Larissa Waters (Queensland, Australian Greens) Share this | Link to this | Hansard source

On behalf of the chair, my colleague Senator Allman-Payne, I present the report of the inquiry of the Community Affairs References Committee on menopause and perimenopause, together with accompanying documents, and I move:

That the Senate take note of the report.

I want to start by thanking all of the witnesses who participated in this inquiry and all of the submitters who poured all of their love and their frustration and their raw honesty into the words that they shared with our committee. It was an enormous privilege to hear what they had to say, and I'm so grateful that the Senate provided that platform to listen to women and to listen to their experiences.

I'd also like to deeply thank the secretariat—in particular, Claudia and Apolline—for the detailed work they did in pulling together the wealth of evidence that has now gone into this excellent report. I'd also like to thank all of my Senate colleagues who participated in this inquiry and made it such a successful and interesting experience—in particular, the chair, Senator Allman-Payne; but also Senator Marielle Smith, who, of course, co-sponsored this inquiry reference with me; Senator Louise Pratt, also from the government side; and then, from the opposition benches, Senator Maria Kovacic, Senator Wendy Askew and Senator Hollie Hughes. The level of engagement from all of the senators on this inquiry was really gratifying, and I thank everyone for their work and for the passion with which they approached this topic.

We know that women have been suffering in silence for far too long, and we know that we often don't pay enough attention in this place, frankly, to gender equality in the women's health space. This was the reason why, almost a year ago now, not only was I the first person to say the word 'perimenopause' in federal parliament but I recognised that there was a deep need for the lack of policy in perimenopause and menopause to be redressed. So it was with the intention of trying to establish an evidence base and to hear from women in the community so as to give us the information we needed to develop that policy that I was proud to propose this inquiry be undertaken. I'm very pleased that not only was the inquiry co-sponsored by the government but there was unanimous support from the chamber to do this necessary work.

It sends a really powerful message that after almost a year of hearings—and we had quite a few of them; seven in fact—we've reached a consensus report. I want to acknowledge that, whilst some additional comments were made by coalition senators, everyone has signed on to these recommendations, and they're very strong. They're perhaps not quite as strong as they would be if it was just me writing them, but this is part of democracy, this is part of compromise, this is part of bringing together the evidence base and making some suggestions to government.

I'll briefly run through some of the key recommendations. We're really pleased at the strength of sentiment and the consensus report that has been produced. We urge the government to read this carefully and to please respond within the timeframe that you're meant to, unlike on the reproductive health care inquiry report, which was also a consensus report, that sadly has been gathering dust on a shelf of the government benches now for almost 18 months. Let's not repeat that, hey, because women deserve better.

I also want to flag that, whilst some women experience almost no symptoms of perimenopause or menopause, and that's great for them, there's a real variety of experiences, and women experience mild, moderate and sometimes extremely debilitating symptoms. This is affecting them not only in the healthcare space but also in the work space. Part of the intent of this inquiry was to look at both health policy and workplace policy, so I'm pleased that we were able to do that.

I want to start in the health space. We heard horror stories from many women who already lacked the education to work out that what they were experiencing was in fact perimenopause, but, when they went to seek some advice from their GP, many times their GP didn't put the pieces of that jigsaw puzzle together either. GPs are obviously very busy, they're very bright people and they've got a lot to stay across, but this inquiry heard that we really need to better educate GPs on this particular issue. One hour in undergrad is not enough. We also need to give them the tools to make sure that, when they're seeing patients, they've got electronic prompters to help them work out, 'Okay, maybe this person is perimenopausal,' and to acknowledge that the age range for when perimenopause and menopause can happen is in fact a lot broader than perhaps you might expect.

We heard that not only was it hard to get a diagnosis—and sometimes women had to go to multiple different GPs before they felt heard; they didn't feel disbelieved or dismissed—but, once they were able to get a diagnosis and some treatment prescribed, actually the most modern and often most suitable treatment for them was simply out of reach for their financial means. We took evidence that the most up to date treatment with the fewest possible adverse impacts, the least possible slight increase for cancers, is not on the PBS. We took evidence that, if you're on the full suite of MHT—which is the new word for HRT, menopausal hormone therapy—with both oestrogen and progesterone, and sometimes also testosterone, it can cost you up to a hundred bucks. In fact, one witness said it cost $297 per month for her to get the treatment she needs. Clearly, she could afford it, but I can't think of many other Australians that are in a position to afford it, and no doubt she made sacrifices to be able to spend that amount of money on her treatment.

So we heard that the treatments need to be affordable. We also heard there's an awful shortage of them. That's wreaked havoc for people who might have a prescription for a particular type of MHT, but it's then discontinued, it's hard to get a GP appointment to get a substitute, the substitute is not quite right and they've got to go round to 12 different chemists to try and get their script filled. What an absolute nightmare. The recommendation from this committee was that we look at ways of addressing those shortages and that we look at ways of addressing the financial cost of getting appropriate treatment.

We heard that big pharma wield an awful lot of power in that decision-making process and that, effectively, if they decide that they don't want to go on the PBS, you can't really compel them, and, therefore, Australians can't get affordable medicine. There's got to be a way around that. This committee recommends that the government consider finding a way of making MHT more affordable for Australian women and people who need it. So we invite you to brainstorm some solutions, perhaps look at some of the international examples that the committee looked at, and find a way to make sure that MHT and other treatments are both affordable and accessible. So there was really powerful evidence in the health space.

We then took quite a lot of evidence about what to do in the workplace, and I acknowledge that this was the more contentious element of the inquiry. We did reach consensus that, clearly, people wanted flexibility. If they were suffering debilitating symptoms—and, as I said earlier, not everybody does, but for those who do—what they wanted most was understanding and awareness from their employer, and then the right to have flexibility, such as the right to maybe start a bit later if they'd had an absolutely rotten night's sleep, the right to be able to take a toilet break when they're having really heavy bleeding or the right to request to work from home if they just were not up to the job that particular day. This committee recommends that that flexibility be included in our fair work laws—a right to request flexibility on the basis of perimenopause and menopause. I think that is a really good, strong recommendation.

We also encourage employers to work with their employees and develop perimenopause and menopause policies. We need to bring this issue out of the shadows. There should not be a stigma around something that more than half of the population go through. Part of how we dispel that stigma is a national education campaign for everyone. That's important. But employers need to actually consult and talk with their staff and together have a workplace policy about this issue that will enable people to feel more comfortable raising this issue and generally reduce that stigma.

The third part of the workplace piece is leave. I approached this inquiry thinking we should have menopause leave. I want to acknowledge that I changed my mind during the course of this inquiry. I listened to the evidence and I was persuaded, for a number of reasons, that actually what would be more beneficial for a larger number of people would be reproductive health leave. That would ensure that people with all sorts of different issues can have the benefit of that leave. It would also mean that men can take it too if they want to go and get the snip or if they want to go with their partner to the first scan of their baby. I think it's important that we make sure that this leave is available for everyone, including men who might need it too, because flexibility might not be enough when those symptoms are really debilitating. I acknowledge that that's one of more contentious recommendations, but the Greens strongly support the union campaigns and the campaigns of many advocates for paid reproductive healthcare leave.

I'm really pleased that we got this inquiry up and, again, I really thank everyone for their participation in it. I look forward to the other contributions.

Marielle Smith (SA, Australian Labor Party) Share this | Link to this | Hansard source

I also write to speak on this report. As deputy chair of the committee, I want to thank my colleagues who participated in this inquiry, particularly the chair, Senator Allman-Payne, and my colleague Senator Waters for her initiative in bringing it forward and her willingness to allow me to co-sponsor it with her and for her genuine commitment to improving women's health outcomes too. I also want to thank the experts, academics, advocates and professionals who participated in our inquiry and presented to our public hearings. We are grateful for your expertise. I thank you for your contributions in an area that perhaps hasn't been appreciated or heard in the way it should have been for a very long time. I really hope our committee and our inquiry help to change that.

Most of all, I want to thank every woman who provided a submission of her own lived experience or who came to our many hearings around Australia to share her story with us. Some of these stories were shocking and confronting, but everyone was genuine in their desire to create change. Especially those women who shared very intimate details of their healthcare journeys and very harrowing stories of their healthcare journeys, I want to thank you for doing that with our committee because your evidence shaped the recommendations in our report.

Nine months ago, when we referred this inquiry, I spoke of the need to shine a light on this issue and to spark a national conversation which could be part of addressing some of the stigma and discrimination which surround these issues. We expected to hear from women across the country, but I think all of us were a bit overwhelmed and surprised by the number of submissions that came in and the impact it has had on women who were able to share their stories. I have been working on issues of women's health for a long time and it is clear that, the deeper you dig, the more you find that women's experiences of pain are too often dismissed and ignored, whether that's for periods, endometriosis, PCOS, issues related to pregnancy, maternal health care, mental health or all the way through to menopause. Women tell us they are not always believed and they are not always getting the good-quality primary care that they deserve. They tell us that their pain is dismissed or carelessly attributed to other causes. They tell us that they are labelled as 'irrational', 'emotional', 'hysterical' or 'crazy' and of the devastating impact of these statements.

It's almost like when we are taught about women's health at school the journey begins at puberty and ends at childbirth, like nothing of significance or consequence happens in a woman's life after that, as though her health journey simply disappears. But that is absolute nonsense. Menopause isn't an optional part of ageing. It will affect every woman lucky enough to reach middle age at some point in her life. So why does it feel like our society hasn't been prepared for that? Why is it the case that our health system is letting so many women down? So many women have walked into their GP's office and have not felt heard and able to access good quality advice and care. Why has the stigma that surrounds menopause been able to impact and infiltrate so many aspects of a woman's life?

It was appallingly clear to us through the course of our inquiry that medical professionals are not being properly taught how to treat menopause effectively and that there's not enough contemporary training and professional development to ensure that, when a woman walks into her GP's office, she is getting good quality, up-to-date and accurate care. We heard in our committee that medical students receive as little as one hour of training in menopause. Again, menopause is not an optional part of a woman's life. It's something that affects 50 per cent of the population. It's time for that to change.

Many of our recommendations go to what needs to happen within our healthcare system when it comes to training medical practitioners and clinicians and providing them with professional development and support so that when a woman walks into that consult, she gets good quality care the first time around; she's not shopping around to five or six different GPs desperate for help. We've heard this from women time after time. If they couldn't get good quality care and didn't know where to go for good quality information, they started scrolling. When they started scrolling, they were overwhelmed with junk products and junk advertisements for products that could do more harm than good.

Socia media can be an enormous benefit for women. It can provide incredible opportunities for peer support. But throughout this inquiry, I spoke of my own algorithm, my own Instagram page, targeting me and marketing me with products to treat menopause. We need to make sure we're looking at these products. We need to make sure that the TGA is reviewing them. There is validity in considering how some of these products are labelled. We have recommendations that go to that, the TGA, and women in regional and rural areas, for whom stigma can take a different shape. We know that country women, like the country women in my family, just tend to get on with things. That stigma looks a bit different. We also know that, in many of these communities, you don't always have more than one GP or more than one option, so shopping around isn't possible. And if woman's GP isn't providing that good quality care and doesn't have up-to-date information on the treatments available for menopause, then there are very little options for her. One woman spoke to me of her need to drive hours and hours to find a GP qualified to provide her with good quality care.

We also heard throughout our inquiry that the evidence base on the impacts of menopause just isn't sufficient. We know menopause doesn't affect every woman in the same way. Many, many women will go through perimenopause and menopause flawlessly. They won't have a symptom that impacts their ability to participate in the workplace. They won't need care from their doctor. They won't need medication. There might be some annoyances, but it won't seriously impact their lives. But there are some women for whom menopause can be really troubling and present really serious challenges and obstacles to their participation in the workplace. We were thinking about those women when we made our recommendations around the workplace and what might need to change.

Our recommendations focus on flexibility and what we can do to give women a right to request that flexibility. For example, workplace adjustments. For many women that's a small change, like being able to prop a desk fan up on your desk while you're at work can make a difference. A breathable uniform can make a difference. If you usually catch the peak-hour train and you're going through a hot flush, it might be helpful to catch the 9.05 train every now and then, so there's that little bit of flexibility in your starting time at work.

Small changes can make an extraordinary difference. We want women to have the right to request them, and we want workplaces to start talking to the women in their places of work about what makes a difference to them. However, there are different challenges for women who don't work in offices. If a woman works in an early learning centre where she is subject to the need to maintain ratios, she is often outside. For a woman who works on the till at a supermarket or for a woman who's working in a factory or construction, there's no desk to put a desk fan. Changes to uniforms aren't going to cut it.

This is where we think there needs to be more research done into what flexibility and workplace support look like for these women and whether reproductive and sexual health leave is actually the answer for them. I admit a lot of the evidence we received about what could change in the workplace came from women in white-collar workplaces. If we're going to support the women who feel like their economic participation is impacted by some of their symptoms, that conversation needs to be much, much broader, and so do our policy solutions. So we've called for research there. We've called for more work to be done and for that to happen in government.

Again, I reaffirm that not everyone will experience negative symptoms of perimenopause and menopause. For many, many women, this will not be a journey that causes distress or impacts their ability to thrive at the peak of their careers. But, for a number of women in our community, it will have an impact. There are things we can do in our healthcare system, changes we can make, which would provide extraordinary relief, and there are small changes we can make in our workplaces—changes which might be the difference between a woman at the peak of her career being able to continue at work or go for that promotion and her not being able to do so. If we're not having a conversation in our workplaces about that, those things won't change.

We have 25 recommendations. I thank the committee for the generosity they extended in trying to get to recommendations which we could all stand up and support. I think they're sensible. I think they're reasonable. I'm proud of what we've done to spark this national conversation together. But it's now over to us as a government and to workplaces across Australia—especially, may I say, the medical profession—to get up to speed on perimenopause and menopause. Women are waiting for change, and it's time we delivered that for them.

Maria Kovacic (NSW, Liberal Party) Share this | Link to this | Hansard source

():  I take note of the report of the Community Affairs References Committee inquiry into menopause and perimenopause. I would like to thank the hundreds of women who came forward with their experiences with menopause and perimenopause, the medical experts who gave their advice, and the countless women's organisations who worked with the committee on this inquiry. I also thank my colleagues Senators Waters, Marielle Smith, Pratt, Allman-Payne, Askew and Hughes. This was a group of women who worked together in order to try and come to some answers that would actually create meaningful outcomes for Australian women.

During the inquiry, I received countless emails from women who were grateful just to be seen and heard after generations of invisibility on this issue. They came forward despite the stigma that surrounds menopause and perimenopause. One woman wrote to me and said: 'I worked in a private equity firm and began going through menopause in my mid-40s. In 2018, I was sat down and asked to leave my job because my manager believed I "wasn't coping with the pace of the job anymore" and they "needed someone with a more youthful approach".' She said, 'How insulting after 10 years of loyal, dedicated service.' Another woman who contacted me said: 'I am so pleased that there is a Senate inquiry into menopause and perimenopause. I'm not sure how much "good" will come of the inquiry, but I sincerely hope that light is shed on the subject and the conditions are able to be freely discussed and not dismissed as female hysteria or taboo.' I firmly believe that much 'good' can come of this inquiry and of this mostly consensus report.

The report makes a series of very important recommendations which will undoubtedly assist all women—our mothers, daughters, sisters and friends all across Australia—experiencing perimenopause and menopause, including some who are currently wondering what on earth is happening to their bodies. Maybe they'll be able to look to this and go, 'That's what is happening to me,' where others before them haven't been able to. As I've said many times in this chamber before, half of the population experiences menopause, and we need to update our systems to accommodate this phase of life, especially as our population gets older. We can only fix problems if we acknowledge them. We can't fix problems by pretending that they do not exist or not talking about them because they are a little bit uncomfortable or awkward to talk about.

One set of recommendations I would like to highlight surrounds education and awareness. What we heard during the inquiry process was there is a general lack of understanding of menopause and perimenopause across the board, whether that is women themselves, doctors or workplaces. There is a clear need to do more in the education space. Bettering our education and awareness on the topic of menopause is the first step of many that will make a positive impact on the lives of women. Like many of the women who gave evidence, I too had no idea that many of the symptoms I was experiencing were related to perimenopause or menopause. It means women will know what to expect when they experience menopause. Doctors will be more able to provide correct diagnoses and treatment. Workplaces will find ways to accommodate, and the stigma surrounding it will be reduced.

Another important set of recommendations surround the access to hormone replacement therapies, which make a real and significant difference to the lives of some women experiencing menopause. Women who choose to take MHT should be able to access it readily. They should not have to run around for hours to find a pharmacy that has it in stock. This is Australia in 2024. If we need a medication, we should be able to get it. Ensuring timely and affordable access to these therapies is in the domain of the Australian government, and I look forward to seeing their response to this report.

The only real area of divergence in this report is on the topic of menopause leave. As we outlined in our additional comments, it is the view of the coalition senators that the conversation on menopause-specific leave was primarily driven by a small group, and that the vast majority of evidence submitted actually flagged serious concerns over what negative impacts could be derived from such a policy. Coalition senators absolutely agree that a review into workplace flexibility has merit. Industrial relations laws are complex, and it is our view that the Community Affairs Committee's remit is on health and social services. During this inquiry the interaction with businesses and IR experts was limited, so we sought to extend that into a deeper discussion, into deeper scrutiny and a deeper inquiry. That is why it was our view that the Senate refers an additional inquiry into the impacts of IR laws on menopause to the Education and Employment References Committee, which is better placed to inquire into these matters and make accurate and compelling recommendations in this space.

I think it is really important for us when we speak of what the outcomes of this are to reflect on the many and varying experiences of Australian women, on the opportunity that we have here to be their voice and to do it in a way that is respectful and can deliver meaningful outcomes. I think there are many times where there are different agendas that mean we do not deliver the outcomes that we need and I do not believe this inquiry was one of those. I believe we worked in good faith to deliver the best possible outcomes for Australian women. I hope that, as a result, we can see a change across the board both in workplaces, in medical educational institutions and in our ordinary lives, where we can talk about problems in the same way that we talk about mental health and have it as a normal part of our everyday lives.

I thank again my colleagues for their participation in this inquiry. I just want to finish up with a couple of our additional comments in our report around the widespread concerns of Australian women around having sensible discussions designed to increase public awareness, to destigmatise, to provide access to treatments and supports, and to encourage further research and foster new pathways for vocations related to menopause and perimenopause.

Louise Pratt (WA, Australian Labor Party) Share this | Link to this | Hansard source

Thank you, Acting Deputy President Allman-Payne, for your own contribution to this inquiry. It is good to see you sitting in the chair presiding over this discussion. Women in Australia are demanding a better understanding from workplaces, medical practitioners, research bodies, governments and our society more broadly about their experience of perimenopause and menopause. But I guess the same could be said for our reproductive lives as a whole.

There's a growing movement in our nation where women are determined to no longer live with preventable and too often debilitating symptoms of perimenopause. Equally, as this inquiry showed, women are concerned about their long-term health, and there are a whole range of health risks that change with menopause, such as heart disease, stroke and more. And, I have to say, I know personally what a difference it makes to have a GP who listens and responds to your needs at this time of life, and I give my thanks to Dr Belinda Wozencroft. However, as the evidence for this inquiry shows, too few women have access to the supports they need. So our report from the Community Affairs References Committee on issues related to menopause and perimenopause is timely.

I thank Senator Waters and Senator Marielle Smith for bringing it forward. I also deeply thank my colleagues who were there, asking questions and participating together. I think it was good that, as women, we were able to engage with other women, medical practitioners and everyone around the nation to discuss these issues. I do wish at times there had been some engagement from male senators—but perhaps it might not have been so much fun!

The inquiry sat a little too close to home for me in its relevance at times, so I stand here tonight very much part of the movement of women asking for change and recognition of these issues. Women's poor experiences when seeking health care for symptoms of perimenopause and menopause were deeply reflected in the evidence put forward to the inquiry, with more than 300 submissions, seven days of public hearings, a hundred people or more giving evidence. I thank all of those people, and I want to give particular thanks to the women who shared with us their personal stories and experiences, some very traumatic. On that note, I have to say that at times, as they were speaking about their own experiences, I felt like they were portraying my own experience back at me. We heard stories of delayed diagnosis, over- or underprescribing medication, the effect of out-of-date medical knowledge on MHT, misdiagnosis or total dismissal of their pain and symptoms. There were harrowing stories from women facing significant barriers accessing appropriate health care.

Our inquiry showed that we have a health system that, in its foundation, has been built by men and largely based on men's biology. I guess at the time, as it evolved, it was a baseline for normal, because their hormonal profile did not have the fluctuations, perhaps, that women have and, perhaps, that is why our medical system did this. However, that is not normal. It is normal in our lives that our hormonal profiles fluctuate and change. We saw, in the course of the inquiry, a representation of the fact that women have been historically underrepresented in clinical trials and medical research, resulting in a gender data gap. We even saw old tropes about women being overly emotional and hysterical, and this their recent and current experiences with medical practitioners—current experiences, frankly, of medical misogyny. Stigma, shame and self-doubt make it difficult for women to discuss their needs with their general practitioner, let alone in their workplace, with their partners, families and other healthcare providers.

We saw examples of limited or no access to health professionals who are trained with even a basic medical knowledge about menopause. This was exacerbated by the experience of living in a rural or remote area. We saw limited or no access to evidence based information so that women could understand an absolute myriad of symptoms and treatment options—symptoms that go far beyond what you might expect in terms of a hot flush. We saw inadequate training for our normally very dedicated health professionals—health professionals who are still captured by an outdated understanding of menopause hormone therapy.

I want to highlight some of our recommendations: the need for a national response and a perimenopause awareness campaign and that menopause and perimenopause modules are included in all medical university curriculums and the need to mandate this education for all physicians practising in the public health system across Australia. When you look at the fact that the largest group drawing down dollars in the Medicare billing system are women reaching perimenopause or in menopause, there are in fact savings to be made by doing this properly; we can't show up, time and time again, undiagnosed or misdiagnosed, for our symptoms. We also recommended that workplace laws should ensure women can access flexible working arrangements.

As our inquiry saw, midlife can be a tough time for some women. We balance a lot of things: the busy lives of our children, demanding jobs, financial stress and, perhaps, ailing parents. When you add to this your own perimenopausal and menopausal health issues, it is little wonder that we did see the evidence of some women cutting their hours or dropping their income at a time of their life when we would hope that they would be growing their careers.

I was particularly moved by the experiences of women experiencing early menopause—women whose medical practitioners threw them into early menopause with cancer treatment or a hysterectomy and yet whose medical support did not include addressing the immediate issues that would arise from going into early menopause. This was really distressing to listen to: the lost education and career opportunities for women who, because of these kinds of symptoms, were unable to continue working because they didn't have access to the help or support they needed.

In finalising these remarks tonight, I want to say that the very best part of this inquiry—and I'm really quite moved by it—is seeing firsthand the incredible difference that the right support and care makes; the wonderful movement of practitioners; women getting together to talk about their experiences; successful campaigns for adjustments in workplace entitlements and flexibility; but, more than anything, a reduction in stigma by having an ability to talk about the symptoms and issues as they arise. Women are engaging and talking to each other. There's an incredible community of practice that is growing. There are a number of physicians who are ethically treating women with MHT. And there are the global trends where we see these treatments improving all the time. British Columbia saw, for example, free menopausal hormone therapy recently announced in their jurisdiction.

So I'm very pleased and proud to be part of this movement, and I very much commend the report to the Senate.

Hollie Hughes (NSW, Liberal Party, Shadow Assistant Minister for Mental Health and Suicide Prevention) Share this | Link to this | Hansard source

I also rise to take note of the Community Affairs References Committee's report on perimenopause and menopause. The inquiry looked into issues in a way that was comprehensive. We spent a great deal of time looking into this matter. We travelled around the country hearing from women and men of all persuasions and circumstances about the varied experiences that they'd had and about how the range of symptoms, mental and emotional experiences and treatment roadblocks impacted on productivity and their ability to flourish in the workplace. We also heard from a range of business groups, medical organisations, clinicians and health practitioners involved in the employment, treatment and care of women at this stage of life.

I guess one of the biggest takeaways of the inquiry for me was the sheer lack of understanding and awareness surrounding menopause and perimenopause. I admit that I had never heard the term 'perimenopause' before I was put on this inquiry. As a woman who's getting towards the end of my 40s, it's extraordinary that I had never heard that term. We did learn that menopause is a lot more than a hot flush and no more babies. There's a whole lot more that goes on with menopause, and I think a lot of women don't know that what they're experiencing is perimenopause.

At this stage, I want to take the time to acknowledge my colleagues from around the chamber who were on this inquiry. There's nothing like a group of women sitting around sharing experiences, such as what the hot flush looks like and how itchy skin, which was something I was experiencing—and had no idea—was a possible symptom of perimenopause. I would like to give particular thanks to Senator Allman-Payne, who without I'm not sure I'd already have my Oestrogel. She taught me all about what I should be getting, so that when I walked into my GP I knew exactly what to tell Jeremy I wanted.

This just demonstrates the importance of having the conversation, the need to have the conversation, and for it to be out in the open. It is extraordinary to think 50 per cent—really 51 per cent—of the population will go through this. They will go through menopause. Whether they experience significant symptoms or not, whether they struggle with it or cruise on through, they are going to go through this; yet it's something that is still taboo, that is not spoken about.

I know as we all were travelling and talking about it, certainly most of our mothers never breathed a word about menopause. Even when I was at school, when girls got their period it was something that was secretly talked about between you and your mum and no-one else. You never breathed another word. But you see teenage girls now, and it's like, 'Whatever.' It's not a big thing. The shame, the stigma and the embarrassment around menstruation issues have dissipated. It's got to what I always think is a good stage where people can openly joke about it or make a comment or where it's not a big deal, and boyfriends don't hide tampons under the bananas at the supermarket. They're all quite happy and open when it comes to those issues. I really hope we can get the same way with menopause, because the more open and frank discussions we have, the more we can see the funny side of it and the more we can support each other. The more we acknowledge that this is a natural part of life, the more the acceptance will just naturally grow, and it will not be some big deal that everyone's got to deal with.

We did hear that there are a lot of areas that need improvement. The recommendations that we've made have highlighted the need for that broader awareness, that need to destigmatise and increase understanding. We probably just need to get the term 'perimenopause' out there, because lots and lots of women have never in their lives heard of it. We want to empower women to speak openly about this and about their experiences. I think it's also important that we empower men to speak about it as well. And it would be nice if once in a while one of the blokes in here to put their hand up for a community affairs committee inquiry that's looking at things that they think are soft social issues, not big tough ones like defence or national security: 'We don't go to that.' Particularly for men who have partners, wives, daughters, mothers, they are going to be part of this experience whether they like it or not. By having those open and frank discussions, mothers and sons—I have two teenage boys—they will understand what's happening, or what is going on at any given moment, so that when they are in relationships later in life it won't be something that confronts them or be something about which they have no comprehension in terms of what it means for them or their partner.

The lack of knowledge of GPs was really quite disturbing. Women's anatomy was not even taught in the fifties, which is 80 years ago. Less than 80 years ago, they did not even teach women's anatomy. GP learning is something that has to be significantly improved. A lot of GPs still have a lot of outdated views when it comes to hormone replacement therapy. They are still drawing the breast cancer link. Obviously, those things can be much better managed, products are different and a debunking has occurred. There are a lot of issues that need to be addressed when it comes to GPs.

Men are encouraged to have prostate checks, the bowel cancer screening checks go out and there is heart health. All of these things are discussed but there needs to be a focus more on women's health, particularly post babies. Everyone does a lot pre babies. You spend a lot of time at the doctor with babies. Then you kind of go into a health vacuum because you are kind of just ticking along. There does need to be more of awareness and understanding that women at some time will require longer consults. When things are happening and changing within, whether it is anxiety, whether it is sleepless nights, whether it is itchy skin, these can all be signs of perimenopause or menopause and it does not have to happen bang on 50. It can happen much earlier in life. Women need to stop being dismissed out of hand that this could not be happening to them because they are too young. We heard time and time again of the number of women who did enter early menopause and were fundamentally gaslit by the health professionals—that there was no way they could be experiencing this.

I acknowledge Senator Waters' comments around her very clear passion for menopause leave at the beginning of this inquiry. It does show why these things work, how people's minds can be changed and attitudes can be shifted, because we did hear an awful lot from women's groups as well as industry groups that menopause leave might not be the right way to go. Certainly the coalition's additional comments have opposed, if you like, that it should be a legislated kind of leave.

When we talk about the awareness of menopause, when we put it out there and talk of the symptoms, not everyone gets brain fog. We don't want everyone thinking that every woman in their 50s all of a sudden becomes addled; that is not what happens. But we do need to acknowledge these things occur. If we get the awareness out there and destigmatise this, we want it to be something that is a positive for women. Women when they are going through menopause are quite often at the peak of their career, at the peak of their productivity. We should be really harnessing that to make sure we are not losing women at that time of their cycle and not bringing in any sort of unconscious bias from employers about hiring women in their mid-40s and beyond. You are going to get the best out of women much in those years. Their kids can get the bus home by themselves. There are a few things have gone on in their lives. They are probably not dealing with nappies anymore or as many school assignments or racing around to sports, so they have more time. They are not going into the workforce looking for part-time; this is when they can step up to full-time work. We need to make sure that employers understand menopause is something 50 per cent of the population is going to go through. It is not the end of the world. A lot of women are not going to have a lot of symptoms. Eighty per cent of women are going to skate through with mild or no symptoms at all, but we do need to break down the stigma and raise that awareness.

Penny Allman-Payne (Queensland, Australian Greens) Share this | Link to this | Hansard source

I won't speak for long. I want to associate myself with the comments from my colleagues that spoke to this report. I want to place on record my sincere thanks to senators Waters, Marielle Smith, Pratt, Askew and Hughes for the collaborative way in which they worked on this inquiry. It was a real joy to work with you. I also want to thank the secretariat for the incredible amount of work they put into all of the inquiries, particularly this one. But most of all, I want to thank those women. It was a real privilege to sit and listen to your stories, your lived experience evidence, and the committee will be forever grateful for the contribution you have made because it will benefit all women in this country.

Wendy Askew (Tasmania, Liberal Party) Share this | Link to this | Hansard source

I, too, want to take note of the Community Affairs References Committee report tabled today. This inquiry examined issues related to menopause and perimenopause. The experience of menopause is a highly personal one, and, while no two journeys are the same, this inquiry highlighted a concerning common thread that was brought sharply into focus. Menopause is still a highly stigmatised experience for women in Australia.

For too long, women have been suffering in silence with systems that can range from hot flushes to brain fog, chronic fatigue, disturbed sleep, itchy skin and menstrual changes, just to name a few. The severity of symptoms is different for every individual woman. For some, it can be just a blip in their day; for others, it can be quite debilitating. Symptoms are also often deeply personal and emotive. It can be difficult for women to share with those around them, even close family and friends.

The purpose of this inquiry was to understand the menopause experience of women across the country, to shine a light on it and to bring it out of the shadows. Sharing personal experiences can be challenging. In this context, I want to thank each person who made a submission or gave evidence to the committee during the inquiry. I also want to take this opportunity to thank the hardworking secretariat for their diligent and in-depth work on this topic. I also want to thank broadcasting, who travel the country with us and make our hearings happen. There is a lot that goes on behind the scenes. I want to thank, as others have, the community affairs committee members who participated in this inquiry, all of us women. I'm pretty sure we all learnt something about the menopause experience along the way.

One of the incredible things about participating in these inquiries is that we get to hear the firsthand lived experience of those we hope to help improve their lives and their menopause experience. The evidence we received clearly showed that the experience of menopause and perimenopause and its impact on the workplace is a highly personalised and individual experience. It also highlighted the awareness and education gap across most industry sectors on how best to support female employees entering midlife.

Working together, the committee has taken a collaborative approach, and I am pleased that we were able to agree on constructive recommendations to help improve the experience of women at this stage of their lives. Many of the recommendations in the report are around raising awareness and improving the educational understanding of menopause and perimenopause for medical care providers, workplaces, and the community in general. I believe the recommendations reflect the desire of the committee to improve the menopause experience, including through education and awareness for employers about the impact of menopause in the workplace and the need to provide flexibility and understanding to employees.

I was pleased to be invited to participate as a panel member at the Clifford Craig Foundation's Let's Talk Women's Health Brunch in Launceston a couple of weeks ago. The topic was menopause at work. The keynote speaker was Theo O'Connor, director of menopause@work ASIA PACIFIC. Thea is well known for her innovative approaches to health across various environments and has played a key role in helping numerous workplaces in many diverse industries become more menopause friendly. She was also one of our early witnesses in the inquiry. It was truly refreshing to hear her speak about empowering women to navigate their careers in the life stage of menopause with confidence. I must admit that, as a postmenopausal woman, I certainly felt motivated and challenged to take on the world, and I'm pretty sure the 200-plus women in the room did as well.

I later joined Thea and local Launceston GP, Dr Natasha Vavrek, on a panel to discuss the broader aspects of menopause. Dr Vavrek is a director of The Bubble Tasmania and a consulting specialist women's GP at The Bubble Launceston. She provided a positive approach to the management of menopause symptoms, highlighting the benefits of GPs undertaking additional training in this area. Around the room, you could sense the relief that people were actually willing to talk openly about menopause, even the half a dozen men who dared to come along. The question-and-answer session was extremely interactive and informative.

I look forward to participating in future discussions on this topic in the coming years, which brings me back to the inquiry where many witnesses shared their experiences of dealing with menopause in silence. What a heartbreaking and difficult situation to be in. Some even said they thought they were experiencing early-stage dementia or they were losing it and, as a result, they had considered leaving their workplace rather than seeking support. Unfortunately, that suggestion has been supported by evidence in relation to the retirement age of women.

As coalition senators, we believe there is a need for a balanced approach between government oversight and private sector autonomy to give employers the tools needed to help women experiencing menopause and perimenopause to continue participating in their lives and to continue to be actively engaged at work. However, we want to ensure that any intervention or mandated change by the government does not penalise or ostracise working women. Instead, we need to destigmatise and raise awareness of the symptoms and how they impact women at work.

It's in this context that I and my coalition colleagues do not support the introduction of legislated menopause leave. We believe it is something that should be assessed at a business level, with more flexibility being provided as required. And who is to say that by mandating menopause leave it wouldn't lead employers to consider that hiring men is more cost-effective, ultimately leading to unintended consequences and exacerbating the gender disparities in the workforce.

Despite some disagreement on this point, I was pleased the committee was able to agree to the report's other recommendations, including the need for further awareness and education and the need for a broader community based awareness campaign aimed at destigmatisation. This is particularly prevalent in the healthcare sector, with the committee hearing evidence of the lack of education among primary care physicians. In some cases, as we've already heard, there's just one hour during GP training spent on menopause. I actually recently heard from a GP who was told during their training that menopause patients are known as the 'sinking heart patient'—the one where you know they're coming in and you want to get them in and out as fast as you can. That was the advice she received from her training physician.

One approach could perhaps be promoting a menopause specific check-up, along the lines of the prostate awareness material for men, as women approach midlife. And, in support of that, also encouraging healthcare professionals to participate in modules to educate and specialise in women's health, including menopause. They are available.

We heard evidence that the lack of expertise among healthcare professionals had led to delayed diagnosis and treatment options, including the reluctance among health professionals to recommend hormone replacement therapy. Coalition senators highlighted the importance of enhancing access to menopausal hormone therapies as they are crucial for women experiencing severe symptoms. Also, ensuring equitable access is a key element in effectively managing the more debilitating effects of these conditions.

We all want to improve the experience of women in midlife who are experiencing perimenopausal and menopausal symptoms, and I want to reiterate my thanks to all those people involved directly and indirectly with this inquiry. The majority of the findings of this report are sensible and designed to increase awareness, destigmatise symptoms, and provide access to treatments and supports. We also encourage further research with a view to developing new pathways into vocations related to these conditions. It's only through focused education campaigns, awareness campaigns and efforts to destigmatise and create understanding that will we be able to foster flexible arrangements at work that have the best chance to succeed.

Bringing these conditions and their symptoms into the conversation is important if we are to truly destigmatise perimenopause and menopause. I thank the committee for its role in helping to shed light on it as we seek to improve the experience for women in Australia. I seek leave to continue my remarks later.

Leave granted; debate adjourned.