Professor Sue Davies, AO, a pioneer and leading expert on women’s health in Australia, which is why her name has letters after it—was awarded an Officer of the Order of Australia last year.
His many achievements as an endocrinologist (hormonal medicine) and menopause specialist are listed here; She was Professor of Women’s Health at Monash University’s School of Public Health and Preventive Medicine for nearly two decades.
Professor Davies has been a long-standing, outspoken advocate for advancing women’s health, and is not about to stop, especially with the Victorian state election looming.
Her current concerns are the availability of hormone replacement therapy (HRT) for women with early menopause and the lip service she says the state and federal governments give to women’s health.
About 4% of Australian women experience premature ovarian insufficiency (POI) or complete loss of ovarian function before the age of 40, and 10% experience early menopause before the age of 45.
Yet many don’t get proper treatment because they don’t think they need it or their doctors don’t know how to properly treat it, she says.
Professor Davies talks to Lens about menopause and politics.
We’re in an election week, and the Victorian Premier has announced she’ll spend $70 million or more on women’s health, including clinics to treat menopause. Would that be good?
The 20 new women’s health clinics do not have enough health care providers experienced in menstrual and menopausal disorders to provide the “comprehensive care” proposed.
Not only will a new skilled workforce be needed in these clinics to deliver the promised care, but upskilling will need to extend to GPs and pharmacists so they can recognize conditions and know when to refer, and specialist endocrinologists and gynecologists who will be called upon. To provide expert advice. Women need appropriately trained health care providers, not bricks and mortar.
But are they specifically talking about upgrading care for menopause, endometriosis and polycystic ovary syndrome?
There is still a critical need for an accessible clinical service that provides care for women suffering from menstrual and menopausal problems.
While endometriosis and polycystic ovary syndrome get a lot of air-time, such services require health care providers skilled in the full spectrum of gender-specific problems, including menstrual migraines, premenstrual dysphoric disorder and an array of conditions that cause irregular menstruation. as well as the nuances of menopause-related care.
Currently, there are few public clinics, apart from Alfred Health’s women’s clinic and menopause clinics at Monash Health and the Royal Women’s Hospital, that offer these services and, as part of healthcare delivery, train doctors to provide the necessary care.
All right. Did New South Wales do something similar—put $40 million into a women’s health ‘hub’?
These things are very political, and so you really need someone in government to champion a particular cause. You might equally ask, why did the previous federal health minister commit $58 million to endometriosis this year? Why didn’t he pledge $58 million to midlife women’s health instead? Because someone got the word endometriosis in her ear and influenced her.
I mean, often these decisions are about who speaks for reason. There are some decisions that are clearly national health priority issues like, say, obesity or diabetes, but with many other conditions it’s really about who shouts the loudest, and it’s often not about what’s needed.
One politician said, ‘We’re going to give $40 million, and we’re going to improve menopause.’ Now, after they’ve done that, they’re trying to form a committee to figure out how to spend it.
You are currently researching early menopause. What are you learning?
We’re doing a study of young women with early menopause, and there’s universal agreement that when women go through menopause before age 45, it’s different from natural menopause. It is a hormone deficient condition, just like someone with an underactive thyroid.
Ninety percent of women under 45 have functioning ovaries, but then there’s this 10% that don’t, and we know that if you don’t give these women estrogen, they have an increased risk of premature fractures, early heart disease, and premature death—every Research shows that.
Yet, when we were recruiting women for the study, we found that most were not on hormone therapy, and doctors were telling these young women they didn’t need it.
It is dangerous. I mean, it’s one thing for a 50-year-old woman to have a few hot flushes, but a 40-year-old who’s not getting the proper therapy, they’re 55 to 60, they’re starting to fracture and they’re at risk for heart disease. These women are desperately in need of treatment.
And is there a reluctance of doctors to get these women on HRT because of the controversy surrounding it?
It has been known for some time that HRT slightly increases the risk of breast cancer, but this has been exaggerated, and there are some in the medical community who do not understand that early menopause is a serious condition, and that the data show that women who receive proper, modern hormone replacement therapy Mortality is reduced by about 40%.
While HRT in old age is widely debated, none in this age group.
What would be the ideal set-up for early menopausal patients in a city like Melbourne?
The GP should listen to your story, ask about your menstrual patterns, ask about your other symptoms and then do some blood tests, as in younger women you need to rule out other causes.
If this is identified as early menopause, the doctor will educate the patient on what this means for them. If there’s someone who doesn’t have children, we’ll give them some advice, because if you’re hoping to have children, it’s quite devastating—say you’re 36 or something, you need to be informed about the diagnosis with clarity.
You want to be able to understand the diagnosis and the health consequences, and then provide all the information about hormone therapy, which at this age, if there is no cure for breast cancer, every woman should be prescribed.
You should have a bone density and a cardiovascular risk assessment, and you should have an evaluation for a possible cause. Is it serious? Is it autoimmune? Can you have thyroid disease? Is it genetic? A sensible GP should be able to manage this.
What about menopause and the workplace?
I would like to see a really high quality study of women in the workplace. I went to ANZ and met a very young, glamorous female executive, maybe six years ago, and they were very polite to me, but they weren’t interested in women in the workplace and menopause, women’s mid-life health, young women’s health. .
I bet if you went and talked to them now, I don’t know if they would fund anything, but I think we would have more awareness to talk about it.
Then we started a study. It was in its infancy, and while we were able to show that women with severe menopausal symptoms had lower self-reported work performance, we didn’t realize that we should have been asking questions about women who didn’t work. Was there any reason that they would quit working, or choose not to work?
What do you think the answer to these questions?
I don’t know, I’m concerned that menopause is being overemphasized in the workplace and that it’s not the primary reason women don’t work, and that there might be some extra embellishments.
There is a whole debate going on around this. It’s a big deal in the UK now. It’s slowly spreading here, but people are making these claims about the effects of menopause at work, and it’s based on very poor quality data.
I don’t know the answer, because we haven’t seen it across the work scale. Is it different for a cleaner vs. a senior executive? Are women in high, low and middle positions in the workplace and those who cannot work because of their symptoms the exception or the rule? i don’t know
Elizabeth Ng et al, Functional hypothalamic amenorrhea: a diagnosis of exclusion, Medical Journal of Australia (2022). DOI: 10.5694/mja2.51376
SR Davis et al, Health care providers’ perspectives on menopause and its management: a qualitative study, Climacteric (2021). DOI: 10.1080/13697137.2021.1936486
Pragya Gartulla et al, Menopausal vasomotor symptoms are associated with poor self-rated work ability, Maturitas (2016). DOI: 10.1016/j.maturitas.2016.02.003
Provided by Monash University
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