Neglecting menopause in doc training is ‘skipping the ABCs’

3 minute read

Meanwhile poorer patients are forced to choose between higher breast cancer risk or no treatment at all. An urgent PBS review is needed.

According to Dr Ceri Cashell, co-founder of Avalon Family medical practice in northern Sydney, a lack of comprehensive sexual health education, particularly regarding perimenopause and menopause, meant GPs and other medical professionals were missing a “key part of the story” with regards to women’s physical and mental health. 

“It sounds a bit overarching, but sex is a potent determinant of disease, probably more so than social, cultural and economic and racial factors, but it is entirely absent from medical education. Gender is not [even] considered,” Dr Cashell told the Senate inquiry on menopause today. 

“We largely base our medicine around a white, 70kg male. Women were only included in medical research in 1994, and many female animals were only included in preclinical research in 2016, so the majority of drugs that I prescribed as a GP were never tested on female animals, never mind women. 

“I’m not sure how the government can mandate that change, but having federal grants that offer money to universities who do focus on sex as a determinant of disease and working with the colleges to look at how they develop their postgraduate education in all specialties, not just GPs – would be a good start. 

“[As GPs] we have a lot of passion in the space and most of us are trying our best. We can’t be experts in everything but everyone should be an expert in female health, because everybody sees women in some capacity.” 

Regarding access to PBS-listed HRT and MHT treatments amid ongoing shortages of several estradiol and combination estradiol/norethisterone transdermal patch products, Dr Cashell said patients were suffering as a result of the high costs associated with producing and supplying body-identical versus synthetic therapies and discrepancies in PBS availability for progesterone versus estrogen replacements. 

“My patient population is pretty affluent, and they still really struggle to pay for body identical hormone therapy,” Dr Cashell said. 

“I had a patient on Friday who was no longer able to afford HRT, which had her moods completely controlled.  

“Instead she asked for valium, because a box of 50 valium is PBS listed and costs $15, whereas her anxiety and depression is controlled on progesterone, and estradiol. 

“Progesterone is [also] a huge issue. 


MHT doesn’t cause (or prevent) cancer or heart attacks

MHT patches still in short supply

Give women the gold standard, not scraps of empowerment

It has to be held against the price point of the synthetic progestins because they are both considered in the same class as only being useful to protect the uterine lining from estradiol on its own or oestrogen on its own, and all the studies would suggest that they do have a small increased risk of breast cancer. but all of the data on the natural progesterone shows that it does not.  

“So our poorest women either have the option of a higher risk of breast cancer, or no treatment at all. 

“We need an urgent review of our PBS so that all women who wish to use hormones can access the safest and most effective forms, whether that is contraception or body identical HRT.” 

The Senate inquiry on issues related to menopause and perimenopause is due to report its findings by 10 September, with public hearings being held in Sydney, Melbourne and Brisbane over the course of the next few months. 

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