Chapter 1Introduction

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.[1]

1.1From 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.[2]

1.2To 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.

1.3Every 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.

1.4Evidence 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.

1.5It 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.

1.6During 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.

Referral of the inquiry

1.7On 6 November 2023, the following matter was referred to the Senate Community Affairs References Committee (the committee) for inquiry and report by the first sitting Tuesday in September 2024:

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.[3]

1.8On 1 July 2024, the Senate granted an extension of time to report until17September 2024.[4] On 17 September 2024, the Senate granted an extension of time to report until 18 September 2024.[5]

Conduct of the inquiry

1.9Details of the inquiry were published on the committee’s website and the committee invited a number of organisations and individuals to lodge submissions. The committee received 290 submissions, which are listed at Appendix 1.

1.10The committee held seven public hearings, and one site visit, across Australia:

17 June 2024 – Sydney, New South Wales;

18 June 2024 – Melbourne, Victoria;

29 July 2024 – Brisbane, Queensland (including a site visit to the Menopause Centre in Greenslopes);

30 July 2024 – Canberra, Australian Capital Territory;

5 August 2024 – Adelaide, South Australia;

6 August 2024 – Perth, Western Australia; and

13 August 2024 – Canberra, Australian Capital Territory.

1.11A list of witnesses who gave evidence at the public hearings is available at Appendix 2.

1.12In this report, references to Committee Hansard are to the proof transcripts. Page numbers may vary between proof and official transcripts.

Structure of this report

1.13This report is comprised of five chapters, as outlined below:

This chapter sets out general information outlining the conduct of the inquiry and provides background information pertaining to perimenopause and menopause, its symptoms, health impacts and effects.

Chapter 2 focuses on the experiences of menopause and perimenopause. It examines the lack of awareness and understanding surrounding perimenopause and menopause, in addition to social impacts and differing cultural perspectives and experiences.

Chapter 3 discusses the impact of perimenopause and menopause on a woman’s working life and its economic consequences, including retirement age, workplace promotions, and superannuation accumulation. It also investigates menopause leave and flexible working arrangements.

Chapter 4 explores the challenges to diagnose and manage perimenopause and menopause. It examines a lack of medical awareness and training, midlife as an opportunity for preventative healthcare and potential tools that could assist in diagnosis. Additionally, the chapter outlines available treatments and their associated costs and barriers to access, alternative and complementary therapies and the advertisement and regulation of some other therapies.

Chapter 5 investigates current federal and state government approaches to addressing issues related to menopause and perimenopause. The chapter also explores international approaches, and considerations raised by inquiry participants for policy makers.

Acknowledgements

1.14The committee thanks all those who contributed to the inquiry by making submissions, providing additional information, appearing at public hearings and facilitating the site visit.

1.15In particular, the committee thanks those submitters and witnesses who shared their moving, and sometimes challenging, lived experiences with perimenopause and menopause. The committee appreciates the courage and generosity of these individuals in sharing their personal stories.

1.16These personal testimonies have been vital in deepening the committee’s understanding of the issues related to menopause and perimenopause across Australia and have helped inform the recommendations of this report, which aim to improve outcomes for women and their families, into the future.

Note on the terminology used in this report

1.17Throughout this report, the term ‘woman’ or ‘women’ is used broadly.[6]

1.18This report uses the term ‘perimenopause’. The committee is aware that ‘menopause transition’ and ‘post menopause’ have important biological differences, which the term perimenopause can fail to capture.[7] However, to remain in line with the inquiry’s terms of reference, perimenopause is used in this report to refer to both the menopause transition and the first year after menopause.

1.19In this report, the terms ‘menopause’, ‘menopausal’ and ‘perimenopause’ are used broadly as terms encompassing the menopause transition and the final menstrual period for ease of readability throughout the report. However, for clarity, the specific terms and their biological implications are explained in detail below.

What is the menopause and perimenopause?

1.20Menopause refers to a woman’s final menstrual period, which is identified after one year without menstruation.[8] Perimenopause, also known as the ‘menopause transition’,[9] refers to the phase prior to a woman’s final menstrual period which commences when menstrual cycles start to vary in length by seven or more days,[10] and includes the year after the final menstrual period.[11] Submitters highlighted that as the identification of the menopause is driven by menstrual cycles, it can be more difficult to identify onset in women with irregular menstrual cycles.[12]

1.21Several inquiry participants also noted that the perimenopause phase can last for years before reaching menopause.[13] The Australasian Menopause Society (AMS), submitted that ‘perimenopause can last 4–7 years’ and therefore it is ‘common for women in their mid-forties to be entering perimenopause’.[14]

1.22The Australian Academy of Health and Medical Sciences provided a useful visual for understanding the phases of the menopause transition:

Source: Australian Academy of Health and Medical Sciences, Submission 27, p. 4.

1.23A number of submitters highlighted the ongoing nature and effects of menopause where it was explained that women continue to experience the impacts of menopause beyond the perimenopause period.[15]

1.24Professor Elizabeth Hill and Ms Sydney Colussi highlighted that symptoms can still be experienced during the post-menopause phase, but often at a lower frequency or intensity.[16] Inquiry participants also noted that given Australian women’s increased life expectancy, Australian women are now, on average, living more than one third of their lives in the post menopause phase.[17]

Physiological changes

1.25Perimenopause and menopause signal a change in the body’s hormonal production.[18] Estrogen, progesterone and testosterone are hormones that ‘sharply’ decline when a woman undergoes her final ovulation at menopause.[19]

1.26Leading up to menopause, joint submitters Chelvanayagam, Bouse, Cotellessa, and de Lacy noted that ‘the normal rise and fall of the menstrual cycle becomes chaotic in perimenopause (for around 10 years)’.[20] They elaborated that the receptors for these hormones are found throughout ‘every tissue of a woman’s body’ and therefore fluctuations and declines in these hormones can cause ‘widespread physical and mental impacts’.[21]

1.27The Victorian Women’s Trust explained the consequences of these hormonal changes, informing the committee that:

… during late-stage perimenopause and menopause diminished oestrogen causes an increase in the levels of the hormones Follicle-stimulating Hormone (FSH) and Luteinising Hormone (LH). The brain centre that secretes these hormones, the hypothalamus, directs many bodily functions, including body temperature, sleep patterns, metabolic rate, mood and reaction to stress, so with higher levels of FSH and LH all these can be disturbed, including causing the very common hot flushes.[22]

1.28Dr Fatima Khan, a Melbourne based menopause specialist, similarly described menopause as a ‘multi-organ syndrome’ in which a decline in reproductive hormones ‘causes symptoms affecting multiple organs including the brain, heart, bone, skin, gut, pelvic floor, bladder, etc’.[23]

Age at menopause

1.29The Royal Australian College of General Practitioners (RACGP) outlined that people in their early 50s will ‘typically’ start to experience menopause, but that it can occur earlier in certain populations.[24] For example, the Australian Longitudinal Study on Women’s Health (ALSWH) explained that women from African, Latin American, Asian and Middle Eastern countries typically experience menopause earlier.[25]

1.30ALSWH went on to explain that in Australia, the average age at menopause is 51 years old.[26] The menopause transition usually starts at around 47 years of age and typical symptoms, such as hot flushes and night sweats, continue on average for seven years.[27] Menopause experienced before the age of 45 is considered ‘early’ and before 40 as ‘premature’.[28]

1.31The ALSWH outlined that ‘age at menopause is an important indicator of future health and ageing’.[29] For example, and as further discussed below, the Monash Centre for Health Research and Implementation (MCHRI) explained that:

… the menopause and menopause transition is a time of accelerated cardiometabolic and osteoporosis risk. These adverse impacts are even greater in women with early menopause, especially those with medically induced early menopause.[30]

Early menopause

1.32There is a proportion of women who will experience early menopause, as a result of biological factors, medical treatments or surgical intervention.

1.33The ALSWH indicated that the risk of experiencing biological early menopause can be increased by a range of factors, including:

smoking;

being underweight;

never giving birth;

infertility;

recurrent miscarriages or stillbirth; and

‘having a reproductive history including a first period before age 11’.[31]

Primary ovarian insufficiency and biological early menopause

1.34The Women’s Health Services Network identified that approximately 12 per cent of women experience early menopause (between the ages of 40–44 years) and/or primary ovarian insufficiency (before age 40).[32] It noted that experiences of primary ovarian insufficiency (POI) are also often difficult to diagnose and can result in delays in diagnosis and treatment.[33]

1.35The committee heard evidence that women who experience premature menopause are at enhanced risk of developing cardiovascular disease, depression, osteoporosis and type two diabetes.[34]

1.36POI can occur for girls who have never had a period, through to women in their teens, twenties or thirties.[35] Importantly, women with POI often have more severe menopause symptoms and psychological distress and are at a higher risk of chronic disease.[36]

Medically induced menopause

1.37While menopause is a natural biological occurrence for all women, some women may undergo surgical and other health interventions, resulting in medically induced menopause.

Cancer treatment

1.38Cancer Australia informed the committee that early menopause can be triggered as a result of cancer treatment, especially for breast, endometrial and ovarian cancers.[37] It explained that treatments of gynaecological and oestrogen-dependent cancers can include surgery, ovarian suppression and/or endocrine therapies, which can cause temporary or permanent menopause in women.[38] Chemotherapy and radiation are also ovarian suppressing treatments which can induce permanent menopause.

1.39Further, evidence indicated that menopause after cancer treatment may be more severe than for those experiencing non-cancer induced menopause.[39] This parallel was also drawn by other submitters, which indicated that more women are surviving cancer now, and thus more women are experiencing early or induced menopause.[40]

1.40Cancer Australia also noted that in addition to surgery, other treatments for gynaecological and oestrogen-dependent cancers such as ‘ovarian suppression and/or endocrine therapies’ can result in ‘temporary menopausal symptoms or permanent menopause’.[41]

Surgically induced menopause

1.41Surgically induced menopause occurs through the process of a bilateral salpingo-oophorectomy, where both ovaries are removed, which can trigger menopause.[42] Menodoctor, a New Zealand based specialist menopause clinic, explained that ‘unlike natural menopause, there is no perimenopause phase’ which results in a sudden loss of hormones and potentially more ‘intense’ symptoms.[43]

1.42Submitters advised that oophorectomy can be a recommended course of treatment for women at high inherited risk of breast and ovarian cancer.[44]Some women spoke to their experiences of having oophorectomy to treat pre-menstrual dysphoric disorder (PMDD) or endometriosis.[45]

1.43An oophorectomy is often carried out in conjunction with a hysterectomy.[46] Surgical menopause is also associated with increased risks of cardiovascular disease, diabetes and depressive symptoms.[47]

1.44The ALSWH raised that bilateral oophorectomy used to be ‘commonly performed at the time of a hysterectomy for benign diseases to prevent ovarian cancer’; however, this is no longer recommended unless a woman has a ‘high inherited risk of ovarian cancer’.[48]

Symptoms of perimenopause and menopause

1.45Symptoms of perimenopause and menopause are highly variable, but a range of submitters noted ‘common’ symptoms of menopause and perimenopause include:

vasomotor symptoms (hot flushes or night sweats);

sleep difficulties;

fatigue;

muscle and joint aches/pains;

brain fog;

anxiety;

depression;

irritability;

urogenital symptoms;

headaches;

low libido;

pelvic pain;

breast tenderness;[49]

paresthesia;[50] and

gum disease.[51]

1.46Women can also experience genitourinary syndrome of menopause (GSM) which encompasses a range of genital and urinary symptoms, including discomfort, vaginal dryness, sexual and pelvic pain, urinary incontinence and prolapse.[52]

Challenges in defining symptoms

1.47Some submitters raised that there are various issues and challenges ascribing concrete definitions of menopausal symptoms.[53] Jean Hailes for Women’s Health (Jean Hailes), a female-focused health and wellbeing not-for-profit, asserted that ‘attempting to define and describe a broad set of menopausal symptoms is not helpful because menopause is a biopsychosocial issue’.[54]

1.48It elaborated that comprehensive reviews have found that the consistency of symptoms across various factors (for example culture, race and ethnicity) and ‘consistency of risk factors for symptoms, found no evidence of a common menopause syndrome’.[55]

1.49 Dr Gabriela Berger and Dr Anita Peerson similarly contended that:

There is no consensus on definitive menopause symptoms, ranging from hot flushes and night sweats to dozens of vasomotor, physical, urogenital, and psychological symptoms. … Most studies provide a snapshot of menopausal symptoms at a discrete point in time and disregard a whole of lifecycle approach.[56]

1.50Professor Martha Hickey, the lead for menopause services at the Royal Women’s Hospital, emphasised that ‘uncertainty’ and ‘confusion’ about menopause symptoms are ‘major barrier[s] to evidence-based diagnosis and clinical care’. Professor Hickey highlighted that:

Establishing what symptoms are attributable to menopause is an urgent priority. This will require systematic review of prospective studies as people transition through menopause and beyond.[57]

Unique experiences

1.51Several submitters highlighted that the menopause and perimenopause experience is different and unique to each woman.[58]

1.52Council on the Ageing (COTA) Australia, a peak body that represents Australians over 50, explained that changing hormone levels ‘can produce different symptoms’, with some women experiencing no symptoms while others can undergo moderate to severe symptoms.[59] For example, Victorian Women’s Trust submitted that many women will not be ‘particularly symptomatic’ while others may experience ‘hot flushes and night sweats, insomnia, fatigue and loss of zest’ amongst other symptoms.[60]

1.53This variability in experience and impact on an individual was also detailed by Research Australia, as it noted:

There is enormous variation in the physical symptoms, the duration and onset of menopause and perimenopause. There is variation in the severity of symptoms, the extent to which they are debilitating for any one individual, and the impact they have on an individual’s identity, self-esteem, mental health and wellbeing. There is also variability in how perimenopause and menopause interact with other diseases (chronic and acute) and the impact of lifestyle factors like diet and smoking.[61]

Health impacts and effects

1.54The time of life at which the menopause transition occurs intersects with a time of mid-life health that includes ‘an increasing risk of metabolic diseases including diabetes and cardiovascular disease, breast and bowel cancer, and osteoporosis’.[62]

1.55Inquiry participants highlighted to the committee that menopause (including premature, early and post menopause) and its associated reduced oestrogen production may increase certain health risks, most notably cardiovascular disease, diabetes, osteoporosis, some cancers and dementia across the life course post-menopause.[63]

Osteoporosis

1.56The AMS reported that oestrogen is an important hormone for maintaining bone strength, therefore when its levels drop, ‘accelerated bone loss occurs’.[64] It noted that ‘the average woman loses around 10 per cent of her bone mass in the first five years after menopause’, and this loss can lead to osteoporosis.[65]

1.57Both Healthy Bones Australia and AMS outlined that early menopause is a risk factor for osteoporosis,[66] and therefore ‘intervention at peri/menopause can reduce the risk of osteoporosis, fractures and morbidity’.[67]

Cardiovascular health

1.58Perimenopause and menopause can be a time of increased risk for women in relation to cardiovascular health, with emerging risks associated with cardiovascular disease.[68] This increased risk is associated with the lower production of oestrogen.[69]

1.59Further, the loss in oestrogen causes the body to redistribute fat from the hips to the waist.[70] The AMS explained the consequences of this fat redistribution, noting:

This fat redistribution can increase the risk of metabolic syndrome, which includes obesity, high blood pressure, high blood sugar and abnormal cholesterol levels. Metabolic syndrome is associated with increased cardiovascular disease risk.[71]

1.60The AMS also noted that ‘the increase in sleep disorder at midlife can also increase cardiovascular disease risk’.[72]

1.61Moreover, the Monash Women’s Health Research Program outlined that cardiovascular disease is the leading cause of death in postmenopausal women.[73]

Diabetes and some cancers

1.62Pertaining to diabetes, Newson Health Group Limited advised that the ‘biochemical changes’ that result from low oestrogen levels can cause increased insulin production by the pancreas, increased insulin resistance and increased risk of type 2 diabetes.[74]

1.63The AMS noted that the risk of ‘metabolic syndrome’ also causes an increased risk in ‘type 2 diabetes mellitus and many cancers, which both cause significant morbidity and mortality’.[75]

1.64Further, the Monash Women’s Health Research Program emphasised:

Diabetes is increasing in women and the adverse outcomes conferred by diabetes are considerably greater in women than men.[76]

Neurological health

1.65There is some evidence to suggest that women are at a higher risk of developing dementia the longer they live in the post menopause period.[77] However, certain menopause treatments, such as menopause hormonal therapy (MHT), when used within five years of the last menstrual period, may have protective qualities for brain health.[78]

Mental health impacts

1.66Menopause can also directly contribute to adverse mental health outcomes. DrFatima Khan explained that cognitive difficulties, such as brain fog, and mental health challenges can be one of the first indications of menopause occurring.[79] For some women, the committee heard that menopause can induce experiences of depression or anxiety.[80]

1.67Some submitters also discussed that the emergence of physical menopause symptoms, such as hot flushes and sleep disturbances, may exacerbate or contribute to mental health symptoms.[81]

1.68The mental health symptoms of menopause can also have broader impacts, including loss of confidence, as well as challenges in the workplace or feeling unable to continue to perform in a professional setting.[82]

Footnotes

[1]Affiliation of Australian Women’s Action Alliances, Submission 31, p. 10.

[2]See, for example, Senate Community Affairs References Committee, Ending the postcode lottery: Addressing barriers to sexual, maternity and reproductive healthcare in Australia, May 2023; Senate Community Affairs References Committee, Number of women in Australia who have had transvaginal mesh implants and related matters, March 2018.

[3]Journals of the Senate, No. 77, 6 November 2023, p. 2217.

[4]Journals of the Senate, No. 116, 1 July 2024, p. 3555.

[5]Journals of the Senate, No. 133, 17 September 2024, p. 4032.

[6]These terms are used in recognition that most people who experience perimenopause and/or menopause identify as women. Notwithstanding this, the committee acknowledges that sex and gender are distinct concepts, and that perimenopause and menopause are also applicable to individuals that do not identify as women, including trans, gender-diverse and non-binary people.

[7]Professor Susan Davis, Director, Monash University Women’s Health Research Program, Committee Hansard, 18 June 2024, p. 10.

[8]See, for example, Royal Australian College of General Practitioners (RACGP), Submission 1, p. 3; Monash Women’s Health Research Program, Submission 11, p. 3.

[9]RACGP, Submission 1, p. 3.

[10]See, for example, Monash Women’s Health Research Program, Submission 11, p. 3; Department of Health and Aged Care, Submission 15, p. 4; Organon, Submission 24, pp. 2–3; Dr Fatima Khan, Submission 46, p. 1.

[11]See, for example, RACGP, Submission 1, p. 3; Sexual Health and Family Planning ACT, Submission 102, p. 3; Australian Medical Association, Submission 115, p. 1.

[12]See, for example, Monash Women’s Health Research Program, Submission 11, p. 3; Australian Academy of Health and Medical Sciences, Submission 27, p. 4.

[13]See, for example, Dr Fatima Khan, Submission 46, p. 1; Dr Ceri Cashell, Submission 44, [p. 5]; Metluma, Submission 56, Attachment 1, [p. 10]; AIA Australia, Submission 101, [p. 3]; Australasian Menopause Society, Submission 177, p. 23; Royal Australian and New Zealand College of Gynaecologists and Obstetricians, Submission 140, p. 2.

[14]Australasian Menopause Society, Submission 177, p. 23.

[15]See, for example, Maridulu Budyari Gumal, Submission 109, p. 7; Dr Ceri Cashell, Submission 44, [p.6]; Menodoctor, Submission 39, p. 10.

[16]Professor Elizabeth Hill and Ms Sydney Colussi, Submission 48, p. 18.

[17]See, for example, National Council of Women, Submission 161, p. 4; Australian College of Rural and Remote Medicine, Submission 12, p. 1; Menodoctor, Submission 39, p. 4; NSW Government, Submission 53, p. 3; Maridulu Budyari Gumal, Submission 109, p. 3.

[18]See, for example, Dr Fatima Khan, Submission 46, pp. 1–2; Chelvanayagam, Bouse, Cotellessa, and de Lacy, Submission 59, p. 4; Victorian Women’s Trust, Submission 99, p. 20.

[19]Chelvanayagam, Bouse, Cotellessa, and de Lacy, Submission 59, p. 4.

[20]Chelvanayagam, Bouse, Cotellessa, and de Lacy, Submission 59, p. 4.

[21]Chelvanayagam, Bouse, Cotellessa, and de Lacy, Submission 59, p. 4.

[22]Victorian Women’s Trust, Submission 99, p. 20.

[23]Dr Fatima Khan, Submission 46, p. 1.

[24]RACGP, Submission 1, p. 3.

[25]Australian Longitudinal Study on Women’s Health, Submission 35, p. 3.

[26]Australian Longitudinal Study on Women’s Health, Submission 35, p. 3.

[27]Professor Martha Hickey, Submission 138, p. 3.

[28]RACGP, Submission 1, p. 3.

[29]Australian Longitudinal Study on Women’s Health, Submission 35, p. 5.

[30]Monash Centre for Health Research and Implementation (MCHRI), Submission 34, p. 5.

[31]Australian Longitudinal Study on Women’s Health, Submission 35, p. 3.

[32]Women’s Health Services Network, Submission 149, p. 11.

[33]See, for example, Women’s Health Services Network, Submission 149, p. 11; Australasian Menopause Society, Submission 177, p. 20; Professor Roger Hart, Director, Menopause Alliance Australia, Committee Hansard, 6 August 2024, p. 16.

[34]See, for example, Department of Health and Aged Care, Submission 15, p. 6; Viv Health, Submission 5, [p. 3]; Australian Longitudinal Study on Women’s Health, Submission 35, p. 3;Women’s Health & Equality, Submission 113, [p. 2].

[35]Clinical Associate Professor Amanda Vincent, Early Menopause Lead, Monash Centre for Health Research and Implementation, Committee Hansard, 29 July 2024, p. 18.

[36]Clinical Associate Professor Amanda Vincent, Early Menopause Lead, Monash Centre for Health Research and Implementation, Committee Hansard, 29 July 2024, p. 18.

[37]Cancer Australia, Submission 38, p. 1.

[38]Cancer Australia, Submission 38, pp. 3–4.

[39]See, for example, The Royal Women’s Hospital Melbourne, Submission 33, p. 5; Australian Nursing and Midwifery Federation, Submission 163, p. 5; Chelvanayagam, Bouse, Cotellessa and de Lacy, Submission 59, p. 5; Research Australia, Submission 98, p. 7; Sexual Health and Family Planning ACT, Submission 102, p. 3; Professor Martha Hickey, Submission 138, p. 7.

[40]See, for example, Monash Centre for Health Research and Implementation, Submission 34, p. 1; Professor Martha Hickey, Submission 138, p. 37.

[41]Cancer Australia, Submission 38, p. 3.

[42]Professor Martha Hickey, Submission 138, p. 35.

[43]Menodoctor, Submission 39, p. 37.

[44]See, for example, Cancer Australia, Submission 38, p. 3; University of Melbourne, Submission 105, p. 8; Professor Martha Hickey, Submission 138, p. 7; Australian Longitudinal Study on Women’s Health, Submission 35, pp. 7–8.

[45]See, for example, Name withheld, Submission 215, [p. 2]; Naomi, Submission 196, [p. 1].

[46]Australian Longitudinal Study on Women’s Health, Submission 35, p. 5.

[47]Australian Longitudinal Study on Women’s Health, Submission 35, p. 12.

[48]Australian Longitudinal Study on Women’s Health, Submission 35, pp. 7–8.

[49]See for example, Sexual Health and Family Planning ACT, Submission 102, p. 3; Women’s Health and Equality Queensland, Submission 113, [p. 2]; Australian College of Rural and Remote Medicine, Submission 12, p. 2; Queensland Nurses and Midwives Union, Submission 107, p. 5; Newson Health Group, Submission 18, pp. 1–2; Australian Longitudinal Study on Women’s Health, Submission 35, p. 3; Chelvanayagam, Bouse, Cotellessa and de Lacy, Submission 59, p. 5; Urological Society of Australia and New Zealand, Submission 108, p. 2.

[50]Australian Menopause Centre, Tingling Extremities, www.menopausecentre.com.au/tingling-extremities/#:~:text=Tingling%20extremities%20during%20menopause,-Tingling%20extremities%2C%20medically&text=In%20more%20mild%20cases%2C%20tingling,normal%20after%20compression%20is%20relieved (accessed 16 September 2024).

[51]Dr Alistair Graham, ‘Does menopause affect teeth and gums?’ Mona Vale Dental, 11 May 2023, www.monavaledental.com.au/does-menopause-affect-teeth-and-gums/ (accessed 16 September 2024).

[52]See, for example, Australian Physiotherapy Association, Submission 10, [p. 5]; Chronic UTI Australia, Submission 22, p. 1; Urological Society of Australia and New Zealand, Submission 108, [p. 1].

[53]See, for example, Dr Gabriela Berger and Dr Anita Peerson, Submission 52, p. 3; Professor Martha Hickey, Submission 138, p. 5; Jean Hailes for Women’s Health, Submission 119, p. 27.

[54]Jean Hailes for Women’s Health, Submission 119, p. 27.

[55]Jean Hailes for Women’s Health, Submission 119, p. 27.

[56]Dr Gabriela Berger and Dr Anita Peerson, Submission 52, p. 3.

[57]Professor Martha Hickey, Submission 138, p. 5.

[58]See, for example, Gabriela Berger and Anita Pearson, Submission 52, p. 7; Sage Women’s Health, Submission 100, p. 1; Australian Medical Association, Submission 115, p. 1; The Office for Women, Submission 135, p. 2; Chief Executive Women, Submission 136, p. 4; Australasian Menopause Society, Submission 177, p. 2.

[59]COTA Australia, Submission 165, p. 10.

[60]Victorian Women’s Trust, Submission 99, p. 20.

[61]Research Australia, Submission 98, p. 6.

[62]RACGP, Submission 1, p. 4. See, for example, Australian Psychological Society, Submission 6, p.3; Newson Health Group Limited, Submission 18, pp. 4–5; Australian Association of Psychologists, Submission 21, [p. 1].

[63]See, for example, Australian College of Rural and Remote Medicine, Submission 12, p. 2; Australian Longitudinal Study on Women’s Health, Submission 35, pp. 3 and 10–11; Besins Healthcare, Submission 146, [p. 4]; Private Healthcare Australia, Submission 155, p. 3; The Society of Hospital Pharmacists of Australia, Submission 3, p. 3; Women’s Health and Equality Queensland, Submission 113, [p. 2]; Queensland Nurses and Midwives Union, Submission 107, p. 5; Australasian Menopause Society, Submission 177, p. 2; Monash University Women’s Health Research Program, Submission 11, p. 2.

[64]Australasian Menopause Society, Submission 177, p. 12.

[65]Australasian Menopause Society, Submission 177, p. 12.

[66]See, for example, Healthy Bones Australia, Submission 132, [p. 1]; Australasian Menopause Society, Submission 177, p. 12; Dr Roy Watson, Proxy for Chair, Gynaecology Community of Practice, Strategic Executive Committee, SA Health Maternal, Neonatal & Gynaecology Community of Practice, Committee Hansard, 5 August 2024, p. 36.

[67]Australasian Menopause Society, Submission 177, p. 12.

[68]See, for example, Maridulu Budyari Gumal, Submission 109, p. 3; Women’s Health and Equality Queensland, Submission 113, [p. 2]; Jean Hailes for Women’s Health, Submission 119, p. 6; Women’s Health in the South East, Submission 120, [p. 11]; Avalon Family Medical Practice, Submission 142, [p. 4]; Australasian Menopause Society, Submission 177, pp. 2 and 12–13.

[69]Besins Healthcare, Submission 146, [p. 4]. See, for example, Department of Health Victoria, Submission 14, pp. 4–5; Australasian Menopause Society, Submission 177, pp. 2 and 12–13.

[70]Australasian Menopause Society, Submission 177, p. 13.

[71]Australasian Menopause Society, Submission 177, p. 13.

[72]Australasian Menopause Society, Submission 177, p. 13.

[73]Monash Women’s Health Research Program, Submission 11, p. 4.

[74]Newson Health Group Limited, Submission 18, p. 5. See, for example, Avalon Family Medical Practice, Submission 142, [p. 4]; Private Healthcare Australia, Submission 155, p. 3; Australasian Menopause Society, Submission 177, pp. 2 and 13; RACGP, Submission 1, p. 4; Society of Hospital Pharmacists of Australia, Submission 3, [p. 3].

[75]Australasian Menopause Society, Submission 177, p. 13.

[76]Monash Women’s Health Research Program, Submission 11, p. 4.

[77]Newson Health Group Limited, Submission 18, p. 5. See also, for example, Royal Australian and New Zealand College of Psychiatrists, Submission 19, p. 3; Monash Centre for Health Research and Implementation, Submission 34, p. 22; Menodoctor, Submission 39, p. 35.

[78]Viv Health, Submission 5, [p. 4].

[79]Dr Fatima Khan, Submission 46, [p. 2].

[80]See, for example, Dr Fatima Khan, Submission 46, [p. 1]; Chelvanayagam, Bouse, Cotellessa and de Lacy, Submission 59, pp. 7–8; Sage Womens Health, Submission 100, [p. 4]; HER Centre Australia, Submission 8, [p. 4]; Professor Jayashri Kulkarni, Director, HER Centre Australia, Monash University, Committee Hansard, 30 July 2024, p. 10; Maridulu Budyari Gumal, Submission 109, p. 6; Women’s Health in the South East, Submission 120, pp. 12–13.

[81]See, for example, Women’s Health in the South East, Submission 120, p. 13; Diversity Council of Australia, Submission 133, p. 3.

[82]See, for example, Dr Keturah Hoffman, Submission 76, [p. 1]; Queensland Nurses and Midwives Union, Submission 107, p. 6; Women’s Health Road, Submission 117, [p. 3]; UnionsWA, Submission 152, p. 1; Women in STEMM Australia, Submission 154, p. 36; Community and Public Sector Union, Submission 158, p. 6; Australian Nursing and Midwifery Federation, Submission 163, p.5; Queensland Unions, Submission 166, p. 2; Health Care Consumers, Submission 170, p. 21.