health professionals, including nurses and physiotherapists

he committee recommends that the Australian Medical Council work with Medical Deans Australia and New Zealand to ensure that menopause and perimenopause modules are included in all medical university curriculum.

The committee recommends that all governments and the medical colleges work together to require and facilitate further education on menopause and perimenopause for physicians practising in the public health system across Australia.

The committee recommends that the Australian Government considers increasing funding and expand the recipient base for the delivery of incentivised continuing professional development to medical practitioners on perimenopause and menopause.

The committee recommends that the Australian Government consider how to expand the scope of practice of nurse practitioners to ensure better support for women experiencing menopause in rural and regional areas.

The committee recommends that the Department of Health and Aged Care, through the Medicare Benefits Schedule (MBS) Continuous Review, review existing MBS item numbers relevant for menopause and perimenopause consultations, including for longer consultations and mid-life health checks, to assess whether these items are adequate to meet the needs of women experiencing menopause.

The committee recommends that the Australian Government consider whether a new MBS item number or the expansion of criteria for the mid-life health check, is needed to support greater access to primary care consultations for women during the menopause transition.

The committee recommends that the Department of Health and Aged Care, including the Therapeutic Goods Administration, consider action to address the shortages of menopause hormonal therapy (MHT) in the Australian market and consider options to secure sufficient supply, including a review of the supply chains and pricing trends of MHT, with a view to enabling universal affordable access to treatment and care

The committee recommends the Therapeutic Goods Administration continue to monitor the advertising alternative medicines and treatments in Australia and take action as appropriate. The committee further recommends the Department of Health and Aged Care consider reviewing the labelling of TGA approved medicines.

The committee recommends that the Australian Government examine options to implement a means of ensuring that MHT items are affordable and accessible, including consideration of domestic manufacturing and alternate means of subsidising costs to the consumer. Such examination should include, but not be limited to, considering ways to encourage pharmaceutical sponsors to list a broader range of MHT items, such as body identical hormone therapy products, on the Pharmaceutical Benefits Scheme to ensure appropriate access and lowered costs for all women who need it.

The committee recommends that the Pharmaceutical Benefits Advisory Committee (PBAC) reforms comparator selection during evaluation of new MHT items to include quality of life health impacts. The committee also recommends that the PBAC regards body identical hormone therapy products in a separate drug class to remove the lowest cost comparator to synthetic therapies

The committee recommends the Australasian Menopause Society regularly review and update their guidance for medical practitioners around best practices in the treatment and management of mental health symptoms.

The committee recommends that the Australian Government work with state and territory governments to implement or leverage existing women’s health facilities with multidisciplinary care, including in the public health system, to better support women during the menopause transition across Australia.

The committee recommends that organisations tasked with improving menopause care utilise learnings from international best practice.

The committee recommends that the Australian Government investigate improvements to the collection and use of data to assist with research into the experience of menopause and perimenopause, and surveillance of the outcomes of the use of MHT.

The committee recommends that the Australian Government task the National Women’s Health Advisory Council to assist state and territory governments to deliver a National Menopause Action Plan which considers best practices in menopause care

The committee recommends that the Australian Government task the Department of Health and Aged Care and the Department of Employment and Workplace Relations to monitor international best practices to ensure Australia is at the forefront of menopause and perimenopause care.

Feedback from The Australasian Menopause Society (AMS)

he Australasian Menopause Society (AMS) welcomed the findings of the Senate Inquiry into
Menopause and Perimenopause. Specifically, the AMS is delighted to see recommendations relating to increasing education of health care professionals, from student levels right up to specialists, as well as the suggestion of increased funding for the delivery of continued professional development to all medical practitioners.

AMS President Dr Sylvia Rosevear says, ‘This report highlights the importance of the work AMS carries out and how vital it is to our Doctors, Nurses and Allied Health Professionals. We are determined to incorporate evidence-based research in training these professionals. The recommendation to continually improve our highly lauded fact sheets is valued and we’re keen to action this.’

The AMS endorses the recommendation that options be further explored to guarantee that menopausal hormone therapy is made both affordable and accessible to all women who need it, no matter their background or socio-economic status.

AMS are keen to work alongside the Australian Government on the following recommendations:

The suggested awareness campaign on menopause and perimenopause

A study on the economic impacts of menopause, including the impact on women’s workforce participation, and alongside this the development of workplace policies in consultation with employees; and

The proposal that menopause and perimenopause be included in both medical university curriculum and graduate outcomes for health professionals.