When it comes to menopause, Australia could learn a thing or two from toothed whales.
The unusual comparison was made by the journalist Imogen Crump in a panel of women with experience of menopause at a Senate inquiry investigating its health and economic effects.
“Only humans and toothed whales go through menopause,” Crump told the inquiry, which began this week in Sydney and Melbourne.
Crump explained that among toothed whales – which include orcas, beluga whales and narwhals – it’s the “older female whales [that] lead the pod”.
She described the female whales as “the peacekeepers, the teachers … showing the next generation migration patterns and food sources”.
In contrast, the inquiry has heard that Australian women in this phase of life are being held back from their full potential because they are not finding adequate support for their health needs from medical professionals. At the same time, commercial interests are attempting to take advantage of the gap by selling them ineffective treatments.
The Greens senator Larissa Waters, who established the inquiry, said “we need evidence-based policies” to help women in workplace and healthcare settings.
More hearings will take place in Brisbane, Canberra and Adelaide before the committee delivers its report in September. So what solutions are on the table so far?
Better education
Kaz Cooke, the author of It’s the Menopause, said Australia needs a public health campaign so people can access evidence-based information. Cooke told the inquiry that menopause was having a moment, but most women only know about it because it’s become a marketing opportunity as “every cowboy and girl in town is coming and trying to sell stuff including that appalling vaginal laser treatment”.
Many women with experience, including Crump, told the inquiry they had heard of menopause but weren’t aware of perimenopause – the time when women are still getting periods but symptoms emerge as the body transitions to menopause. Better education is key, she said. Cooke said information campaigns, one for doctors and one for women, should feed into each other. Armed with the right resources, women can go to their doctor as experts on their own condition, like the empowerment model recommended in the Lancet.
The director of Monash University’s women’s health research program, Prof Susan Davis, endorsed Cooke in her evidence, “particularly the exploitation of women by commercial interests who have jumped on menopause”. Davis said the current situation, where doctors and women are often left confused, was because of a push in the 1990s to prescribe hormone replacement therapy to all women. That was followed by the controversial and misreported 2003 Women’s Health Initiative study, which found a small but significant increase in the risk of breast cancer. That had left doctors “terrified” to prescribe HRT.
Davis said the free Practitioner’s Toolkit for Managing Menopause developed by Monash and endorsed by several key organisations lists every treatment available and its effectiveness. It helps women take good quality information to their doctors, she said.
Incentivise training for healthcare professionals
Women who gave evidence to the lived experience panel of the inquiry said they were dismissed or offered ineffective treatments by healthcare professionals when they sought menopause care. One woman named Sandy said when she asked her GP a question about menopause he told her all he learned in medical school was that menopausal women were either “mad or sad”.
Davis told the inquiry that universities should require all medical students to undertake a compulsory module on midlife women’s health in their curriculum, as Monash University does. She said there is a new generation of young doctors have no idea know what menopause is. “Many pharmacists and GPs are more likely to suggest complementary and alternative therapies they know don’t work better than placebo because they don’t want to have the conversation because they don’t feel confident to have the conversation.”
Of the first 1,000 registrations for the World Congress on Menopause to be held in Melbourne in October aimed at primary practice, only 78 were men, Davis said. Australia needs to incentivise training because often for doctors running a private practice attending additional training comes at personal cost, including to pay a locum to run their practice while they complete training, Davis said. Long consultations and care for women also weren’t incentivised by government Medicare subsidies, she said.
Understand how menopause affects work
Mary Delahunty, the chief executive of the Association of Superannuation Funds of Australia, said menopause affected how much time women spend in the workforce and the amount of money they earn. This contributes to the superannuation gap between men and women, which leaves women worse off at retirement. The inquiry heard of potential policy reform options: the Finance Sector Union of Australia recommended the government amend section 65 (1A) of the Fair Work Act to include the right for a worker suffering from perimenopause or menopausal symptoms to apply for flexible work; while financial services firm Future Group called for mandated menopause leave.
But Delahunty said it was important to first determine the size and scope of the challenge before making policy recommendations. “Only limited research has been undertaken on the impact of menopause transition on work and careers,” Delahunty said, with the studies having “markedly” different findings. The Association of Superannuation Funds of Australia believes a comprehensive survey of Australian women is needed to better inform policy decisions,.
Davis said “a lot of the data” coming out from marketing surveys claiming “women are leaving work in droves because of menopause is inaccurate”. No recent high-quality information existed, she added. Davis said the data now being analysed as part of the Australian Women’s Middle Year’s Study would fill this gap. The study invited a sample of over 8,000 women aged 40 to 69 in every electoral area in Australia to join in a general health study. The random sampling was important, Davis said, as it did not focus on any particular group such as women who are or weren’t working, or those with severe menopausal symptoms.
Use technology
Davis told the inquiry about an app under design for women aged 45 to 59 that will prompt them annually to go through a list identifying their menopause symptoms. That list will then be uploaded to their electronic medical record.
Any symptoms bothering them will then be flagged to their GP, which will form the basis of a consultation. The GP’s software will get prompts from certain words or diagnoses which will direct them to the practitioner’s toolkit for managing menopause.
The research project, MenoPROMPT, is being developed by Monash in collaboration with the University of Melbourne, the peak body for GPs, Jean Hailes and the Australasian Menopause Society. It is now at the test stage.
Better care for induced menopause
Early menopause may occur due to surgery or cancer treatments. This happened to Sonya Lovell, the founder of the podcast, Dear Menopause. She told the inquiry that when her GP was delivering her diagnosis of early-stage breast cancer, the doctor looked at her husband and, addressing him, said: “Sorry, Paul, but Sonya will go into menopause. This might be a rough time for you.”
Lovell felt not just let down by her GP but also her oncology doctors, breast surgeon, and breast cancer care nurse. “Not one showed a good understanding of, or empathy for, the debilitating sudden onset of induced menopause.” Lovell believes government needs to better fund training for all cancer healthcare professionals to support patients experiencing cancer-induced menopause.
Don’t look at menopause as an isolated event
“There aren’t 30 symptoms of menopause,” Davis told inquiry. “There are 30 symptoms of why it’s tough to be a woman at midlife. There are lots of reasons why women get to midlife and are not performing well at work, and it’s not just about menopause.”
She said: “Don’t look at menopause as an isolated event. It happens in the context of what’s happened to a woman before she’s reached menopause and the context of her life at menopause.”
