Findings and recommendations from the senate inquiry into issues related to menopause and perimenopause.
On 6 November 2023, the Senate referred an inquiry into the Issues related to menopause and perimenopause to the Senate Community Affairs References Committee. The report was tabled on 18 September 2024.
The inquiry paid particular reference to:
- the economic consequences of menopause and perimenopause, including but not limited to, reduced workforce participation, productivity and retirement planning;
- the physical health impacts, including menopausal and perimenopausal symptoms, associated medical conditions such as menorrhagia, and access to healthcare services;
- the mental and emotional well-being of individuals experiencing menopause and perimenopause, considering issues like mental health, self- esteem, and social support;
- the impact of menopause and perimenopause on caregiving responsibilities, family dynamics and relationships;
- 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’;
- the level of awareness amongst medical professionals and patients of the symptoms of menopause and perimenopause and treatments, including the affordability and availability of treatments;
- the level of awareness amongst employers and workers of the symptoms of menopause and perimenopause, and the awareness, availability and usage of workplace supports;
- existing Commonwealth, state and territory government policies, programs and healthcare initiatives addressing menopause and perimenopause;
- how other jurisdictions support individuals experiencing menopause and perimenopause from a health and workplace policy perspective.
The inquiry was an extensive and largely bipartisan effort that aimed to gather insights from Australian women across varied and diverse backgrounds nationwide. It also engaged a wide array of business groups, medical organisations, clinicians and health practitioners involved in the employment, treatment and care of women at this stage of their life.
Australian women do not receive adequate menopause and perimenopause support
The committee received 290 submissions and held seven public hearings across Australia, seeking to explore the multitude of issues related to menopause and perimenopause and consider measures to adequately support women during this phase of their lives.
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: in Australia, women do not always receive adequate support to manage their symptoms, both in the health system and in their workplaces.
The report stated: ‘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 percent 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.
‘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.’
‘MENOPAUSE IS A GENDER EQUITY ISSUE BECAUSE WOMEN’S HEALTH IS UNDER-RESEARCHED, RESEARCH INAPPROPRIATELY EXCLUDES FEMALE PARTICIPANTS, AND WOMEN ARE CHRONICALLY UNDERSERVED AND UNDERDIAGNOSED BY MEDICINE.’
– submission to the Senate Committee by the Royal Australian and
New Zealand College of Psychiatrists
Mind the gap: awareness lacking amongst HCPs
In relation to diagnosis and care, over the course of the inquiry the committee learned of the variety of barriers that can exist for patients accessing diagnosis and treatment for perimenopause and menopause symptoms.
The systemic drivers of the lack of diagnosis and access to treatment include a lack of medical awareness and training, difficulties accessing informed healthcare practitioners, availability and length of medical consultations, and access to potential diagnostic tools.
Dr Christina Jang of the Australasian Menopause Society summarised the two key issues, namely training and time: ‘Australian research has shown that many healthcare professionals have significant gaps in their knowledge and training in menopause such as failure to recognise symptoms of menopause and lack of confidence to counsel women about the benefits and risks of menopausal hormone therapy. Many simply lack the time. We can’t do menopause in a 15-minute consultation.’
The issue of menopause training for medical practitioners cannot be underestimated. There are over 38,000 GPs and 1,700 specialist gynaecologists in Australia. However, there are only 877 members of the Australasian Menopause Society.
Medical practitioners have a limited understanding of the variety of presentations of symptoms of perimenopause and menopause. The current level of education received at medical schools is clearly insufficient. The committee was alarmed to hear that most medical students only spent an hour on the topic of menopause during their undergraduate studies, considering it will affect more than half the population. Given the whole-of-body impacts of some menopause and perimenopause symptoms, there is a real need for menopause-specific education to enhance education and awareness across all healthcare disciplines.
Beyond improving undergraduate medical education related to menopause and perimenopause, the Committee recommends that the Australian Government increase funding and expand the recipient base for incentivised continuing professional development (CPD) on perimenopause and menopause. To this end, Jean Hailes for Women’s Health was provided with $1.2 million by the Commonwealth Government to advertise and subsidise CPD for health professionals on managing menopause. This work will be undertaken in collaboration with the Australasian Menopause Society.
‘Women deserve access to medical practitioners who are informed and aware of menopause and its symptoms, and who are confident in providing advice on the best management options currently available,’ the report affirmed. ‘As such, the committee is of the view that initiatives and incentives to ensure better training of medical practitioners should be considered by the Australian Government as well as state and territory governments.’
Coalition senators acknowledged the majority of the findings of the report are ‘sensible and designed to increase public awareness, destigmatise, provide access to treatments and supports, and to encourage further research and foster new pathways for vocation related to menopause and perimenopause.’
With regards to the issue of ‘menopause leave’ in the workplace, the senators firmly articulated their stance: ‘We must be clear that we do not support any recommendations calling for changes to legislation, or to compel the insertion of menopause and perimenopause leave in Australian businesses and organisations.
‘Notwithstanding the abundant evidence received during the inquiry about the general reticence to support the introduction of menopause leave due to the risk of further workplace disadvantage for women, the Coalition is of the belief that the choice and responsibility should fall on the private sector to make determinations as to whether it should include such accommodations as part of an attractive employment package.’
The senate report has been welcomed by women’s health organisations, including Jean Hailes, Monash Women’s Health Alliance and Women’s Health Services Network.
Dr Sarah White, CEO of Jean Hailes, said the report highlights critical areas to improve support and health care for women during and after the menopause transition. ‘We are particularly pleased to see recommendations for improved healthcare professional education, affordable treatments and workplace flexibility.
‘It’s great to see a call for more comprehensive research, particularly on how women from multicultural and First Nations communities experience menopause and the economic impacts of menopause on women’s workforce participation. This information will be fundamental to informing evidence-based policies and support systems.’
Professor Susan Davis AO, Head of the Monash University Women’s Health Research Program, said: ‘The Senate Inquiry into menopause and perimenopause highlights the need for greater understanding of the impact of menopause across the diverse spectrum of people who are affected by this life phase. As I was quoted as saying in the report: ‘we are walking blind’.
‘Having more research as the first recommendation of the report puts the need for greater knowledge at the front and centre of improving health care provider training, health care delivery and policies, such as workplace policies, that impact Australians with respect to menopause.
‘It is also noteworthy that the committee recognises that work engagement for midlife women is not simply about ‘fixing menopause’ but that research is needed to elucidate the other, possibly more substantial, determinants of workforce participation and satisfaction for midlife women.’
List of recommendations
Recommendation 1
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.
Recommendation 2
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.
Recommendation 3
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 Healthand Physical Education learning area.
Recommendation 4
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.
Recommendation 5
The committee recommends that the Australian Government introduce reforms to allow the Workplace Gender Equality Agency to re- commence data collection on the supports employers are providing, and their usage, for employees experiencing menopause and perimenopause, including specific workplace policies.
Recommendation 6
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.
Recommendation 7
The committee encourages Australian workplaces develop perimenopause and menopause workplace policies in consultation with their employees.
Recommendation 8
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.
Recommendation 9
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.
Recommendation 10
The 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 curriculums.
Recommendation 11
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.
Recommendation 12
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.
Recommendation 13
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.
Recommendation 14
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.
Recommendation 15
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.
Recommendation 16
The committee recommends that the Department of Health and Aged Care, including the Therapeutic Goods Administration (TGA), 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.
Recommendation 17
The committee recommends the TGA continue to monitor the advertising of 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.
Recommendation 18
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.
Recommendation 19
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 recommends that the PBAC regards body-identical hormone therapy products in a separate drug class to remove the lowest cost comparator to synthetic therapies.
Recommendation 20
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.
Recommendation 21
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.
Recommendation 22
The committee recommends that organisations tasked with improving menopause care utilise learnings from international best practice.
Recommendation 23
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.
Recommendation 24
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.
Recommendation 25
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.
