WellFemme’s Senate Inquiry Submission

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.