The Landscape of Menopause in WA

There certainly is a lot of buzz around perimenopause and menopause at the moment. Oprah’s talking about it, Gwyneth, Naomi, Myf, Mia, and Ali to name a few. These women who were at the pinnacle of their careers when we were growing up are now helping to shine a light on this much stigmatised topic. Menopause is no longer the past used by date state of being for women in their midlife. It’s the age of enlightenment and empowerment where women can roar beyond their fertile years. Or is it?

Many women who cross the GP’s threshold are utterly depleted: suffering from carer fatigue; nurturing their own children and partners, their ageing parents, friends, colleagues, and everyone but themselves. Women are socially conditioned to persevere regardless and place themselves at the bottom of the pile. There is mounting pressure to hold it all together whilst emanating a façade of perfection in all arenas. A lot of us segue from childbearing at an older age to the early phases of perimenopause and wonder why life starts to unravel. Some women face premature menopause not long after they have even contemplated their fertile potential. Sure, menopause is natural, but living beyond it for decades is not. 

‘The Menopause Gold Rush’ is well amongst us in WA and every cream, shake, supplement, diet and exercise plan that appears on our algorithm promises eternal youth and the journey through menopause a breeze. Often coming at a considerable cost however, we know that these offerings are sometimes not sufficient enough for severe symptoms. On the positive side, social media has allowed for some Australian ‘menopause champions’ to spread the good word with sound medical advice. Given that women make up so much of our work force, acknowledgement of menopause in the workplace is also finally becoming a reality as well. But where in Perth can women go when they actually need a doctor to sit down with them to address their individual challenges with perimenopause and menopause?

We know all biological women will ultimately go through menopause. Twenty percent will sail through relatively unscathed. Eighty percent, however, will struggle with variations of every conceivable symptom known to the human body. Menopause isn’t just about hot flushes and being grumpy. The effect of oestrogen fluctuation during perimenopause can cause palpitations, profound fatigue, crawling feelings under the skin, broken sleep, wild mood swings, torrential periods, burning mouth syndrome and more. 

We are aware that oestrogen depletion at menopause can contribute to rapid muscle and bone loss, cognitive decline, elevated cholesterol and poor glucose metabolism. It’s no wonder that the diseases women die of might be related to oestrogen deficiency.

Over twenty years ago the Women Health Initiative study came out which sent the women’s rights movement backpedalling.

This widely publicized study was so far reaching that it completely turned GP’s, specialists, and women alike off hormone replacement therapy (HRT) and it halted any conversation around menopause in society. Dr Margaret Smith, a pioneering Perth based gynaecologist did so much to educate GP’s and specialists about menopause through the decades prior to this study, but suddenly everyone stopped listening and menopause was pushed underground once more.

This study has since been reassessed, showing a statistically insignificant effect of (old fashioned) progesterone (not oestrogen) causing breast cancer. In modern history, this has been one of the greatest disservices to women everywhere! Women were driven to either suffer in silence or seek out compounded ‘bioidentical hormones’ which, being variable in their composition despite touted as being ‘natural’ have not reached TGA approval status. 

Replacing lost hormones in the form of Estrogen, Progesterone and Testosterone can be life changing for many women and all women should have the option to do so. Modern HRT is pharmacologically derived but is body identical. However, every woman’s experience of peri/menopause is unique, and the way that each type of HRT might work in a women’s body is certainly not one size fits all. 

Moreover, such a considerable change takes place in a woman’s body at this time in life, that myriad of other medical and psychological issues could be at play. 

Women struggling during the perimenopause and menopause need a doctor to firstly listen to and then validate their symptoms. This alone is half the battle for a lot of patients, to be heard. Being experienced GPs who understand the complex interplay of all the systems of the body, Dr Michelle Cotellessa and myself know that a balanced approach is crucial. Diet, exercise, and good sleep are absolutely imperative to a woman going through perimenopause and menopause. However, women cannot even begin to think about improving these things when they are lacking in the vital hormones which allow them to function in their daily lives. 

General practice is under considerable pressure in Western Australia with our burgeoning population. Expecting a GP to be able to address multiple issues in a 15-minute consult is impossible if one is expecting good care. Both Dr Michelle Cotellessa and I understand these challenges for both patient and doctor alike and acknowledge that getting down to the nitty- gritty of a menopause consultation takes a lot of time and effort. After much time working as general GPs, we have honed our skills in the women’s health sphere working alongside gynaecologists and allied health professionals in the area. We have seen the desperate need for the women of WA to have a dedicated service run by specialist GPs to address their midlife needs. In addition, a special group of women who have been rendered menopausal by surgery and/or cancer treatments and cannot take hormone replacement therapy are of particular interest. Women of a different sexual identity are not immune to menopause either and they too need expert care. Most importantly, HRT is not for everyone, and a careful weighing of risks and benefits to the individual needs to be undertaken.

‘Hera Menopause and Women’s Health’ is the first GP led menopause clinic in WA where our model of care means we have time to listen, validate and address a woman’s needs in a tailored, bespoke fashion. Being ourselves professionals, partners, mothers, daughters, and women who have lived experience of menopause we understand what our patients are going through. We are evidenced based and scientific in our approach, but our aim is for this to be a collaborative journey. As clinicians, we strive to treat our patients with the most up to date knowledge and care to get them back on their feet and embracing life. 

‘Hera’ wife of Zeus was a headstrong character in Greek Mythology who may have been the first to encourage all women to ‘take back control and tell their own story.’ We want the women of Perth to thrive through their menopausal years, not succumb to it. Perimenopause and menopause needs to be part of the conversation for all women, and no longer swept under the carpet as a taboo subject. Our attitude as a society towards menopause desperately needs to change and Hera as a centre of excellence in menopause care hopes to do this at a grass roots level supporting the women of Perth. 

Written by Dr Sunita Chelvanayagam, Menopause Specialist and Co Founder of Hera