Advanced Pharmacy Australia (AdPha) welcomes the Albanese Labor Government’s $573.3 million funding package to provide women with more choice, lower costs and better health care.

Announced on 9 February, the new package of measures incorporates key recommendations from AdPha, shaped by the expertise and insights of its members.

AdPha President Tom Simpson praised the government for listening to patients and health care stakeholders, including the valuable contributions of AdPha Women’s and Newborn Health Specialty Practice members, to take action on expanding care and access in women’s health.

“AdPha members welcome these long-awaited measures, which will help remove barriers that have prevented women from accessing affordable health care for too long,” Mr Simpson said.

“We have strongly advocated for a comprehensive approach to managing perimenopausal and menopausal symptoms – focusing on awareness, education, and access to affordable, evidence-based treatments.

“We are pleased to see many of our recommendations, put forward during the Senate Inquiry and through our submission, reflected in this new package of measures,” he said.

“A/Prof McGuire from our Women’s and Newborn Health Committee specifically mentioned in her evidence that it had been over 20 years since any new medicines for menopause had been listed on the PBS, and these new listings will ensure that menopause hormonal therapies remain both affordable and accessible,” Mr Simpson said.

“Currently, over 85% of women experiencing bothersome symptoms of menopause or perimenopause are not receiving evidence-based care, despite the availability of both hormonal and non-hormonal therapies. With treatment options declining in recent years, we hope these reforms will reverse that trend.

“It is also great to see new contraceptives listed on the PBS for the first time in over 30 years, reflecting and subsidising contemporary treatment options that are used by many Australian women,” he said.

“We thank the government for prioritising women’s health and recognising the invaluable role of pharmacists in advocating for and supporting women’s health care needs.

“As this expands to including the provision of contraceptives and anti-microbials for uncomplicated UTIs at PBS co-payment prices for concession card holders by pharmacists – in direct support of our first recommendation of our Federal Budget submission – we look forward to enhanced multidisciplinary collaboration between doctors and pharmacists as we achieve patient-centred care,” Mr Simpson said.

“As medicines experts across all stages of reproductive health – from pregnancy, labour, and lactation to menopause and beyond – pharmacists are well-positioned to support women through these changes. With these new measures, we can play an even greater role in ensuring women receive safe, appropriate, and efficient care.”

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Menopause occurs naturally when a woman’s ovaries no longer have any eggs to release, and its symptoms are caused by a drop in hormone levels.

More than three million Australian women are currently in the 40–59 age bracket – the years that are most associated with menopause.

More than two million women aged over 60 years are affected by biological changes post-menopause that increase lifelong risks of cardiovascular disease, dementia, diabetes, osteoporosis and some cancers.

Despite this natural prevalence, perimenopause and menopause remain hidden conditions, with 85% of Australian women experiencing significant symptoms mostly undiagnosed, misdiagnosed, untreated, and/or mistreated.

Hot flushes, night sweats, brain fog, depression, anxiety and weight gain are just some of the many symptoms that women can suffer during their perimenopause and menopausal years.

More than 30% of Australian women will experience severe impacts on their general and psychological well-being, which can lead to breakdowns in relationships, mental health illnesses and decreased productivity both in work and home lives.

After unexpectedly experiencing the start of perimenopause, Associate Professor Erin Morton from Flinders University realised how little community awareness there was about this stage of life. She was concerned about the lack of knowledge and support available, and the impact of symptoms, costs and time commitments on daily tasks, employment and family budgets.

“Three years ago I realised I’d hit perimenopause and I was rather horrified at how little was known or seemed to be done about it,” says Associate Professor Morton.

“This is an area of health that is so neglected and is still really stigmatised. There seems to be a lack of knowledge across healthcare roles, poor access to services, negative attitudes and lagging research to support women through this important time of life.  There is very little information and support available, not to mention a lot of misinformation about hormone replacement therapy.”

Drawing on more than 20 years of clinical trial and health data expertise, Associate Professor Morton decided to take matters into her own hands and has created a registry that gathers information on Australians’ experience of perimenopause and menopause.

The new registry is called VITAL (Virtual Registry of Peri-/Menopause in Australia) – and has a particular focus on exploring community priorities and creating tangible improvements in healthcare outcomes.

“VITAL is designed to provide the perimenopause and menopausal community with greater opportunities for involvement in their own care, and critically to collect key data that can be used to identify trends and improve research and education for measurable improvements in women’s health.

“I decided to create this community-driven registry to give a voice to the perimenopause and menopausal population; to define what peri really means, what really matters to them and its true – and hidden – impacts across the country.

“I believe there should be more focus and funding on women’s lifelong health, and more attention made to improving their perimenopause and menopausal quality of life and subsequent health outcomes,” adds Associate Professor Morton.

The online registry is officially registered with the World Health Organisation (WHO) and the Australian Commission on Safety & Quality in Healthcare clinical trials and registry platforms.  It has received cross-party recommendations in both Federal Houses of Parliament during Women’s Health Week recently.

VITAL is open to everyone – perimenopause and menopausal participants, family, friends, colleagues, healthcare providers and policymakers – at: flinders.edu.au/research/vitalmeno

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Every woman’s experience with this transition is highly personalised and symptoms can vary from mild interruptions to more severe impacts in their day-to-day life. It is worth noting, however, that only 20 per cent of women report no menopausal symptoms whatsoever.¹

A 2021 multinational study found that less than half of women reported feeling “very well supported” during the menopause transition and that women who do not feel supported report more symptoms and a greater negative impact on their experience.²

Pharmacists can play an important role in helping the significant majority of women that do face symptoms to navigate through perimenopause and ensure they can confidently make informed health choices to stay in control of their symptoms. 

More than hot flushes

Vasomotor symptoms (hot flushes and sweats) are the hallmarks of menopause, occurring in approximately 75 per cent of postmenopausal women, with 25 per cent of these being severely affected.¹

While notable, hot flushes are not the sole issue that menopausal women must contend with. According to global, natural healthcare company SFI Health – Home of Flordis, menopausal women have a lot to think about, including changes to the vaginal microbiome, UTIs, insomnia, brain fog and memory loss, and elevated depressive symptoms.

“There are a multitude of potential symptoms,” said Simone Barrance, Science & Education Manager at SFI Health – Home of Flordis, “and while some women will not experience symptoms, many will. The pharmacist is in a unique position to help menopausal women understand their symptoms and the different treatment options available to help relieve them.”

Changing perceptions

While every woman’s experience with menopause is different, there has been a notable shift in perceptions and expectations of the experience. The next generation of women approaching menopausal transition is more likely to reject stigma and have higher expectations around healthcare and support than previous generations.

“In previous generations, women were expected to deal with it quietly, but today’s women expect information and treatment options,” said Dr Karen Magraith, President of the Australasian Menopause Society.

“Many of them are busy working and raising adolescent kids and caring for ageing parents and are expected to function at a very high level, despite debilitating symptoms.”

In the UK, research by the Menopause Experts Group found that employment tribunals involving menopause have increased by 44 per cent year on year³, highlighting women are expecting accommodations in the workplace.

Women are also seeking products that are high quality, sustainable and ‘stylish’ – just like themselves.

“Menopausal women are no longer treating their own health and natural processes as something to hide or be ashamed of,” Ms Barrance said.

“Ultimately, this next generation expects more and better service from health care professionals. However, we still need to do more to continue to change the conversation around menopause and help women understand the different treatment options that are available to them.” 

Integrative support for menopausal women

A key role that pharmacists can play in supporting women through the menopausal transition is education around treatment options.

Actaea racemosa, also known as black cohosh, has been used for the relief of menopause symptoms for many years, providing an evidence-based option derived from nature for women going through this natural life stage.

Given the variance of quality and efficacy of black cohosh products available, it is important for pharmacists to seek standardised, clinically proven extracts produced with a careful focus on quality.

Ze 450 is a specific extract of black cohosh first authorised in Germany in 1998. It is also one of only three black cohosh extract types approved by the European Medicines Agency for review by the Committee on Herbal Medicine Products (HMPC).

Ze 450’s proposed mechanism of action is the modulation of serotonin, dopamine, GABA & Q-opioid brain receptor activity and signalling pathways in the brain. It’s also proposed to counteract inflammation and oxidation caused by oestrogen fluctuations.

SFI Health – Home of Flordis utilises the well-researched extract in two products to provide relief from multiple menopausal symptoms: Femular (Actaea racemosa [Ze 450] extract dry concentrate 6.5 mg equivalent to dry root and rhizome 42.25 mg) and Femular Forte (Actaea racemosa [Ze 450] extract dry concentrate 13 mg equivalent to dry root and rhizome 84.5 mg).

Being available in two doses means support for varying degrees of menopausal symptoms, from perimenopause through to post-menopause and both have undergone dose-dependent studies showing statistically significant improvements in menopausal symptoms.

Research has demonstrated that Femular can provide relief of multiple menopausal symptoms within weeks, and ongoing benefits increasing with use, especially at the three and nine-month marks.⁵

Role of pharmacists

Community pharmacies are increasingly becoming the first port of call for a myriad of health care needs and those that provide satisfactory support are likely to see customers return.

With most women experiencing menopause symptoms for five to 10 years⁶, pharmacists that ensure they can provide quality menopause education, support and suitable treatment options will be in a much stronger position to support them.

References

1 menopause.org.au/hp/information-sheets/what-is-menopause

2 gremjournal.com/journal/03-2021/womens-perception-of-the-menopause-transition-a-multinational-prospective-community-based-survey

3 menopauseexperts.com/tribunals-triple-in-less-than-2-years

4 nccih.nih.gov/health/black-cohosh

5 Drewe J, et al. The effect of a Cimicifuga racemosa extract Ze 450 in the treatment of climacteric complaints – an observational study. Phytomedicine. 2013;15 (20):659– 666.

6 menopause.org.au/images/factsheets/Menopause_What_are_the_symptoms.pdf

This article was originally published in the September issue of Retail Pharmacy magazine. 

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