Time for a national conversation about menopause

4 minute read

A senate inquiry is in motion and it’s a moment for women ‘of a certain age’ to step out of the shadows.

Back on 31 October, HSD broke the news that Greens Senator Larissa Waters had called for a senate inquiry into menopause and perimenopause.

That inquiry has now been set in motion and is due to report in September 2024.

The terms of reference cover issues relating to perimenopause and menopause, including awareness, economic cost, physical impacts, mental and emotional wellbeing, caregiving responsibilities, government policies and programs, and cultural and societal factors.

Professor Jayashiri Kulkarni AM, is professor of psychiatry at Monash University and is also director of the HER Centre Australia. One of her areas of expertise is menopausal depression – a topic that is likely to be on the inquiry’s agenda.

“Depression and anxiety caused by hormone changes during the menopause transition are under recognised and treated poorly,” said Professor Kulkarni in response to the announcement of the inquiry.

“As a result, many women suffer for years. This Senate inquiry will hopefully assist in raising awareness and developing new approaches for women’s mental health issues especially related to menopause.”

I had the pleasure of interviewing Professor Kulkarni late last year when she published an article in Nature about menopausal depression.

“As with many aspects of women’s mental health, menopausal depression is down the bottom of the barrel when it comes to research funding and clinical trials,” she said in that interview with me.

“Patients in this group are caught between two hard rocks.

“On the one hand, there is the misogynistic far right wing which has no interest in women’s health generally.

“On the other hand are the far left-wing feminists who don’t want to talk about hormones, because they don’t want women in leadership positions to be seen as being at the whim of their hormones.”

Oh, that old chestnut.

Got to be in the room where it happens

Call for Senate inquiry into menopause

Not to discount the conditions that afflict men as they grow older, but the many and varied experiences of women going through menopause are something to behold.

Once known as “the change of life” the general edict was that it was something women should just live with while smiling and waving, ensuring that nobody was inconvenienced by the crippling symptoms that hit them like a freight train.

It was a subject whispered about in the company of other women and never talked about in public. There was a healthy dose of shame attached to the so-called “change”.

Fortunately we have come a long way since then but there is still much to be done, especially when it comes to talking about the impact of menopause on a woman’s health and wellbeing. It’s far from just irregular periods and brain fog. And we need to get the full picture on the agenda of our policymakers and health leaders.

Headaches, hot flashes, disturbed sleep, anxiety and depression, mood swings, not to mention the ongoing debates about the long-term effects of treatments for menopause, like hormone replacement therapy – there are a lot of questions to be answered and pathways to be cleared.

Let’s talk about hormone replacement therapy.

“The good news is that hormone treatments such as oestrogen therapy can be an effective way to treat the condition — either as an adjunct to antidepressants or as a solo first-line treatment,” Professor Kulkarni wrote in Nature.

“Yet there remains considerable reluctance to use them; in many cases, a diagnosis of any form of depression still leads to an automatic prescription of an antidepressant.”

That infamous Women’s Health Institute study from 2002 which reported increased risk of breast cancer, heart disease, stroke, and blood clots has been refuted in the 21 years since, but the media attention it got at the time is hard to forget. And that’s part of the problem.

“Once things like that hit the media headlines, it is very difficult to turn things around,” Professor Kulkarni told me.

“Hormone replacement therapy has also advanced, including the development of synthetic selective oestrogen-receptor modulators, which should improve safety.”

Professor Kulkarni is keen to see menopausal depression considered a specific condition as part of clinical guidelines.

“We need more funding for research, particularly head-to-head clinical trials.”

What we also need is a national conversation about how women are treated by the healthcare professions when it comes to perimenopause, menopause and post-menopause.

Let’s hope the Senate inquiry will be the start of that conversation.

Do you have a story tip for us, or a topic you would like to see us cover? Contact the editor at editor@healthservicesdaily.com.au.

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