Submission to the Standing Committee on Community Affairs, Inquiry into issues related to menopause and perimenopause.

15th March 2024

To the Senate Inquiry Committee,

Thank you for the opportunity to make a submission for this inquiry.

Our submission addresses all sections of the Inquiry.

After generations of non-action around the impact of menopause on women and the wider community, we find ourselves in a sea of misinformation about menopause, a primary care crisis and a substandard patient management experience that has further deepened the health equality crisis for women here in Australia.

Recently, The Lancet Series on menopause emphasized the need for a holistic approach to support women during this life transition. This includes providing high-quality information, decision-making tools, empathic clinical care, and workplace adjustments as needed.

Women aged 45 years and over comprise 17% of the ageing Australian workforce (Tilly et al., 2013), meaning that over one million working women are currently going through, or have already gone through, the menopause. Menopausal flushes and sweats affect 60-80% of women, lasting about 7 years on average, with 1 in 3 women experiencing severe symptoms.

We concur that access to credible health information is crucial for informed decision-making.

It’s time for action with a new model of care that is available now.

Current care pathways are congested, with well-resourced GPs becoming increasingly unavailable. To address this, we are recommending a new model of care utilizing technology for education, improved health literacy, cognitive behavioural therapy, and behavioural nudges – for at the very least to help women understand menopause (another tragic outcome of not providing more education early on where women are only taught about menstruation and not menopause). This would see multidisciplinary teams, supported by technology-driven triage pathways, offer group coaching and elevate red flags and prescribing to doctors. A funded team-based approach involving psychology, pelvic floor physiotherapy, exercise psychology, menopause nursing, and pharmacists is proposed to alleviate the strain on GPs.

While increasing time-based funding is the recommended solution, we know from our research that workplaces and wider communities need to step up in order to truly shift the dial on menopause in our community. In workforces that are under resourced and a primary care model that is already under financial strain a new solution is required.

The use of technology and generative AI to build awareness, educate, encourage positive lifestyle change, prompt health screening and empower informed decisions making will be critical to success. This then enables primary care to focus on the key medical issues at hand.

Recognizing perimenopause is a gateway to chronic illness, we are recommending the Government fund assessments for women in their late 30s and early 40s as a preventative care pathway and to improve quality of life for millions of women in Australia. Additionally, there is a need for specific care pathways for surgical or medical menopause and addressing ADHD in the context of menopause.

Our solution of a high-touch, high-care model is a step in the right direction to solve for all of the above and more.

To validate this solution, we recently partnered with the Digital Health CRC and Western Sydney University to evaluate this new model of care.

Evaluation of a Smart Health Community for Menopausal Women

Preliminary Findings Only

Introduction

The aim of this study was to assess the feasibility and acceptability of an integrated care model for menopausal women, focusing on awareness, education, empowerment, and behavioural change using a digital health platform. The study evaluated different intervention modalities including one-on-one coaching, group coaching, and digital content alone.

Methodolgy

A mixed methods approach was employed, involving the random allocation of 52 women into three groups:

1. One-on-One Intervention and Digital Content
2. Group Intervention and Digital Content
3. Digital Content Only

Participants engaged with the interventions over a specified period, with their experiences and outcomes measured through quantitative assessments and qualitative interviews.

Intervention Description

The intervention included access to a digital health platform offering educational resources, tools for self-assessment, and support for behavioural change. Participants in the coaching groups received additional personalised support and guidance from trained professionals.

Findings

• 59% of participants completed at least three sessions, with higher completion rates observed in the one-on-one coaching group.
• There was no significant change in menopausal symptoms, as measured by hot flushes, Greene Climacteric Scale, and Quality of Life scale.
• However, participants reported a significant change in the Menopause Representation Scale, indicating an improved sense of control over their menopausal experiences.
• Satisfaction rates were high, with 80-90% of participants in the coaching groups expressing satisfaction, compared to 60% in the digital-only group.
• Open rates for digital content were above 70%, indicating good engagement.
• Senate inquiry submission – 15th March 2024
• High dropout rates were attributed to work commitments, highlighting potential challenges in accessing support within current work environments.

Qualitative research summary

• Participants reported increased self-awareness and understanding, despite no significant change in physical symptoms.
• Many participants, particularly those with less severe symptoms, described improved emotional management and outlook on life.
• Participants highlighted benefits such as peer support, dispelling of myths, and empowerment through sharing experiences.
• Dissatisfaction with some healthcare providers was noted, indicating a need for improved training and support in managing menopause.
• Participants described a shift in outlook, including increased self-compassion, acceptance, and advocacy for their needs at work.
• Overall, participants had positive experiences within the program, appreciating the safe space for sharing and the holistic approach to health.

Conclusion and Recommendation:

The study demonstrates the feasibility and acceptability of the integrated care model for menopausal women, emphasising the importance of peer support, education, and empowerment. Recommendations include further program structuring for accountability and ongoing support, as well as addressing challenges in accessing support within work environments.

Given there is a national desire for evidence-based workplace interventions, we welcome the opportunity to partner with the Australian Government to get our evidence-based repeatable and scalable solution into the hands of working women now which will support Australia’s productivity and growth agenda.

We need to keep women in the workforce and at their best to support a stronger economy.

Further recommendations as part of our submission:

1. Diverse Populations: There is currently a lack of research into the experiences of women of diverse backgrounds, including Indigenous Australians. Research must capture the breadth of these experiences. This includes women of different ages, ethnicities, socioeconomic statuses, geographical locations, gender identities and cultural backgrounds. Such diversity would ensure that interventions are culturally sensitive and effective across various groups.
2. Healthcare Provider Training: Many healthcare providers lack adequate training and knowledge about menopause which is leading to suboptimal care for menopausal women. Research must evaluate the effectiveness of educational initiatives aimed at improving healthcare provider understanding of menopause symptoms, treatment options, and communication strategies with patients. This could involve assessing the impact of training programs, guidelines, and decision-support tools on provider knowledge and patient outcomes.
3. Policymaker Accountability: Policymakers largely lack the understanding required yet play a crucial role in shaping the healthcare and workplace environments for menopausal women. Inquiries like this one highlight the failures of past policy, or lack of any suitable policy around this topic. Having the right people at the table to drive this change is crucial and this includes engaging men in the conversation, who rightly or wrongly are often the key decision makers. Any future policies must clearly evaluate the implications of interventions on outcomes such as healthcare access, workplace satisfaction, and quality of life.

By addressing these areas through further research, we can accelerate our understanding of menopause and develop a pipeline of evidence-based interventions and policies to better support women during this life transition.

Sincerely,
Georgie Drury, CEO and Co-Founder Metluma
Dr Nicole Avard, GP and Co-Founder Metluma
Jarrah Eddy, Clinical Nutritionist and Co-Founder Metluma