The federal government has recently pledged to create a new Medicare rebate for menopause health assessments. It’s due to be available from July 1^[1].

The announcement featured in the government’s response^[2] to the Senate inquiry^[3] into menopause, released last week, though was first flagged earlier this month as part of the government’s pre-election funding package for women’s health^[4].

So what is a menopause health assessment? And how will it improve the health care women receive during this stage in their lives?

Why we need this

Outside reproductive health, women’s health care has generally been modelled on the needs of men. A prime example is the government-funded midlife health check^[5] for people aged 45 to 49. This is intended to identify and manage risks to prevent chronic diseases such as diabetes and heart disease.

The recent Senate inquiry^[6] into issues related to menopause and perimenopuase highlighted that the timing of this health check is not fit for purpose for women. This is because at menopause^[7], which occurs on average at the age of 51 in Australia^[8], women’s health profiles change.

Women gain tummy fat^[9], their cholesterol levels go up^[10], and glucose (sugar) metabolism becomes less efficient^[11]. All these changes increase a woman’s risk^[12] of heart disease and diabetes.

Vast numbers of women are given a clean bill of health at this midlife health check in their late 40s. But when they subsequently go through menopause, they can go on to develop heart disease and diabetes risk factors^[13], which may go undetected.

Some women also go through early menopause^[14]: around 12% between the ages of 40 and 45, and around 4% before 40.

Those women who experience menopause before age 45 are known to be at significantly higher risk of heart disease^[15] than other women. But, by the time women with early menopause qualify for the midlife health check, crucial metabolic changes^[16] may have silently occurred, and the opportunity to intervene early to address them may be missed.

Changes that happen at menopause can increase a woman’s risk of developing a chronic disease. Monkey Business Images/Shutterstock^[17]

What will a menopause health check involve?

The federal government has committed A$26 million^[18] over two years to fund the new menopause health assessments, as part of a $64.5 million package designed to improve health care for women experiencing perimenopause and menopause.

Some $12.8 million^[19] will also be dedicated to a menopause-related community awareness campaign.

My own research has shown women understand menopause means the loss of fertility, but often have little knowledge of the health changes^[20] that occur as part of the menopause transition. So increasing health literacy around menopause is much needed.

Similarly, for the introduction of these menopause-specific consultations to be effective, women will need to know what these health checks are for, if they’re eligible, and how to access a menopause health check.

The new menopause health checks will be provided by GPs. Exactly what they will involve is yet to be clarified. But I would anticipate they will include a combination of the assessment and management of perimenopause and menopause, overall health and wellbeing, and assessment of risk and prevention of future ill health, notably heart disease, diabetes and osteoporosis.

Upskilling health-care providers

Equally, health-care providers will need to understand the impact of menopause on long-term health and how best to mitigate against disease risks, including the role of menopausal hormone therapy^[21].

My research has shown health-care providers lack confidence^[22] in delivering menopause-related care, indicating a need for more education around menopause.

In line with this, the Senate inquiry^[23] called for the upskilling of the medical workforce in the field of menopause through medical school training, postgraduate specialist programs, and ongoing education of clinicians.

Women in Australia will soon be able to access menopause health assessments. Sabrina Bracher/Shutterstock^[24]

While the government cannot mandate what is taught in medical schools or the content of specialist training programs, its response to the inquiry^[25] encourages these institutions to incorporate menopause in their curricula.

Further, part of the government funding will go towards expanding a professional development program on managing menopause offered by Jean Hailes for Women’s Health^[26].

A good start, but still not enough

The government’s new funding, and the new menopause health checks in particular, recognises that women’s health is strongly dictated by major biological events, such as menopause, as opposed to age.

This is good news. But we need to do more to equip health professionals to provide the best menopause care to women in these health assessments and beyond.

Adding new menopause modules to medical school and specialist training programs will ensure greater awareness of the impact of menopause on women’s health and wellbeing. However, awareness alone won’t ensure high-level training for the complex care many perimenopausal and menopausal women need.

The opportunities for medical graduates to gain hands-on clinical experience in menopausal medicine are mostly limited to the select few who get to work in a hospital specialist menopause clinic during their training.

Notably, there’s no credentialed training program in menopause medicine in Australia. Meanwhile, the North American Menopause Society does offer a credentialed program^[27].

The challenge has been that menopause does not belong to one medical specialty. This is why we need an accredited training program – for both GPs and medical specialists – to ensure a truly skilled workforce able to deliver gold standard menopause care.

But without further federal funding to set this up, it will not happen.

References

1. ^{^} from July 1 (www.health.gov.au)
2. ^{^} government’s response (www.health.gov.au)
3. ^{^} Senate inquiry (www.aph.gov.au)
4. ^{^} for women’s health (www.abc.net.au)
5. ^{^} midlife health check (www9.health.gov.au)
6. ^{^} Senate inquiry (www.aph.gov.au)
7. ^{^} menopause (www.cell.com)
8. ^{^} age of 51 in Australia (www.menopause.org.au)
9. ^{^} gain tummy fat (www.cell.com)
10. ^{^} cholesterol levels go up (pmc.ncbi.nlm.nih.gov)
11. ^{^} becomes less efficient (pubmed.ncbi.nlm.nih.gov)
12. ^{^} increase a woman’s risk (www.cell.com)
13. ^{^} risk factors (www.cell.com)
14. ^{^} early menopause (www.imsociety.org)
15. ^{^} higher risk of heart disease (jamanetwork.com)
16. ^{^} crucial metabolic changes (www.imsociety.org)
17. ^{^} Monkey Business Images/Shutterstock (www.shutterstock.com)
18. ^{^} A$26 million (www.health.gov.au)
19. ^{^} $12.8 million (www.health.gov.au)
20. ^{^} knowledge of the health changes (www.tandfonline.com)
21. ^{^} menopausal hormone therapy (onlinelibrary.wiley.com)
22. ^{^} health-care providers lack confidence (www.tandfonline.com)
23. ^{^} Senate inquiry (www.health.gov.au)
24. ^{^} Sabrina Bracher/Shutterstock (www.shutterstock.com)
25. ^{^} response to the inquiry (www.health.gov.au)
26. ^{^} Jean Hailes for Women’s Health (www.jeanhailes.org.au)
27. ^{^} credentialed program (menopause.org)