Around two million women in Australia have recently undergone menopause and another 80,000 women move into the pre-menopausal stage each year. The financial impact of being misdiagnosed or having untreated symptoms is profound, including leaving the workforce often at their peak earning capacity. Women at this age have a vast accumulation of experience, talent and skills to share that would be beneficial to be retained within organisations.
Recent research conducted by the Australian Institute of Superannuation Trustees found 45 per cent of women under 55 years were retiring early due to sickness, injury or disability, costing a woman on the average wage more than $500,000 in lost earnings and more than $50,000 in superannuation. Insurance giant AIA Australia found women between the ages of 44 to 55 years twice as likely to have a mental health claim when compared to men in a similar age bracket.
The loss of income and productivity impacts society as a whole and cannot be underestimated. “Menopause has a significant impact on AIA’s claims experience. Women who are forced to leave work due to menopause can end up on long term income protection claims and can ultimately then go on to claim total and permanent disability. And sadly, we see suicide claims from this as well,” Simonie Fox, head of shared value at AIA Australia said.
“It is not just a women’s problem; it is a societal issue which needs addressing. Lumping it as a women’s problem is completely unacceptable,” she said.
The insurer has teamed up with the Australasian Menopause Society (AMS) to provide education and tool kits for super fund clients, employers and members to help remove the stigma of menopause, debunk misinformation and manage the condition.
Part of the education is recommending exercise as a “low cost, natural tool women can use to alleviate symptoms and control them,” said Dr Vicky Phillips, director of exercise physiology practice EXPHYS.
“Setting someone up with the education and that strong lifestyle based on exercise so that when they do go through this stage, they have a buffer and they’re already doing things that can benefit them.”
Unrecognised by employers
The attitude of Australian companies towards menopause leaves much to be desired.
“Human resource executives do not recognise that menopause needs to be included as part of a diversity and inclusion strategy,” said Vanessa Giannos, chief executive of human resource consultancy The HR Experts International.
The often unsympathetic work environment has led many women to deny they are suffering from the condition said Giannos. “Women are horrified when I ask them about menopause mainly because they feel like they’re outing themselves at work and they’re already suffering issues at work. They don’t want work people to know they’re menopausal,” she said.
Symptoms affecting women’s performance in the office can include fatigue, concentration difficulties, memory issues which impact on self-esteem and confidence. “Many women consider going backwards, going part time and early retirement. That has a huge impact economically, at the workplace and on diversity,” she said.
AIA’s Fox believed companies have a commercial interest to develop more enlightened human resource policies around menopause to attract and retain female staff. “We have worked with employers to provide education around menopause toolkits and how to bring in great policy within the organisation,” she said. “What drives employers is the bottom line, and the productivity impact is going to be relevant for an employer.”
With an 80 per cent female membership, the $70 billion super fund HESTA is looking at how they can increase awareness for women in more innovative ways to help start conversations with people they would not expect to be having with their super fund. “We want our members to get the care and support they need to look after their health and also enjoy a better retirement,” Anna Claude, the fund’s head of strategy and advocacy said.
The risk of women being misdiagnosed is high according to Dr Nicola Gates, a clinical neuropsychologist and director of Brain and Mind Psychology.
“More women are being misdiagnosed or their hormonal status was not considered, so things were going untreated and there’s an exacerbation of symptoms and difficulties.”
“Doctors were actually saying we don’t recommend HRT first because women don’t want it. And if we say it to them, they won’t come back. So, we let them take their natural therapies and they come back and say I still have bad symptoms,” she said.
Even if women are correctly diagnosed, the debilitating impact on the brain is not widely understood, even among medical practitioners.
“Recognising the mind body connection in the most physiological terms is absolutely paramount. The rest of the body is the support structure for the brain,” Dr Elina Safro, a general practitioner and chair of the clinical governance subcommittee of the AMS said.
There are significant overlaps between mental and cognitive health with depression and dementia being related.
“The thing that is most distressing to women is they are all terrified that they going to get dementia but it is mostly that brain fog that occurs at the time of menopause which is associated with poor sleep, poor concentration and poor memory,” Professor Rod Baber, clinical professor of obstetrics and gynaecology at Sydney University said.
“All of that appropriately leads to a loss of some self-esteem, this is made worse by the lack of community and family support in today’s society. However, in old Europe and many parts of the world, as women age, they are revered.” he said.
The high level of suicide for middle aged women is a chilling statistic of the devastating impact of menopause on mental health.
Data from the Australia Bureau of Statistics in 2020 revealed that the highest suicide rate for women is in the 45-49 age group which Professor Jayashri Kulkarni, director of HER Centre Australia at Monash University described as “unacceptably high”.
“I really hope that in the future… we can make it clear that menopause can affect the brain… but it’s not getting out there into mainstream practice where it needs to be,” she said. The HER Centre is a research institute dedicated to understanding and treating mental illnesses experienced by women.
The lack of understanding is exacerbated by insufficient evidence-based clinical trials on the effects of menopause on the brain. “We know that dementia is a predominantly female disease. Two thirds of all cases of dementia are women. Several studies have shown that women with an oestrogen deficiency have a higher risk for dementia along with those who have had a hysterectomy and early menopause,” Professor Cassandra Szoeke, neurologist and director of the healthy ageing program at Melbourne University said.
Aside from affecting the brain, menopause brings about other health issues. “Menopause isn’t just about the brain, it’s also about cardiovascular function. One in three women over the age of 65 will suffer from bone loss and hence a fragility fracture and we know that oestrogen prevents fractures in women,” Professor Susan Davis, director of the Women’s Health Research Program at Monash University said.
Medical profession lacks current skills
Most general practitioners and many general endocrinologists and gynaecologists have lost or never acquired the skills to manage menopause said Davis.
The lack of training across the medical profession can be tied to the now-debunked 2002 Women’s Health Initiative study that linked hormone replacement therapy (HRT) to breast cancer she said. “The study did a huge amount of harm. Doctors are actually terrified to discuss the issue because women don’t want to take HRT because it caused cancer [they believed].”
“There needs to be a tremendous upskilling of the healthcare workforce, ranging from nurse practitioners through to specialists and doctors. It is a real problem that we’re all dealing with,” she said.
Health organisations such as AMS and Jean Hailes For Women can provide a platform for better communication on the topic. Other initiatives include MenoPROMPT, an evidence-based program to improve the care of women at and after midlife, which is working with the College of General Practitioners to find out what are the most appropriate prompts for family doctors to trigger conversations with women around menopause.
Some of the medical experts at the roundtable called for funding to conduct clinical trials to test the validity of HRT and the link to cognitive performance in menopause. Melbourne University’s Professor Szoeke said trials of this nature would take a very long time as dementia by definition occurs after 60 years of age.
“The problem with dementia is it takes decades to develop. Research really needs to commence at age 40 in pre-menopausal women, and then follow them through the next 30 years. This means that we won’t have these answers for another three decades. Randomised control trials are crucial to provide reliable evidence, and several are already underway globally with this aim,” she said.
“In the meantime, we need to use the current available data which women have been contributing to for many years. We know so much about menopause already, but very little about post-menopause, yet women today live one third of their lives in this stage. We need to measure biomarkers of cognitive decline and neurodegeneration and examine the relationships to be able to guide women sooner on how best to maintain and improve their cognition as they age,” said Professor Szoeke.
“Despite fears about dementia given it is a terminal disease, there is now solid evidence that a proportion of risk is preventable. Prevention is better than a cure, and in dementia we don’t yet have a cure,” she said.
Apart from education and funding for more effective research, stakeholders can collaborate to lobby the government to provide more investment into the treatment of menopause. “If we lobby hard enough, it will turn things around at the federal level,” said Monash University’s Davis.
This article was edited on 31 January 2023 to correct paragraph two to say recent research conducted by the Australian Institute of Superannuation Trustees found 45 per cent of women under 55 years were retiring early due to sickness, injury or disability.