Marking the end of a woman’s menstrual cycles, menopause typically occurs around the age of 51 and represents a significant change in a woman’s life.
The perimenopausal transition is seven years on average and starts in the mid-40s. These transitional years can bring a range of physical and emotional symptoms, ranging from irregular periods, hot flushes, mood swings, sleep disturbances, and anxiety.
About five per cent of women have menopause before the age of 45, and their perimenopausal symptoms, in particular, might be misunderstood.
While every woman’s experience is different, those living in rural and remote areas face additional challenges when navigating menopause, from a lack of access to healthcare services to cultural barriers in discussing women’s health.
Women’s health specialist Dr Liz Gannon, who is based in Broome, has spent seven years working in rural and remote communities in the Kimberley.
She has witnessed firsthand how difficult it can be for women in these areas to get the care they need when it comes to managing perimenopause and menopause symptoms.
“Access to appropriate healthcare is a huge issue in rural Australia and women’s health is no different,” Liz said.
“For many women, the physical distance between them and the nearest doctor or specialist is a barrier, but it’s also about finding healthcare providers who understand menopause and are confident in prescribing treatments like hormone replacement therapy (HRT).”
Continuity of care is another major issue in rural areas, where locum doctors may be common.
“Locum doctors can provide essential care in emergencies or during acute health episodes, but they’re not always well-suited to managing long-term, chronic issues like menopause symptoms,” Liz said.
“Menopause is not something that can be addressed in a single visit; it often requires ongoing management and adjustments to treatments over time.
“Continuity of care is key, and that’s something rural women often don’t have.”
Shortcomings in women’s healthcare highlighted in Senate Inquiry
A Senate Inquiry into menopause, released in September 2024, highlighted these systemic issues and the unique challenges faced by women in rural and remote areas.
The Inquiry heard from women across Australia who had experienced difficulties accessing appropriate care and treatment during menopause.
Many women shared stories of being dismissed or having their symptoms downplayed by healthcare providers, or of struggling to access HRT due to supply shortages, particularly during the COVID-19 pandemic.
The Inquiry’s final report made 25 recommendations aimed at improving menopause care nationwide, with Recommendation 13 focused on increased access to care in rural and remote areas.
Lasting legacy of The Women’s Health Initiative study
One of the key recommendations from the Senate Inquiry was the need for more GP training on menopause, which according to the report showed medical training was virtually non-existent at the undergraduate level, with some medical practitioners recalling that they had just one hour of education about menopause.
Liz agrees, saying there was a lack of training and awareness among many healthcare providers when it comes to menopause, recalling her own training in the space.
“The bulk of my education and training occurred after the Women’s Health Initiative [a US-based study which found links between the use of hormone therapy and cardiovascular events such as heart attacks and strokes as well as breast cancer],” she said.
“Prior to this study, there was optimism that hormonal treatment might be profoundly beneficial to women as they age.
“Following this study, hormonal management of menopausal symptoms was very much feared.
“The end result is that my generation of GPs and gynaecologists are rather weak at prescribing and troubleshooting menopausal symptoms.
“I have become rather cluey in this area because my patients have forced me to be and for that I am grateful; however, I can see the anxiety among my medical peers in prescribing hormones – but I also see growth.
“We now have so much more evidence that puts the Women’s Health Initiative in its proper perspective, allowing us to discuss risks, benefits and alternatives for menopause hormonal therapy.”
“Currently, few healthcare providers in Australia specialise in menopause management, and even fewer are based in rural areas.”
Improving access to expert care for menopause in Australia
There are more than 38,000 GPs and 1,700 specialist gynaecologists registered to practise in Australia. However, there are just 877 members of the Australasian Menopause Society.
Across rural WA, Rural Health West data shows there are 99 GPs listed as having women’s health expertise.
This means that rural women often travel long distances to see a specialist as local GPs may not have the specialist knowledge needed to manage their symptoms effectively.
The Inquiry recommended the expansion of nurse-led clinics in rural areas, where nurses with specialised training in women’s health could help. Telehealth could also be a gamechanger for rural and remote women, particularly Aboriginal women.
Kununurra-based GP, Dr Alice Fitzgerald spoke at the Inquiry in her capacity as the Australian College of Rural and Remote Medicine’s Western Australian representative. In her submission, Alice stated: “We need to look at new and flexible different types of health services. There’s potential for nurse-led clinics and a greater role for nurse practitioners to support women’s health in regional areas.
“The advancements in telehealth are quite significant for populations in rural, remote and First Nations communities, especially since COVID, and we do recognise that many women, in particular, are more able to seek continuity of care via telehealth.
“I think the important thing to note is that telehealth shouldn’t be a replacement for doctors on the ground but an adjunct for GPs and RGs working in rural areas that are particularly hard to staff.
“We really welcome the input from non-GP specialists and other allied health professionals, and use of telehealth in that space is really important.”
In addition to training, more healthcare providers and expansion of clinics, increasing the availability of HRT is another issue to address.
HRT is one of the treatments for managing menopause symptoms, but supply shortages have been a problem in Australia, particularly in rural areas.
Liz said it was important for women to have consistent access to HRT.
“Even going without your regular medication for a few days can make a huge difference in terms of symptom control,” she said.
“COVID created heaps of supply chain issues affecting all of our medications and rural areas seem to have particularly inconsistent access to HRT.
“I am hoping more options will become available on the Pharmaceutical Benefits Scheme to make HRT more affordable.”
Cultural impacts on accessing help
While access to healthcare is a major issue, cultural factors also play a role in how menopause is experienced by women in rural areas. In Liz’s experience, Aboriginal women can seem reluctant to talk about gynaecological health.
“It’s not that they’re not experiencing symptoms—it’s that other health issues often take precedence by healthcare providers and are perhaps a bit easier to talk about,” she said.
However, once Aboriginal women feel comfortable and trust is gained, they are often relieved to discuss their symptoms and seek treatment.
“I am a bit more skilled now in connecting with my Aboriginal patients than when I first moved to the Kimberley.
“The kind (spoken and unspoken) feedback from Aboriginal women has improved my ability to provide culturally appropriate care.
“But once the trust is there, we can have meaningful conversations about menopause and find ways to manage symptoms in a way that works for them.”
More than just physical health
The Inquiry’s recommendations also addressed the need for a more comprehensive and holistic approach to menopause care, recognising that women’s experiences of menopause are influenced by a range of factors, including their mental well-being.
Access to mental health support during menopause is just as important as access to physical healthcare, particularly given the link between menopause and mental health conditions like anxiety.
According to Liz, untreated menopause symptoms can have broader societal impacts, so it is important to support women through their health journeys.
“Perimenopausal and menopausal women of every background engage in leadership roles across society,” she said.
“Supporting these women through their health journeys is not just a healthcare issue—it’s a societal issue.
“Keeping women healthy and helping them make patient-centred decisions about their menopausal symptoms is hugely rewarding.”
Liz is passionate about training the next generation of healthcare professionals to better serve rural and remote communities. “Every day that I invest in training a rural workforce, I know that I am investing in the well-being of rural and Aboriginal communities of the Kimberley,” she said.
“The goal is not only to provide better care for women experiencing menopause, but also to create a more equitable healthcare system that serves all women, regardless of where they live.”
“Investing in women’s health is investing in the future of our communities.”
Dr Elizabeth Gannon, a Consultant Obstetrician Gynaecologist, was among five presenters at The Kimberley Health Professionals Network’s Perimenopause and Menopause – The Struggle is Real education event in August. The event was attended by more than 100 local women.