Professor Sue Davis, AO, is a pioneer and leading expert in women’s health in Australia, which is why she has the letters after her name – an Officer of the Order of Australia, awarded Last year.
His many accomplishments as an endocrinologist (hormonal medicine) and menopause specialist are listed here; she has been a professor of women’s health at Monash University’s School of Public Health and Preventive Medicine for nearly two decades.
Professor Davis has long been a strong advocate for promoting women’s health and isn’t about to stop, especially with the Victorian state election looming.
Her current concern is the availability of hormone replacement therapy (HRT) for early menopausal women, and the discourse she says state and federal governments are giving to aspects of women’s health.
Around 4% of Australian women experience premature ovarian failure (POI) or complete loss of ovarian function before the age of 40, and 10% experience premature menopause before the age of 45.
Yet many are not treated properly because they think they don’t need it or their doctors don’t know how to treat it appropriately, she says.
Professor Davis spoke to Lens about menopause and politics.
We are in an election week and the Premier of Victoria has announced that he will spend approximately $70 million on women’s health, including clinics to treat menopause. That must be good?
There simply aren’t enough healthcare providers experienced enough in menstruation and menopausal disorders to provide the “comprehensive care” offered at 20 new women’s health clinics.
Not only would these clinics need a newly-skilled workforce to deliver the promised care, but the upskilling should extend to GPs and pharmacists so they can recognize conditions and know when. refer them, as well as to the specialized endocrinologists and gynecologists who will be called. to provide expert advice. Women need trained health care providers, not bricks and mortar.
But are they talking specifically about improving care for menopause, endometriosis, and polycystic ovary syndrome?
There continues to be an urgent need for an accessible clinical service that provides care for women with menstrual and menopausal disorders.
While endometriosis and polycystic ovary syndrome receive a lot of airtime, such a service requires health care providers skilled in the spectrum of gender-specific issues, including menstrual migraine, premenstrual dysphoric disorder and the range of conditions that cause irregular menstruation, as well as the nuances of menopause-related care.
At present, there are few public clinics, with the exception of Alfred Health’s women’s clinic and the menopause clinics of Monash Health and the Royal Women’s Hospital, which offer these services and, as part of delivery of health care, train physicians to provide the care required.
OKAY. Has New South Wales done the same: invest $40 million in women’s health hubs?
These things are very political, so you really need someone in government to champion a particular cause. You might also ask why did the former federal health minister pledge $58 million this year for endometriosis? Why didn’t he instead pledge $58 million for middle-aged women’s health? Because someone told him about endometriosis and influenced him.
I mean, often those decisions are about who’s championing the cause. Some decisions are clearly national health priorities like, say, obesity or diabetes, but with many other conditions it really is who shouts the loudest, and it’s not often what which is necessary.
A politician said, “We’re going to give $40 million and we’re going to improve menopause. Now, having done that, they are trying to set up a committee to figure out how to spend it.
You’re researching early menopause right now. What are you learning?
We’re doing a study of young women with early menopause, and everyone agrees that when women go through early menopause, before age 45, it’s different from natural menopause. It is a state of hormone deficiency, just like someone who has an underactive thyroid.
Ninety percent of women under 45 have their ovaries working, but there are those 10% who don’t, and we know that if you don’t give these women estrogen, they are at increased risk of premature fractures, early heart disease, and premature death – all studies show.
Yet when we recruited women for the study, we found that most were not on hormone therapy, and doctors tell these young women they don’t need it.
It’s dangerous. I mean, a 50 year old woman with a few hot flashes is one thing, but a 40 year old person who doesn’t get proper therapy, between 55 and 60 they start to get fractures and they’re at risk for cardiac disease. These women are hopelessly under-treated.
And doctors are hesitant to put these women on HRT because of the controversies surrounding it?
It has been known for some time that HRT slightly increases the risk of breast cancer, but this is exaggerated, and some in the medical community do not understand that premature menopause is really a serious condition, and the data shows that Women who receive modern and appropriate hormone replacement therapy have an approximately 40% reduction in all-cause mortality.
Although there is widespread controversy about HRT in older people, there is none at this age.
So what would be the ideal setup for people with early menopause in a city like Melbourne?
The GP should listen to your story, ask about your menstrual cycle, ask about your other symptoms and then do blood tests, because with younger women you have to rule out other causes.
If it is identified as early menopause, then the doctor will educate the patient on what this means to her. If it’s someone who hasn’t had children, we’ll give them advice, because it’s pretty devastating if you were hoping to have children – say you’re 36 or something, you have to be informed of a diagnosis with clarity.
You want to be able to understand the diagnosis and the consequences on health, then have all the information about hormone therapy, which at this age, unless contraindicated such as breast cancer, should be prescribed to all women.
You should have bone density and a cardiovascular risk assessment, and you should have an assessment for a potential cause. Is it serious? Is it autoimmune? Could you also have thyroid disease? Is it genetic? A sensible GP should be able to handle this.
What about menopause and labor?
I would like to see a very high quality study on women in the workplace. I went to ANZ and met some very young, able female executives, probably six years ago, and they were very polite to me, but they weren’t interested in working women and menopause, women’s health in the middle of life, to the health of young women .
I bet if you went and talked to them now, I don’t know if they would fund anything, but I think there would be more awareness that we need to talk about it.
Then we launched a study. This was in its early stages, and although we were able to show that women with severe menopausal symptoms had lower self-reported job performance, we didn’t realize that we should have asked the questions about women who weren’t working. not. Was there a reason why they left work or did not choose to work?
What do you think are the answers to these questions?
I do not know. I’m concerned that there’s too much emphasis on menopause in the workplace and that it’s not the main reason why women don’t work, and maybe there’s a bit of embellishment.
There is a whole debate bubbling and brewing around this. It’s a big problem in the UK now. It’s slowly spreading here, but people are making these claims about the impact of menopause in the workplace, and it’s based on very poor quality data.
I don’t know the answer, because we haven’t looked at the issue in all dimensions of work. Is it different for a cleaner versus someone who is a senior manager? Are women in high, low and middle positions at work who cannot function because of their symptoms the exception or the rule? I do not know.
Elisabeth Ng et al, Functional hypothalamic amenorrhea: a diagnosis of exclusion, Australian Medical Journal (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 Gartoulla et al, Vasomotor symptoms of menopause are associated with poor self-rated work capacity, maturity (2016). DOI: 10.1016/j.maturity.2016.02.003
Provided by Monash University
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