WEBINAR: ADHD in the Menopausal Transition

The Senate Committee Inquiry into Peri/menopause generated 25 key recommendations, but it will all come to nothing if Government won’t commit to act on them. Here’s how YOU can help ensure that they do!

The Senate Committee members worked their way through 285 submissions and 7 hearings with 118 witnesses this year, and handed down a comprehensive set of recommendations last month. The government now has 3 months to respond, and there are no guarantees that they will accept these recommendations or act on them. 

The other wildcard here is the 2025 election; what if government commits to the recommendations, but then there is a change of government?

Last week Senator Larissa Waters proudly announced the Greens’ plan to allocate $50M annually to peri and menopause related improvements from the Committee’s recommendations. We now need to put pressure on both the government and opposition to at least match- if not exceed- the Greens’ commitment.

This is where YOU can really make a difference. We have provided a draft email below that you can send to the government, opposition and your local MP requesting their commitment to the Senate Committee’s recommendations.

We urge you to please take 5 minutes to send this email, and copy in your local MP. It’s a small but powerful gesture that might make all the difference to services, treatments and conditions for present and future generations of peri and menopausal women.

OUR SUGGESTED EMAIL TO SEND YOUR GOVERNMENT, OPPOSITION AND LOCAL MEMBERS:

TO: Mark.Butler.MP@aph.gov.au,  Ged.Kearney.MP@aph.gov.au, Senator.Ruston@aph.gov.au, Sussan.Ley.MP@aph.gov.au, [Your local MP’s email]

Dear [Minister/Senator/MP],

As a constituent I want to bring to your attention an issue I want more action on: perimenopause and menopause.

Too many women have suffered in silence due to:

• gender bias in our health system,
• a lack of information about peri and menopause, and
• a lack of affordable treatments.

Last month, all parties came together to support 25 key recommendations on perimenopause and menopause. You can read the full report here.

I want to see these recommendations implemented in full and I want this to be an election issue.

Now is the time for action. Women deserve better, and I want to make sure our voices are heard.

The Greens are committed to addressing all the recommendations from the Senate inquiry and allocating $50M per year for that purpose; I am calling on you to match this commitment.

I’d also like the opportunity to speak to you more about [xxxx]

Kind Regards, [Name and signature]

Read Dr Kelly Teagle’s Senate Inquiry submission HERE

View Dr Kelly Teagle’s response to the Senate Committee’s recommendations on Instagram HERE

What is WellFemme About?

If you can’t find the professional help you need for your menopause or perimenopausal symptoms then book a Telehealth consultation with an expert WellFemme menopause doctor.

If you suspect you may be one of the many perimenopausal women with ADHD, this 3-part series written by Clinical Psychologist Kirsten Bouse is a must-read.

Perimenopause and ADHD – Part 1 Understanding

By Kirstin Bouse

The menopausal years span not only a substantial portion of a woman’s life, they also reflect a time of significant change. This change brings challenge and, with ongoing support and a bucket load of patience and self-compassion, the opportunity for growth. Despite its significance, the wider community is generally poorly informed about this life stage.

Equally so, ADHD is a neurodevelopmental difference that has been misunderstood for decades, particularly in females. As such, many females go through life having no idea that they are ADHDers. This is often despite facing many challenges due to the incongruence between their ADHD and the expectations placed upon them from what is, a neurotypical world. There is increasing conversation about both peri/menopause and ADHD but unfortunately, the information can be confusing or downright inaccurate. These articles seek to provide accurate and helpful information about each condition separately and how they intersect.

I’m Kirstin Bouse, a clinical psychologist navigating both perimenopause and ADHD, and here’s a look at these two experiences. If you’d like to read more detailed information, please check out our resources page on the All About Her website (www.allabouthercentre.com.au).

Understanding Perimenopause

Perimenopause is the transition period before menopause, typically starting in a woman’s late 30s to early 40s and lasting between 4 to 10 years. Hormonal fluctuations during this time, especially involving oestrogen and progesterone, lead to a variety of symptoms. Common signs include hot flushes, night sweats, mood swings, cognitive difficulties (often called ‘brain fog’), joint pain, and fatigue.

Perimenopause impacts the ‘whole woman’ and is influenced by her health history, mental well-being, lifestyle, and socioeconomic status. Recognising this comprehensive impact is vital for providing effective support during these transformative years.

Demystifying ADHD

ADHD, or Attention Deficit Hyperactivity Disorder, is a neurological difference that affects attention, impulsivity, and sometimes hyperactivity. It results from variations in brain development and persists into adulthood. Historically, ADHD has been diagnosed based on symptoms observed primarily in boys, leading to significant underdiagnosis in women.

Women with ADHD may not exhibit the overt hyperactivity often seen in males. Instead, they might experience internal restlessness, ongoing cascades of thoughts, difficulties with focus, disorganisation, and a pattern of impulsivity that can go unrecognised as ADHD.

The Interplay Between Perimenopause and ADHD

When perimenopause and ADHD coexist, the challenges can amplify. Hormonal fluctuations during perimenopause can exacerbate ADHD symptoms due to oestrogen’s role in regulating dopamine, a neurotransmitter crucial for ADHD management. Women already aware of their ADHD may feel overwhelmed by intensified symptoms.

Conversely, some women might first recognise signs of ADHD during perimenopause when cognitive changes become more apparent. This dual impact can lead to increased emotional distress and complicate daily life management, highlighting the need for a comprehensive treatment approach.

Moving Forward with Awareness and Support

Understanding perimenopause and ADHD requires a nuanced approach that considers the “whole woman.” Healthcare providers must collaborate across disciplines to offer a multifaceted support system addressing medical, emotional, and practical challenges. For women navigating these dynamics or supporting someone through this journey, education and compassionate understanding are key.

If you suspect you are experiencing ADHD symptoms exacerbated by perimenopause, seek resources and professionals knowledgeable in this intersection. Raising awareness and understanding of ADHD and perimenopause is crucial for providing timely and effective support. For more information, explore our ADHD and Perimenopause Series at www.allabouthercentre.com.au.

CLICK HERE to receive Part 2 (Navigating the Overlap) and Part 3 (Treatment Pathways) direct to your inbox.

You can also view Kirstin’s video chat with Dr Kelly Teagle about ADHD HERE

What is WellFemme About?

If you can’t find the professional help you need for your menopause or perimenopausal symptoms then book a Telehealth consultation with an expert WellFemme menopause doctor.

WellFemme is Australia’s first dedicated Telehealth menopause clinic, servicing locations nationwide including: Melbourne, Sydney, Adelaide, Darwin, Perth, Hobart, Brisbane, Dubbo, Bendigo, Broken Hill, Broome, Alice Springs, Launceston, Cairns, Mildura, Lightning Ridge, Kalgoorlie, Albany, Toowoomba, Charleville, Port Headland, Katherine, Ballarat, Coober Pedy, Bourke, Albury… and your place! 🙂

There is much fear and misinformation regarding MHT and breast cancer. Adding to this confusion, having some cancers – or treatments to prevent them – might actually be a reason to use estrogen therapy. 

By Sally Stankovic and Dr Kelly Teagle

Treating menopausal symptoms after early menopause or breast cancer requires a tailored approach. Hormonal treatment is not the answer for everyone; for example, if you’ve had breast cancer it would not usually be recommended but your symptoms can be managed with other specific treatments.

On the other hand, if you’ve experienced an early menopause (regardless of the cause) then MHT (Menopausal Hormone Therapy) may be a low-risk, effective symptom treatment with important long-term protective benefits. Let’s explore the options…

What is Early or Premature Menopause?

“Early menopause” generally refers to menopause under the age of 45, whilst “premature menopause” or “primary ovarian insufficiency” (POI) refer to the cessation of menstruation and reproductive function before the age of 40. These conditions can occur naturally or be induced by medical and surgical
treatments, or due to other factors such as:

• Natural Causes: Some women may experience early menopause due to genetic factors or unknown reasons, where the ovaries stop producing normal levels of hormones.
• Medical Treatments: Cancer treatments like chemotherapy or radiation therapy can damage ovarian tissue, leading to premature menopause.
• Surgical Procedures: Surgical removal of both ovaries (bilateral oophorectomy) for medical reasons can induce early menopause, eg. risk reduction for women with BRCA gene mutations.
• Autoimmune Conditions: Certain autoimmune diseases can affect the ovaries and lead to premature ovarian failure.

Symptoms of Early Menopause

The symptoms of early or premature menopause are similar to those of natural menopause, which may include hot flushes, night sweats, vaginal dryness, mood swings, and decreased libido. These symptoms can be more severe and long-lasting however in cases of an early and/or sudden decline of estrogen.

Potential Consequences of Early Menopause

The average age of menopause in Australia is 51. However if you are much younger than this at menopause you may be subjected to many more years of low estrogen than “average” women. This puts you at increased risk of premature osteoporosis and heart disease, as well as mood disorders and dementia.

For this reason, it’s critical that women who experience menopause (from any cause) before age 45 get expert advice about treatments that might be needed to reduce their risk.

Managing the Symptoms of Early Menopause

Managing menopause symptoms always involves a combination of medical and psychological strategies, as well as lifestyle adjustments.

Menopausal Hormone Therapy (MHT): MHT can work very well for women with early or premature menopause by replacing lost estrogen and progesterone, which helps to prevent bone loss and cardiovascular disease. However it’s crucial to discuss individual risks and benefits with healthcare providers, especially for women who’ve had cancer. For example, MHT is generally not considered a good option after breast cancers yet can be quite ok after certain types of ovarian cancers (but not others).

If you have concerns that MHT might increase your risk of developing breast cancer, this article may help to alleviate some concerns: “Does Hormonal Therapy Cause Breast Cancer?”

Non-Hormonal Medical Therapies: Some antidepressants can help manage hot flushes and mood swings without affecting estrogen levels, so they are a great choice if you’ve had a hormone sensitive cancer. They can also relieve mood symptoms at the same time.

Gabapentin or Pregabalin, often used for nerve-related pain, can also reduce hot flushes. There is also good evidence for the effectiveness of clonidine or oxybutynin on vasomotor symptoms (flushes and sweats); these are also used for high blood pressure and urinary frequency respectively. Details of these treatments can be found in the Australasian Menopause Society’s factsheet “Nonhormonal Treatments for Menopause Symptoms.”

Vaginal Estrogen, Moisturisers and Lubricants: Vaginal Estrogen: Low-dose vaginal estrogen (in creams or pessaries) can improve vaginal dryness and discomfort with limited systemic absorption, so they are generally considered low risk even for most breast cancer survivors.

It’s super important to also use good vaginal lubricants and moisturisers to prevent damage or pain to the delicate vulvovaginal tissues.

Bone Health: Early menopause increases the risk of osteoporosis, so a baseline bone density scan is a great idea. There is a Medicare rebate if you have early/premature menopause or prolonged loss of periods other than pregnancy.

To offset this increased risk you can use calcium and vitamin D supplements, weight-bearing exercise, strength and impact training to support bone health, but always discuss with a trusted healthcare provider before starting any new interventions.

Cardiovascular Health: A baseline health check with your GP including blood pressure, cholesterol and fasting blood sugars can help establish your pre- existing risk level. Lifestyle modifications such as regular exercise, healthy diet and avoiding smoking can reduce cardiovascular risks associated with early menopause.

Psychological Support: Counselling or support groups can address emotional challenges and fertility or body image concerns associated with cancer treatment and early or premature menopause.

Lifestyle after Early Menopause or Cancer

After early menopause or cancer treatment a healthy lifestyle is hugely important for future health and well-being, and reduces the risk of future cancers.

Physical Activity: You may be tired of hearing it, but that doesn’t make it less true! Regular exercise helps improve fitness and mood, reduces fatigue and lowers the risk of further cancers. Regular vigorous exercise also reduces dementia risk enormously.

Healthy Diet: We’re all prone to a naughty snack here and there, so let’s focus the rest of the time on a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit processed foods and sugars. A Mediterranean diet is anti-inflammatory and proven to reduce the risk of cardiovascular disease and early death in women by over 20%.

Limit Alcohol Consumption: Limit alcohol intake to no more than one drink per day, as alcohol consumption is also linked to an increased risk of breast cancer recurrence.

Quit Smoking: Do your best. Smoking is associated with various health risks, including cancer and cardiovascular disease.

Manage Stress: Probably the hardest one of all. Life is busy for all of us. We’re rushing about between work, family and other commitments, and if we stack up worry and stress on top of it all, something’s gotta give; don’t let it be your health! Practice stress-reducing techniques such as exercise, meditation, deep breathing, hobbies or yoga. Think of it as a necessity, not a luxury.

Regular Check-Ups: Attend regular health appointments for monitoring and screening. If you still have breast tissue, perform regular breast self-exams and attend mammograms or other imaging tests as advised by healthcare providers.

Emotional Support: Seek emotional support from family, friends, support groups or counselling services to cope with emotional challenges and anxiety related to cancer survivorship.

Quality of Life Matters

Ultimately it all comes down to understanding the risks and benefits of various treatment options to make informed choices for your own health. If you’re considering MHT, are the potential risks outweighed by improvements in quality of life and reduced risk of cardiovascular disease, diabetes and osteoporosis? It’s a decision that only you can make, after careful consideration and discussion with your doctor.

There’s no “one size fits all” solution for menopausal symptoms in women who’ve had cancer. Speak to a health professional who has good knowledge about menopause treatments for an individualised treatment plan.

What is WellFemme About?

If you can’t find the professional help you need for your menopause or perimenopausal symptoms then book a Telehealth consultation with an expert WellFemme menopause doctor.

WellFemme is Australia’s first dedicated Telehealth menopause clinic, servicing locations nationwide including: Melbourne, Sydney, Adelaide, Darwin, Perth, Hobart, Brisbane, Dubbo, Bendigo, Broken Hill, Broome, Alice Springs, Launceston, Cairns, Mildura, Lightning Ridge, Kalgoorlie, Albany, Toowoomba, Charleville, Port Headland, Katherine, Ballarat, Coober Pedy, Bourke, Albury… and your place! 🙂

The Menopausal Transition can be tough, and can put a strain on relationships. Let’s explore how to support your partner through menopause.

Listen to Dr Kelly’s Teagle’s “Love Smarter“ podcast chat about midlife relationships with counsellor Todd Zemek HERE.

By Sally Stankovic and Dr Kelly Teagle

Whilst it’s not altogether unexpected, when menopause eventually arrives it can be surprising, unpleasant, and more than a little emotional.  “Hot flushes” have always headlined the stages of menopausal transition but as many of us are discovering, there’s so much more to it. From physical pain to mental and emotional distress, women are swinging between irritation, confusion and tears.

Struggling to maintain relationships. Struggling with their mental health. Struggling to keep their careers. And a huge one: struggling with their self-identity.

The Psychological Adjustments of Menopause

The aging process is no easy pill to swallow. While we all agree that getting old is the goal, it can still be discombobulating to see an older face in the mirror and yet feel so young inside. Or struggle to move as easily as we once did not so long ago. We could be regretting the dream we didn’t pursue. Maybe, life just didn’t turn out the way we thought it would.

It’s a highly personal journey and compounded with the menopause transition, we become sensitive and emotional, and often withdraw. Our partners meanwhile, are scratching their heads wondering what they’ve done “wrong”. We all turn inwards and self-soothe from time to time, but if we’re not communicating with our other halves, there can be a lot of hurt feelings, cross-words and misunderstandings.

It can be a tough time for women, but can be equally as tough on the men who care about them. The woman may not even realise that she’s in perimenopause until she puts the pieces of the puzzle into place, perhaps with a little help from Dr Google and YouTube. Let down also by health practitioners from a lack of information, a lack of diagnosis, and in some cases, an outright denial of symptoms, if we don’t even understand what’s going on with our bodies, how could our partners possibly know?

What’s Actually Happening to Her?

The menopause transition is a normal life stage for anyone born with ovaries. It’s a time when their hormones change and estrogen levels drop, signaling that the reproductive years will soon be over. During perimenopause (the lead up to menopause), the ovaries prepare to stop releasing eggs. At menopause, the body stops releasing eggs entirely. 

This usually happens between the ages of 45 – 55, and while symptoms can and do vary (some women experience very few symptoms, others a lot), one thing is certain – it can significantly affect our relationships, in particular, those with our partners.

What might start out as mild fatigue, the occasional sleepless night or a hot flush here and there (symptoms will vary), can gradually develop into a whole range of worsening symptoms including weight gain, migraines, sleep disturbance, hot flushes, bladder issues, loss of libido, mood changes and breast or joint pain.

From puberty and getting periods to mid-life and menopause, the stories are similar: hormonal changes, mood swings, and physical pain. Except, where once we were dreading the period leaks and stains, now we’re dreading hot flushes, headaches, breast lumps and cervical issues. All just as confusing as once upon a time, back in our youth…welcome to “reverse puberty!”.

What is the Impact of Menopause on Male Partners?

According to “The MATE survey: “men’s perceptions and attitudes towards menopause and their role in partners’ menopausal transition”*, “63% (284/450) of survey respondents reporting that their partner’s symptoms had personally affected them. Specifically, men affected by menopausal symptoms noted that the symptoms put an emotional strain on their relationships (34%; arguments, unappreciated, tension, etc), reduced the frequency of sex/intimacy (33%), and contributed to trouble sleeping (10%).

Some men (11%) noted that it was upsetting or frustrating to see their partners going through this transition. Most men affected by menopausal symptoms believed the symptoms had a very or somewhat negative impact on them (77%), their relationships (56%), or their partners (70%). Approximately 10% of men thought the symptoms had a positive influence on them, their relationships, and partners.”

In another study, “Husbands’ support of their perimenopausal wives”, most of the 96 participants said they had some information about menopause (mostly gained from their wives), but more than 1 in 4 knew little or nothing. One third of the husbands didn’t think they were supportive, but the majority said they provided mostly emotional support. They reported numerous stressors in their lives, including work and financial problems and declining health and sexual response. Lack of information, negative effects of their wives’ menopausal transition, and their own stresses may have interfered with husbands’ ability to provide social support.

In a third study, “Attitude towards menopause among married middle-aged adults”, it was the wives who generally expressed a more positive attitude towards menopause than their husbands, and with more symptoms than their husbands thought they were having.  For both women and men, a more positive attitude towards menopause was associated with women who reported fewer symptoms.

It would be easy (and unfair) to generalise by saying that men just need to show a little more understanding and compassion, but it’s not that simple. Clear communication really does benefit both parties and is the responsibility of both. All relationships go through tests and trials, and many can come through the other side stronger than before. The fact is, menopause has a huge impact on a woman’s physical and mental health, and even her life expectancy, so it certainly pays to make the effort.

Tips to help your support your partner through menopause

Education

Learn as much as you can about perimenopause and menopause to understand her experience.

Menopause causes changes in the female body, mainly through the decreased production of estrogen. Some women have very few symptoms and it’s over quickly, while others can be hit with a host of unpleasantries that last a long time. Understanding the symptoms can help you recognise them as they arise, and anticipate how they will affect your partner.

Start your learning about peri menopause and menopause, with WellFemme’s “Menopause Bootcamp” webinar and our range of informative blog posts.

You might like to watch the series of expert presentations from the 2023 “Menopause Uncensored” Summit too. Session 2, which included Mental Health, Relationships and Sex is a particularly good one to watch together.

Talk

Ask your partner directly how they are feeling, and how you can support them. Understand that their mood swings may be driven by the changes in their hormones, and be erratic and disproportionate to the issue at hand. Try to stay compassionate and supportive rather than reactive.

Sexual Issues

A lot is going on “down there” for her, much of which she may not want to open up about. She may have lost her libido or sex may even have become painful.

Be patient. There are other ways to enjoy intimacy in the meantime.

Find out more in our Blog post and Webinar about Sexual Problems At Menopause.

Support

Encourage (and model) healthy lifestyle changes and activity such as strength training, walking, dancing or yoga – or suggest an activity you could do together. Try to keep some playfulness and fun in your together time; suggest something new to break out of stale routines and unhelpful habits.

Be prepared to suggest some professional help if necessary. Be open and sensitive with her about what you’re seeing and ask if she thinks a professional opinion might be helpful. As a startpoint you might suggest that she try WellFemme’s free Menopause Health Assessment tool, which has useful links and suggestions targeting a range of symptoms.

Keep in mind that mental health conditions often begin or worsen in the menopausal transition, and that this is the peak age group for suicide in women. If she has worrying mental health signs then she may need your support to access care quickly; start with her usual GP.

Partners should seek support for themselves too. You’re not the only one struggling to work out what’s going on with a menopausal partner, so why not try opening up that conversation with friends at similar life-stage and see what happens. You might feel pleasantly validated.

Why is this so Important?

Because you care about her, so her well-being matters. Because she’s the other half of the team. Because she needs your support right now, navigating this uncomfortable time. You can make a huge difference to her experience simply by being alongside her for the journey.

There is help available for your partner during this time: knowledgeable health professionals, lifestyle modifications, daily movement, nutrition, supplements, hormonal and non-hormonal treatments can all help alleviate symptoms, and improve future health.

She’ll work it out, and if you remain engaged and supportive you’ll come through it together, perhaps even stronger than before.

References:

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791510/

*https://www.tandfonline.com/doi/abs/10.1300/J013v38n03_07?src=recsys

* https://www.tandfonline.com/doi/abs/10.1300/J013v36n04_05

What is WellFemme About?

If you can’t find the professional help you need for your menopause or perimenopausal symptoms then book a Telehealth consultation with an expert WellFemme menopause doctor.

WellFemme is Australia’s first dedicated Telehealth menopause clinic, servicing locations nationwide including: Melbourne, Sydney, Adelaide, Darwin, Perth, Hobart, Brisbane, Dubbo, Bendigo, Broken Hill, Broome, Alice Springs, Launceston, Cairns, Mildura, Lightning Ridge, Kalgoorlie, Albany, Toowoomba, Charleville, Port Headland, Katherine, Ballarat, Coober Pedy, Bourke, Albury… and your place! 🙂

WellFemme founder Dr Kelly Teagle has made the following submission to the upcoming Senate Inquiry into menopause:

Committee Secretary
Community Affairs Committee
Department of the Senate
PO Box 6100
Parliament House
CANBERRA ACT 2600
AUSTRALIA

Dr Kelly Teagle, MBBS, BSc, FRACGP, Grad Dip Women’s Health

Principal clinician, WellFemme Telehealth menopause clinic                                                                                                  

14^th March, 2024

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

To the Senate Inquiry Committee,

Thank you for the opportunity to make a submission to this inquiry.  I am Dr Kelly Teagle, a GP specialising in menopause and founder of the WellFemme Telehealth menopause clinic in 2018. WellFemme now has 18 doctors and thousands of patients Australia wide, and demand is growing.

Executive Summary of Recommendations

I wish to make the following recommendations for the Committee to consider:

(As per Annex A):

1. Ensure that the safest evidence-based treatments are listed on the PBS.
2. Create a well-rebated, long consult Medicare item for thorough perimenopausal assessments.
3. Provide funding for the Australasian Menopause Society to oversee GP menopause training.
4. Support GP’s at point-of-care through a combination of rapid-access specialist advice, clinical software algorithms and streamlined referral pathways.
5. Ensure that GPs are well remunerated under Medicare for longer consultations.
6. Permanently include Telehealth items for reproductive and sexual health care in the MBS.
7. Design and deliver public awareness campaigns which are accessible and easily understood regardless of education, language, gender identity, culture or disability.
8. Develop and maintain a DHAC website which collates all the best menopause resources for GP’s and consumers in one well-publicised, up to date location. Include infographics and videos which are translated and adapted for various vulnerable consumer populations.

Additionally:

9. Develop a National Menopause Action Plan with input from key service and policy stakeholders, and
10. Conduct a review of how menopause (and women’s health related) projects are funded.

I would like to comment particularly on sections b, f, h and i of the terms of reference:

b. The physical health impacts, including menopausal and perimenopausal symptoms, associated medical conditions such as menorrhagia, and access to healthcare services;

As a GP I have specialised in menopause care for over a decade now. Personally, I experienced a very early and highly symptomatic menopause at age 42 and had breast cancer in 2022. My perspectives on menopause come from a combination of personal and clinical experiences and my professional knowledge base.

Australian data from 2016 indicated that close to 400 000 women were experiencing untreated moderate to severe hot flushes and night sweats, and this just one symptom of the menopausal transition. For the 15-20% of women with severe symptoms it impacts their ability to sleep, think, work, and interact with loved ones. It erodes functioning, mood, self-confidence and quality of life.

I spoke about some of the reasons why women are not accessing appropriate treatments in an award-winning address to the 2022 Successes and Failures in Telehealth Conference: “Barriers and Breakthroughs in Tele-menopause Care.” [Slides available HERE]

In my presentation to the 2023 Parliamentary Round Table on menopause I also spoke specifically about the problems of access to services; my recommendations are detailed in this link and the 2-page summary at Annex A.

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;

Telehealth is not just good for clinician-to-patient services; there is untapped potential for its use in clinician-to-clinician support. Non-specialist GP’s who might avoid treating their menopausal patients due to a lack of professional expertise or confidence could discuss their cases with more specialised doctors by phone or video.

Outreach models that support GP’s in managing their own patients locally will help keep menopause management in primary care whilst supporting and upskilling GP’s wherever they are. WellFemme is uniquely experienced and resourced with expert menopause clinicians to assist governments in the delivery of such a service.

Telehealth delivery of menopause care has been well validated over almost 5 years of WellFemme operations, and demand for services continues to grow. As outlined in this presentation, service uptake increased dramatically due to COVID and the advent of Telehealth Medicare rebates. To ensure ongoing access to menopause care for ALL Australians who need it, permanent inclusion of Medicare rebates for Telehealth provision of reproductive and sexual health services is essential.

Regarding affordability of best evidence-based treatments: micronized (body-identical) progesterone has overwhelmingly proven to be the safest progestogen for MHT, but it is not subsidised under the PBS. Financially vulnerable women must instead settle for cheaper synthetic progestins that have been shown to increase breast cancer risk.

Additionally, rebates for longer consultations (as needed to properly manage menopausal patients) should reimburse patients at the same cost-per-minute rate as shorter consultations. This is crucial to incentivise GPs to conduct preventive healthcare activities. Medicare inequities also worsen the GP gender pay gap as female GP’s do many more long consultations than males, particularly for complex conditions and mental health care.

h. Existing Commonwealth, state and territory government policies, programs, and healthcare initiatives addressing menopause and perimenopause;

Roles and scope of the many (and growing) organisations in the menopause space are not clearly defined. A comprehensive approach to improving community health and wellbeing will require a strategic model with clearly allocated roles and funding for the various stakeholders, such as those involved in:

• Policy development and provision of advice to government
• Design and execution of research
• Examination and interpretation of evidence for clinicians and the public
• Development and delivery of clinical education to health professionals
• Design and delivery of public awareness campaigns and a definitive website
• Development of networked systems to support GP’s in their local communities
• Development and execution of an integrated national plan for service delivery to public patients utilising a combination of Telehealth and in-clinic options.
• Facilitating and overseeing the supply of affordable, evidence-based medications

For example, the Australasian Menopause Society is Australia’s premier organisation for the collation of worldwide evidence and provision of evidence- based resources for clinicians and consumers. They have neither the resources or funding to develop and deliver formal GP education programs, but they certainly would be the logical organisation to oversee accreditation standards for GP menopause education programs that might be developed by third party providers. This would require consultation with government and allocation of resources and funding for the AMS to take on such a role.

As recommended at the 2023 Parliamentary Round Table, the best (and most cost-effective) way to bring stakeholders together to map out these strategies is to develop a National Menopause Action Plan.

i. How other jurisdictions support individuals experiencing menopause and peri-menopause from a health and workplace policy perspective; and any other related matter.

Most menopause stakeholders have no visibility of government processes for identifying and funding priority peri/ menopause related projects, or their associated tender opportunities. I recommend a review of how such projects are conducted, with clear communication to all potential stakeholders about what work is needed and how to tender or apply for it.

I have contributed to a separate joint submission with A/Prof Erin Morton on this topic.

Yours Sincerely,

Dr Kelly Teagle

References: As hyperlinked throughout

Annex A to Senate Inquiry submission 2024 Dr Kelly Teagle

What is WellFemme About?

If you can’t find the professional help you need for your menopause or perimenopausal symptoms then book a Telehealth consultation with an expert WellFemme menopause doctor.

Burning mouth, dry mouth, inflamed gums… why is it so common to get new mouth problems at menopause?

By Sally Stankovic and Dr Kelly Teagle

If it seems like oral health issues have come out of nowhere and you’re going through perimenopause and menopause, you’re not alone. For many of us, oral health issues are yet another symptom of this change.

During perimenopause and menopause our estrogen levels start decreasing, and we experience changes in our hormones. These changes can be felt as physical (muscular & joint pain/fatigue/difficulty sleeping/headaches) or psychological (anxiety/ depression/ moodiness/ brain fog).

How does Menopause Effect the Mouth?

Estrogen plays a role in maintaining oral tissues. Its decline can lead to oral discomfort, including a burning sensation in the mouth commonly known as Burning Mouth Syndrome. BMS can impact the tongue, lips, and palate, making daily activities like eating and speaking uncomfortable. As its name suggests, it is a sensation of burning in the mouth.

Estrogen deficiency can also contribute to bone loss, affecting the jawbone and potentially leading to dental issues. This bone loss may increase the risk of periodontal disease, impacting the gums and teeth. Inflammation of the gums and teeth may potentially lead to tooth decay and even loss.

Gingivostomatitis is the inflammation of the mouth and gums. This is what generally causes bleeding gums and changes in gum colour – sometimes they can appear pale, at other times a deep red. You may even notice your gums shrinking away from the teeth.

Dry mouth is another common symptom during menopause, and can exacerbate these problems by reducing saliva flow, which normally helps cleanse the mouth and neutralise acids.

Gum health is often taken for granted but it is more important than people realise. Research shows it has been linked to cardiovascular disease. Around menopause, it is especially important to get proactive around prevention when it comes to the health of your gums.

What can I do about Mouth Problems at Menopause?

• Maintain good oral hygiene practices including brushing and flossing twice daily, to remove plaque build-up.
• See your dentist for regular check-ups.
• Quit smoking! It’s a huge risk factor for mouth, throat, lung and other cancers.
• Drink water. Not only does this hydrate the mouth and counteract dry mouth symptoms, it rinses away bacterial build up.
• Minimise sugary foods and drinks that lead to decay.
• Special mouthwashes such as Biotene are available over the counter from the chemist which add a lubricating protective film to mouth tissues.
• Hormone replacement therapy (HRT) may be considered to address hormonal imbalances and alleviate oral discomfort.

As you can see, mouth problems at menopause and perimenopause are more common than you might have thought but there are definitely things that can help. Always discuss with your health practitioner and get a mouth checkup to be sure of the diagnosis though, as there are more serious conditions that might be overlooked.

References:

• Harvard Health on the link between gum disease and heart disease
• Heart Foundation: Gum disease and heart health

Check out this excellent article for more information: Menopause and Oral Health

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