sMater | New Menopause Measures | Dr Melanie Allan

Women's health is now a "national priority". 

There is now a clear focus on improving access to menopause therapies, contraceptives and endometriosis and pelvic pain support.  

This week on sMater, Mater Gynaecologist Dr Melanie Allan discusses the initiatives announced by @albomp and @jim_chalmers_mp, how it supports medical professionals, and the difference it will make to the lives of women across the country.  

GP Education activity log:  

- Podcast title - sMater: Menopause Measures
- Provider - Mater Misericordiae Ltd  
- Date published – April 4, 2025  

- Certificate of completion - https://www.mater.org.au/Mater/media/sMater-Certificates/sMater-Certificate-of-Participation-Menopause-measures.pdf 

#womenshealth #healtheducation #healthcare #menopause #smater #mater

To learn more about Mater, visit https://www.mater.org.au/

Transcript

Hello and welcome to this episode of Smarter, a podcast by clinicians for clinicians

brought to you by Mater, an Australian leader in healthcare for more than a

century. My name's Jillian Whiting. And I'm Dr Maria Boulton, GP and former president

of the Australian Medical Association of Queensland. We're coming to you from Meanjin,

the land on which this podcast is being recorded. Today we welcome Dr Melanie Allan

to sMater. Melanie is a gynaecologist at Mater specialising in fertility, gynaecology,

menopause and adolescent gynaecology. Melanie, welcome to sMater. Thank you very much.

We are Mater. We are Mater. We are Mater. This is sMater.

Today we're going to be looking at the federal government's $573 .3 million women's

health package particularly around menopause and obviously very keen to hear your

thoughts in just a moment. But before we do just a reminder of what Prime Minister

Anthony Albanese had to say when it was announced.

Too often women's health hasn't been taken seriously. Something had to change.

We're investing more and half a billion dollars to make sure that it does. So we're

making new contraceptive pills cheaper. We're funding more free GP appointments but

long -term contraceptives like IUDs. And we're boosting support for women experiencing

menopause. We've already opened 22 new endo and pelvic pain clinics to help women

get treatment sooner and we'll - Open 11 more. Australian women have asked for

change. We've listened and we're delivering that change.

- Let's start with the menopause funding and that includes three menopausal hormone

treatments becoming available through the pharmaceutical benefit scheme. Can you tell

us what are the therapies and give us a brief breakdown on what they are? - Okay,

so the three therapies are ester gel, prometrium, and a combination of the two,

ester gel, pro. And these are more neuro medications, and they are biosynthetic

medications, so more similar to the hormones that we produce ourselves in our body.

Ester gel is to replace any lost estrogen, and that's applied on the skin,

and absorbed at about 20 minutes. The prometrium tends to be taken orally, and then

the other one is a combination of the two. And these are really exciting ones

because they are those bioidentical medications. Then we're seeing less side effects

with them and more advantages with them for women. And the, from each of the

micronised progenitor, it's been a choice of a lot of menopause providers for a long

time, but that financial implication has been really quite inhibitory to getting their

patients the best sort of medication for them. Cost is an issue as we know during,

especially at the moment where there are cost of living pressures. Yes. And it is

great to see these medications come into the PBS, they're long overdue. What do you

think is going to be the impact for women in the community? So I think the impact

will be huge. I think that women bear the additional financial burden of looking

after reproductive health from contraception all the way up to looking after menopause

therapies.

And it's often a really demanding...

so a massive plus to be able to access this healthcare appropriately and readily.

- In terms of hormone therapies, then just bear in mind that we're discussing this

with four GPs as an audience. What are the latest options available? What is the

safest option? And when choosing what to prescribe to a patient, does availability

come into play? Because we know that there are some options that perhaps aren't

available at the pharmacy. Yep, and I think the reduction capacity has increased in

Australia. I know from my time in the UK as well that often there wasn't that

access to the menopause medication it was prescribed, but it wasn't there. I think

these three medications that we've highlighted are really important ones. Those ones

where we're delivering estrogen through the skin, either in patches or gels,

then we're

of risks associated with them and they will help support them during this busy time

in their lives. Any tips on how to apply the gel? I'm speaking to you from

Queensland. It's hot. It's humid. And I think trying to find 20 minutes of your day

when you're not going to be hot and sweaty can be quite challenging compared to

other areas of the country. So I'd probably just either often after the shower,

when perhaps you're a bit, you can dry off when you're cooler, and just sort of

trying to apply the gel over one of your limbs, it doesn't matter which, and

letting it dry. It's also important that other members of your family don't come and

touch your skin during that time, so we don't want that estrogen transferred to

partners or children at that time. So you might be a really difficult challenge for

some people to have 20 minutes by themselves after they've had a shower, but that

would be an ideal time to do it. With things like patches, then obviously that just

pops on, that's not going to go into contact with anyone else. But again, in our

climate, when it's quite sweaty, it may be difficult for those patches to stay on.

How important is that to reinforce that with patience? I'm thinking personally, I

don't know, I think 20 minutes and now you're making me feel terribly guilty. Yeah,

well, I'm sorry about that.

I think we're all trying to squeeze in a bit of time to ourselves in the day.

Perhaps then trying to put that gel on just before you go to bed when everyone

else is settled. You've got to make it work with your with your home life and to

just make sure it is absorbed properly and doesn't get transferred to other people.

Most women reach menopause between the ages of 45 and 55. The Australasian Menopause

Society reports that in Australia, the average age for women to reach menopause is

51, but some women can reach menopause as late as 60.

Now, from the 1st of July, new Medicare rebates will be available for menopause

health assessments, which are designed to help women experiencing experiencing menopause

and perimenopause symptoms, help them receive higher rebates when accessing care.

So can you talk us through those health assessments and what they involve? - The

Australian Menopause Society has produced some fantastic guidelines for us and for our

GP colleagues. And those are great menopause toolkit, which kind of gives you a step

-by -step what you should be asking your patient when they come in, what stage are

they in in their reproductive or post -reproductive journey, and what...

a really nice window into what things we might need to look out for in this period

of their life. The important thing about the health assessments is that it's going

to allow us to spend more time with our patients because of the increase in the

rebates, which is really valuable. One of the questions that we're always asked is

weight, because women can put on weight around this time, particularly around the

middle. Do you have any advice that we can share with our patients regarding weight?

We know that muscle mass decreases during from the age of 40 onwards a certain

percentage each year and thinking about those weight -bearing exercises that we've got

building that muscle mass, we're raising the metabolism so that's sort of working in

the background. We also think about weight -bearing exercise that increases our bone

health as well if we're doing the sort of higher impact things, age appropriate,

joint appropriate exercises as well.

And that's an important thing to be considered. It fills you up for a long time

and it's a good source of energy during this stage of your life. We haven't seen

the detail on the health assessments yet, but would it be really useful if as part

of that we could use a chronic disease care plan where women can access, subsidise

access to dieticians and exercise physiologists and I guess the devil will be in the

detail. That would be really helpful to take that multi -disciplinary approach for

something that's A very big problem impacts our economic workforce,

it's huge and if we make those small interventions at the beginning of menopause and

guide that journey more smoothly then we'll be more productive. You mentioned some of

those risk factors to keep an eye on before. Other services or other specialists,

GPs, can refer menopause or women too. Should they have any of those concerns? There

are women for example who have a personal history of breast cancer or who may be

experiencing menopause.

isn't suitable for those people and we need to think about other types of medication

as well.

Perimenopause usually begins in the early to mid -40s and on average lasts four to

six years. According to the Jean Hailes organisation around 20 % of women have no

symptoms, 60 % experience mild to moderate symptoms while the remaining 20 % have

severe symptoms that interfere with daily life. In addition to symptoms such as hot

flushes, headaches and changes in mood, the Australasia Menopause Society also reports

around two -thirds of women have memory problems and reduced processing speeds.

- When is the best time to start discussions and what to expect in the perimenopause

and menopause stages of life?

- That's a really good question. I see a lot of people in my gynecology clinic who

are just very confused, aged 44, about what has happened to their body. My periods

have become really irregular. What's wrong with me? They're heavy. My energy levels

are terrible. And the answer is you're going through the perimenopause. And I think

it is good that this government funding has come through that is the start you

know, building upon that awareness of women knowing more about their own bodies, GPs

knowing about how to look after them and have those conversations. When is a good

time to talk? I suppose when women are coming in for a smear test, like,

you know, how how is your cycle? We know that the menstrual cycle is such a window

into into your general health and I was reading a paper the day about The menstrual

cycle is a vital sign and it changes during our teenage years, during our 20s and

30s and our 40s and it's telling us that that shorter cycle, those cycles that are

spacing out, something is changing in your body. So can you put an age on it at a

specific time that you should be asking?

That's a really good question. I think probably around about 40 most women start to

notice these changes in their body and start wondering what is happening to me and

having those conversations with their friends. So maybe they visit around about that

time. Would you schedule an appointment for after women's 40th birthdays?

That could be a good time to have that well woman check and start those

conversations, especially if a package is available. Part of the federal funding is

putting some funding aside to upskill GPs who want to be upskilled in the management

of menopause. We know that for a lot of us it's bread and butter, but there are

some that are seeking more education. What would you like to see with that funding

and that education?

- I suppose I'm always a back to basics. First of all, I have a better

understanding about what it is, what the condition is, what the pharmacology is or

what I'm describing so. And so I would like to sort of...

to your individual patient and also thinking beyond the estrogens and the prodigens,

the other medications that are available. And those the difficult cases, the people

who are post chemotherapy, post radiotherapy, to be able to have that sort of

partnership with very well trained GPs and the gynecologists, because they need a lot

of a lot of support, because we often it takes a lot to get a good improvement

for them. - And speaking of other medications, a very common question we have from

patients at this age is what can I do about my low libido? And can you please

prescribe me some testosterone? What is the best approach to treating a woman who

has low libido and what is the evidence when it comes to testosterone treatment?

- Sure, so the evidence for testosterone treatment is for treating hypoactive sexual

desire disorder. So it's for women who have a very low libido and are bothered by

that. And that's when using things like the testosterone gels are the most

appropriate, and we get the best results. We know that testosterone in women is a

hormone that we all make, and is highest in our early 20s, declines towards the

menopause, and surprisingly picks up again around around 65 and 70. There is no sort

of therapeutic level that testosterone should be at.

So in terms of if you-- it doesn't matter what it is, but some women have low

testosterone and are very happy with their libido level. So it's not something that

you could-- it's more how it's affecting their life rather than what their actual

levels are. And firstly, sort of problems with.

difficult. So when I'm approaching a patient I suppose I'd want to know yes about

the menopause symptoms but also is sex comfortable, is sex painful, is there any

trauma history there, has there been any history of endometriosis. Often working with

a pelvic floor physio is a good first step if there is raised pelvic floor tone or

they've had chronic pelvic pain for example. Is that the issue? Is it due to

vaginal dryness? Is using different types of lubricants the right course to go down?

And sort of really unpacking that complex sexual response to why the libido has gone

and it's bothering them. The other thing is then thinking about how estrogen is

delivered. If estrogen is delivered orally, it

can block the testosterone and can take up all the sex hormone binding goblin

receptors so that although there is testosterone around, it's not as available and

sometimes switching to something like transdermal estrogen can make their own

testosterone more available. So I'd probably do that first and then for those women

that are bothered by their low libido, then yes, the testosterone is there.

It hasn't been very easily to be accessible for making those testosterone products

for women, but they are coming through and you don't want to be so high so they've

got acne and increased hair growth. So then the blood tests are useful for

monitoring that. Is that an appropriate range just to keep an eye on things and the

symptoms as well? How often would you do the testosterone levels? I think about

every three to six weeks.

The Jean Hailes 2023 National Women's Health Survey specifically looked at the impact

of symptoms attributed to menopause by Australian women. 37 % of survey respondents

reported the menopause symptoms they experienced in the five years prior made it hard

to do daily activities, 31 % found it hard to work or study, 22 % missed exercise

and 12 % sent misdays of work or study.

To shift focus now and another key part of the funding package centered on

contraception. So what are the medications that have come on to the PBS in March?

So we've got to the newer pills, which are Yas and Yasmin. They're really useful.

They're particularly good for people who are experiencing PMDD because of the of

progesterone that's there and there's lots of different types of progesterone pill but

these two shown to be particularly good. The YAS, talking about our perimenopausal

patients because it has that slightly lower estrogen dose and we know that a lot of

perimenopausal women will experience their kind of those prolonged and worsening PMDD

symptoms and this can be a very helpful medication for them as long as they're safe

to be on the combined pill with the usual safe safety netting for that. Part of

the announcement from the federal government is a package to fund more pelvic pain

clinics. The martyr already has its own persistent pelvic pain clinic.

Can you tell us a bit about the service? Yeah, so it's a great service and it is,

I think our patients that have this persistent pelvic pain, it's one of those really

difficult challenges because it's very complex And I think women can often feel that

they're not listened to, or it's a problem that nobody seems to get a good

treatment for them for. And as they're a GP who's looking after them over many

years, it must be incredibly frustrating. And so at the pelvic pain clinic, we do

treat these women seriously. And we have a multidisciplinary approach. So we know

that people with persistent pelvic pain, it's not just their gynecological organs,

it affects their bowel, it affects their pelvic floor tone, it affects their bladder,

it affects their well -being if you're living with pain for a long time. So it

brings everybody together. So we have a gynecologist, we have a psychologist, we have

a gastroenterologist, we have physiotherapists, we have pain specialists.

So we're bringing everybody together to think about, what is it? How can we help?

How has it gone to other areas in your body that's reflecting the exacerbating

continuing the pain that's there for the pelvic floor physios? Can they work with

release of those areas, stretches, things to help with bowel regulation,

bladder regulation? Our gastroenterologists, we'll talk about people who then have very

sensitive bowels and disturbed guts due to that so they can work with them on their

sort of biofeedback loops to improve those sorts of things and the gynecologist that

they're doing what we do. Normally checking for is there anything we can help with

hormonally? Are there anything topically we can use? So it's really satisfying when

people come back and say actually this has made a difference but it needs to be

taken seriously and it needs everybody to have a good look and a good think about

how we can help. Is there anything else on the horizon medication -wise that you

think we should know about? Yeah so when I went down to the menopause conference

down in Melbourne a few months back they were talking about a phezolinitant which is

an exciting new treatment for vasomotor symptoms for hot flushes which doesn't involve

hormones. And the research has been done on these candy receptors in the brain which

become more sensitive to the changes in heat and this medication is targeted on that

so that it just calms down a bit and doesn't send off these hot flushes all the

time. It doesn't involve hormones, it's very good for vasomotor symptoms, it's not

good for bone density, vaginal atrophy all the other things that we worry about

often sleep is mainly affected by those vasomotor symptoms so it can help with that

but it's a different way of approaching apart from MHT. It's not on the PBS but it

is TGA approved. It is yeah so hopefully that's something that we'll be able to use

for our patients in the in the coming future. It's so interesting Melanie thank you

so much for joining us on Smarter and and sharing with us the updates on women's

health and funding. But before you go, we've got something that we call the check

-up.

So we're going to ask you five quick questions, and it's to learn a little bit

more about Melanie, the person, as opposed to Melanie, the doctor. So Marie is going

to ask you some questions. Are you ready? I'm ready. Okay. If you weren't doing

this, what would you be doing instead? I would be, I would be writing comedy

scripts for television? Yeah, wherever they'd have me.

Yeah, yeah, that's what I would be doing. Very different. It's very different. And

speaking of writing, how do you describe your handwriting? Oh, variable. I think it's

my handwriting. I'm a lefty, which doesn't help to begin with, and I'm a doctor, so

I try really hard, but...

What TV show best portrays your profession? Probably This Is Gonna Hurt, but that's

a very dark side of it. The joy of the experience is probably more like Scrubs.

Yeah. - It's a nice way to put it. - Yeah. Do you have any superstitions?

Do I have any superstitions?

Oh, - Oh yes, if it's a stormy night or it's a full moon,

then label it's gonna be busy.

- And how do you want patients to see you? - I'm somebody who's approachable, they

can ask me any questions, and hopefully I can somebody that explains things to them

so they have an understanding of their bodies and they're empowered by the

conversations they have with me. - Sort of exactly you've done today. So you've been

fantastic. So thank you so much once again for joining us on Smarter Thank you for

our listeners at home or in the car or having a well -deserved break between

patients Thank you for tuning in. See you next time on Smarter