MHT demand is rising, awareness is growing, and workplaces are starting to listen. Now medical training and culturally safe care must catch up.
For generations, menopause was something women were expected to manage quietly. Hot flushes were joked about. Poor sleep was normalised. Brain fog, mood changes, joint pains, vaginal dryness, loss of libido and anxiety were often dismissed as stress, ageing or “just life”.
That silence is finally breaking.
Across Australia, more women are asking about perimenopause, menopause and menopausal hormone therapy, commonly known as MHT. Governments are launching awareness campaigns. Workplaces are discussing menopause-friendly policies. Pharmacies are dealing with hormone patch shortages. Doctors are seeing more women who no longer want to suffer in silence.
This is progress. But it also exposes an uncomfortable truth: women’s awareness is rising faster than the health system’s ability to respond.
Menopause affects millions of Australian women
Menopause is not a niche issue. It affects half the population.
In Australia, menopause usually occurs between 45 and 55 years of age, with the average age around 51. Perimenopause, the transition leading up to the final period, can begin years earlier and may last several years.
Around 4.5 million Australian women fall within the broad age group where perimenopause and menopause are common. Many are working, caring for children, supporting ageing parents, running businesses and contributing to community life.
Some women have mild symptoms. Others experience symptoms severe enough to affect sleep, work, relationships, mood, sexual wellbeing and confidence.
Menopause is not just a medical issue. It is a family issue, a workplace issue and an equity issue.
MHT: not for everyone, but important for many
Menopausal hormone therapy, or MHT, is the current term for what many still call HRT. It can be very effective for hot flushes, night sweats, sleep disturbance and vaginal or urinary symptoms. In suitable women, it may also help protect bone health.
MHT comes in different forms, including tablets, patches, gels, sprays, vaginal creams and pessaries. Some women need oestrogen alone, while women who still have a uterus usually need both oestrogen and progestogen to protect the lining of the womb.
The discussion around MHT has changed over the past two decades. After the Women’s Health Initiative study in 2002, fear around hormone therapy increased sharply. Since then, the science has become more balanced. We now know that the benefits and risks depend on age, time since menopause, medical history, dose, type and route of treatment.
MHT is not suitable for everyone. Women with a history of breast cancer, unexplained bleeding, blood clots, certain heart conditions or liver disease need careful specialist advice. But for many healthy women with troublesome symptoms around menopause, MHT can be safe and effective after proper assessment.
The message should not be “all women need MHT”. The message should be: all women deserve accurate information and individualised medical advice.
The last decade: a shift in the type of MHT
Australian data shows an important trend. Government-subsidised MHT dispensing for women aged 45 to 64 has been broadly stable over the last decade, but the type of MHT used has changed.
Between 2014 and 2023, use of transdermal MHT, such as patches and gels, increased. Use of intrauterine-system-based MHT also increased. Oral MHT remained relatively stable, while vaginal MHT dispensing decreased.
This helps explain why women are hearing more about shortages. Overall use may not have dramatically exploded, but demand for particular products, especially oestrogen patches, has increased.
Another Australian study found that around one in ten postmenopausal respondents were using MHT. Among symptomatic postmenopausal women who may have benefited from MHT, fewer than one-quarter were using it. Importantly, women of non-European ancestry were less likely to use MHT.
That is highly relevant for Indian, South Asian and other multicultural women. It suggests that language, cultural beliefs, access, confidence and health literacy may all influence whether women receive evidence-based care.
Patch shortages show the pressure on the system
Many Australian women using oestrogen patches have struggled to find their usual product. The Therapeutic Goods Administration has reported ongoing shortages of some hormone therapy patches and has allowed some overseas-registered alternatives and substitution arrangements.
For women whose sleep, mood and daily functioning depend on stable treatment, this is not a small inconvenience. It can mean calling multiple pharmacies, switching treatment or returning to the doctor for alternatives.
Patch shortages have also been reported internationally, including in the United States, where rising demand for oestrogen patches has been linked with supply pressures.
If we encourage women to seek help, we must ensure doctors, pharmacists and medicine supply systems are ready.
Awareness is rising, but training gaps remain
A recent article by University of Auckland obstetrician and gynaecologist Dr Michelle Wise highlighted a key problem: demand for menopause hormone therapy is rising, but training gaps remain for doctors.
This is not only a New Zealand issue. It is also an Australian issue.
The Australian Senate inquiry into menopause and perimenopause heard that many health professionals have had limited formal training in menopause care. Some women reported feeling dismissed, misunderstood or told their symptoms were “normal” without proper assessment.
A good menopause consultation is not just a quick prescription. It requires time to discuss symptoms, bleeding patterns, contraception, breast cancer risk, clotting risk, heart health, bone health, mental health, sexual wellbeing, sleep, medications and personal preferences.
This cannot always be done properly in a rushed appointment.
GPs are often the first point of contact, but they are working under pressure.
Menopause education must improve across medical schools, GP training, specialist training, nursing, pharmacy and continuing professional development. Women should not have to educate the health system before receiving care.
Australia’s awareness campaign is a welcome step
Australia’s first national Menopause and Perimenopause Campaign is an important step. It aims to help women recognise symptoms, access trusted information and seek support. Recent women’s health reforms have also included Medicare-supported menopause health assessments, cheaper access to some MHT medicines through the PBS, and work towards national clinical guidance and professional education.
This is welcome. But awareness must be matched by action: trained clinicians, longer consultations, reliable medicine supply, affordable treatment and culturally appropriate information.
October is widely recognised as Menopause Awareness Month, with World Menopause Day marked on 18 October. These campaigns start conversations, but they must not become token gestures. Women need practical help, not just slogans.
Menopause-friendly workplaces matter
Many women experience menopause during their most senior and productive working years. Symptoms such as poor sleep, hot flushes, heavy bleeding, anxiety, migraines and brain fog can affect work performance and confidence.
A menopause-friendly workplace does not mean treating women as fragile. It means providing reasonable and respectful support: flexible work, access to bathrooms, temperature control, breathable uniforms, leave when needed, education for managers and a culture where women are not embarrassed to ask for help.
This is not a favour. It is fairness.
Multicultural women must not be left behind
In many Indian and South Asian families, women speak openly about pregnancy and children but not about vaginal dryness, sexual pain, urinary symptoms, mood changes or menopause. Some women feel embarrassed. Some lack the words to explain symptoms. Some believe suffering quietly is part of being strong.
That silence can delay care.
Menopause should also be used as a health checkpoint for heart health, diabetes risk, bone health, breast screening, cervical screening, mental health and sexual wellbeing.
Health equity means more than translating brochures. It means listening without judgement and giving clear, culturally sensitive, evidence-based advice.
From silence to science
Menopause is not a disease. It is a normal life stage. But normal does not mean insignificant.
Women are speaking up. Governments are responding. Workplaces are listening. Doctors are seeing more demand. Now Australia must move from awareness to action.
We need better menopause training, national guidelines, reliable MHT supply, longer consultations and culturally safe care.
Women are not asking for special treatment. They are asking to be heard, believed and treated with the dignity, science and respect they deserve.
This article provides general health information only and does not replace individual medical advice. Women should speak with their GP or specialist about their own symptoms, risks and treatment options.
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