The conversation around menopause is growing louder, backed by increasing awareness and policies that are challenging decades of silence and misinformation.
For generations, menopause has been a topic few women dared to talk about openly; an unavoidable stage in life that society taught us to simultaneously dread and ‘deal with’. Despite being experienced universally by middle-aged women, many women are unprepared for their journey into menopause – which isn’t surprising, really, considering this important area of women’s health has been woefully neglected in both medical research and product development.
But things are changing. Menopause is finally stepping into the spotlight. It has become one of the most talked about health topics and is now being recognised as the urgent matter of public policy that it is.
The recent Australian Senate Inquiry into ‘Issues related to menopause and perimenopause’ is paving the wa for greater understanding and support for women. It’s clear: this is not just a personal health issue, but a national health priority.
For women approaching or experiencing menopause, it’s no longer something to suffer through in silence. There are more resources, conversations and treatments available to help navigate this stage than ever before.
Beyond the hot flashes: what really happens during menopause
Menopause marks the end of a woman’s reproductive years, but it’s so much more than the end of periods. It usually happens between the ages of 45 and 55, though perimenopause – the transitional phase leading up to menopause – can start as early as a woman’s mid-30s.
During this time, levels of oestrogen and progesterone, the hormones that have regulated so much of a woman’s body for years, begin to drop. This hormonal decline doesn’t just signal the end of fertility, it sets off a cascade of changes throughout the body.
The symptoms can range from the familiar hot flushes and mood swings to brain fog, sleep disturbances and vaginal dryness. Less well-known symptoms include heart palpitations, joint pain, hair loss and tinnitus. Menopause also brings with it significant changes to skin, hair and body composition. Weight gain, particularly around the abdomen, is common, as is a loss of muscle mass and strength. Many women also notice changes in their hair texture and increased dryness of their skin.
It’s not just about hormones. Menopause is a complex process that affects nearly every system in a woman’s body. Oestrogen, in particular, has far-reaching effects on the body. It influences how the body uses calcium, maintains cholesterol levels in the blood, and protects against cardiovascular diseases. The decline in oestrogen levels and its association with accelerated bone loss and decreased bone mineral density are well established. It has also been linked to increased risk of cardiovascular disease, diabetes and some cancers
Mental health can take a hit, too, with as many as 68 percent of women going through perimenopause developing depressive symptoms. Anxiety can creep in as well, adding to the rollercoaster of emotional and physical changes happening during this time. While there are few studies about anxiety and perimenopause, some evidence finds the incidence of anxiety disorder in menopausal women is as high as 25 percent. Changes in physical health, such as thyroid issues or sleep disturbances due to night sweats, can also contribute to anxiety and depression.
A 2023 report from health fund HCF found more than 70 percent of Australian women aged 45 and over do not feel well informed or prepared for menopause and its symptoms. ‘In Australia, while there is increasing awareness among women about common menopause symptoms like hot flushes and brain fog, understanding of more complex aspects – such as genitourinary syndrome of menopause (GSM) [which includes vaginal dryness, painful intercourse and incontinence] and the effects of oestrogen deficiency on the brain, cardiovascular system, gut microbiome and skin is minimal,’ says Dr Judy Craig, medical director of Natural Looks Cosmetic Medicine in Perth. ‘Also, few women are aware that perimenopause may begin as early as 35 years of age and present with symptoms of anxiety, impaired cognition, depression and insomnia.’
Dr Craig says while there is an increase in awareness of the need for Menopausal Hormone Therapy (MHT), amongst women, many women still leave their GP appointment without a prescription and continue to suffer.
‘Improving education and creating more open dialogues about menopause could help bridge these gaps, enhancing both understanding and support for women navigating this stage of life,’ she says.
Busting myths about hormone therapy
‘There are 3.28 million Australian women aged 40-59 years old today going through varying stages of perimenopause and menopause,’ says Dr Liz Golez, GP-obstetrician and principal cosmetic doctor at Lift Aesthetics in Sydney. ‘Twenty-eight percent of women will experience severe vasomotor symptoms such as hot flushes (the hallmark of menopausal transition/perimenopause and early postmenopause). Despite available safe treatments (hormonal MHT or non-hormonal therapies), more than 85 percent of Australian women bothered by these symptoms fail to receive approved therapy.
‘Genitourinary syndrome of menopause (vaginal dryness, vulvovaginal atrophy, itching, laxity, and incontinence) affects 50 percent of post- menopausal women but only seven percent are prescribed oestrogen therapy.’
For years, hormone replacement therapy(HRT) was the go-to treatment for menopause symptoms – until one 2002 study created mass confusion.
‘The2002 Women’s Health Initiative (WHI) study was reported as showing a link between HRT and breast cancer,’ says Dr Ginni Mansberg, an Australian GP and television presenter with a special interest in menopause and women’s health. ‘Sure, it did – for women with an average age of 63 when starting synthetic high-dose HRT. The quantum of risk? For every 10,000 women on a placebo, we saw 30 breast cancers, but we saw 38 in the takers of HRT. Not a big increase. If you took the group of women who started taking HRT before age 60, there was no increase in risk. But the finer details were just missed by reporters.
‘After this, journalist Barbara Seaman wrote The Greatest Experiment Ever Performed on Women: Exploding the Estrogen Myth. The prevailing view became that taking HRT is deadly and basically an indulgent beauty treatment, that to ask for it showed weakness. Women shut up. Doctors stopped learning about menopause and the whole thing fell under the cone of silence.’
This misinformation has led to decades of confusion and fear around a treatment that could actually help many women. In fact, modern research shows that bioidentical oestrogen therapy can reduce the risk of breast cancer and other serious conditions when managed carefully.
Dr Judy Craig says, ‘A large barrier to positive action to address the medical and economic consequences of oestrogen deficiency (menopause) is a reluctance of organisations, including medical advisory bodies and governments, to embrace the latest research data showing the positive health benefits of menopausal hormonal therapy (MHT). ‘
She argues that only by improving awareness, increasing research funding and fostering open dialogue can we begin to address the gaps in menopause care and support as well as the broader economic and social costs associated with menopause.
‘For change to occur, I believe we need more women in all aspects of management, government, research and education at an executive level and we need them to be informed on the issues facing menopausal women and be aware of the latest research and economic impact,’ she stresses. ‘Increasing public and government awareness may in time precipitate change.’
Medical misogyny: why women’s health has been overlooked
Menopause has long been marginalised as a health concern, deemed insignificant when compared with other medical conditions. It can be argued this stems from societal tendencies to undervalue women’s health issues, particularly those related to ageing.
‘Historically, women’s health issues have been neglected, trivialised and underfunded,’ says Dr Craig. ‘While many are familiar with how the concept of “hysteria” was used to dismiss and pathologise women’s challenges in the 18th and 19th centuries, they may be shocked to realise that before 1993 women were rarely included in clinical trials, leading to a lack of proven data on the effects of many drugs and treatments on women.
‘In addition, there has been little investment in research into women’s health. A report from McKinsey and company stated that approximately one percent of healthcare research and innovation (2021) was invested in female-specific conditions beyond oncology. This neglect of women’s health research has also led to an ignorance of the prevalence of the medical, psychological and economic impact of menopause on women. In 2017 a review of the literature found that there were few studies assessing the impact of menopause transition on women’s careers. Studies addressing the economic impact of menopause transition have predominantly been published since 2022.’
According to a 2023 perspective in Nature Ageing, less than one percent of published studies of the biology of ageing considered menopause. This gap in research translates to gaps in women’s health care.
‘Menopause is inextricably intertwined with ageing in female individuals,’ lead author Fabrisia Ambrosio, PhD, shared in an interview with Harvard Medical Magazine. ‘On average, females will live about a third of their
lives postmenopausal. We lack data to understand how menopause affects ageing and how it might contribute to disease or age-related declines. In preclinical models, it’s something that we just haven’t effectively addressed, and so we haven’t been able to study it well.
‘The science has so much catching up to do. Hundreds of years of research studies have been dominated by male animal models and male humans.’
A new age of menopause awareness
Governments across the world are beginning to recognise menopause as an urgent matter of public policy.
In the UK, where menopausal women are believed to be the fastest-growing workplace demographic, more than 500 workplaces have been certified as ‘menopause-friendly’. Anti- discrimination laws that include menopausal status have also been bolstered, with employers now legally obliged to make ‘reasonable adjustments’ for women going through menopause.
In November 2023 the US government created a Women’s Health Research Initiative to determine gaps and infuse new funding, the first tranche of which is US$100 million. Further, a new bill, the Menopause Research and Equity Act of 2023, has been presented to Congress to ensure commitment to ongoing research related to menopause, perimenopause or mid-life women’s health.
In February 2023 the Australian Government established a National Women’s Health Advisory Council to examine the systemic issues impacting gender inequities in health outcomes and improve Australia’s health system for women and girls. The council will provide strategic advice to the government after looking at the healthcare offered in areas such as menstruation, reproductive healthcare, menopause, medical consent and pain management.
‘As the awareness of the economic impact is very recent, it will take time to translate into affirmative action in many nations,’ says Dr Judy Craig. ‘I believe that the UK has led the way in this regard. The UK government passed the Menopause and the Equality Act in 2010 which details how workers may be impacted by menopause and outlines the legal obligations that employers have under the Act. On 6 March 2023 the Minister appointed Helen Tomlinson as the Government’s DWP Menopause Employment Champion. Tomlinson’s aim is to educate women and encourage employers to sign the Menopause pledge. This is an important step in the process of raising awareness and supporting women in the workforce whilst they navigate the transition to menopause and then manage post- menopausal changes for life.’
How aesthetic clinics are getting involved
Interestingly, aesthetic clinics are emerging as an unexpected source of support for menopausal women. As menopause accelerates the ageing process – manifesting as sagging skin, loss of elasticity and increased dryness – many women turn to cosmetic treatments for help.
‘Menopause care aligns seamlessly with the mission of aesthetics and anti-ageing clinics, which focus on addressing the signs and effects of ageing,’ says Dr Judy Craig. ‘The hormonal changes associated with menopause, particularly oestrogen deficiency, contribute to accelerated skin ageing through collagen degradation.
By offering treatments that address both the hormonal imbalances and their aesthetic consequences, clinics can provide more comprehensive care and significantly benefit their clients.
‘In addition to facial treatments, many devices used for addressing facial ageing, such as radiofrequency or laser therapies, have been adapted to treat vaginal changes associated with menopause. Both areas experience similar issues; loss of mucosal and skin elasticity and thickness, and collagen degradation, making it possible to use these technologies to address concerns in both domains.’
As the conversation around menopause grows, one thing is clear: women deserve better care, more research and a louder voice in this conversation. Menopause isn’t the end – it’s the start of a new chapter. And with the right resources and support, it’s a chapter every woman can and should feel empowered to embrace.
