Submission to the Standing Committee on Community Affairs inquiry into issues
related to menopause and perimenopause.

To the Senate Inquiry Committee,

Thank you so much for instigating this inquiry and I appreciate the opportunity to make a formal submission to it. My submission is dedicated to everyone who has shared their stories about their menopause journey with me, which has included all genders and ages. Their openness and vulnerability inspire me daily to continue to support their wellbeing during this time.

I am a wellbeing scientist and practitioner focused on mentoring professional women during their menopause journey through the business I founded – Strong into Superb. My passion on supporting wellbeing during menopause grew when I was perimenopausal and studying for my Master of Applied Positive Psychology, also known as wellbeing science. I then became post-menopausal due to the removal of my ovaries in 2021 and there was limited support for the hormonal impact this had on my life. Thankfully, I did not have cervical cancer. However, this meant I was not ‘eligible’ for support through the Ovarian Cancer society and nor did my surgeon offer any post-surgery support for menopause. This increased my passion to support wellbeing for all during menopause, so that others could have the evidenced-based support that I did not. In February 2024 I started the first pop-up Menopause Cafés (Cafés) in Canberra, both in person and online, which occur monthly. The Menopause Café movement started in Perth, Scotland, in 2017 and has spread worldwide, with volunteers now hosting pop-up events in the UK, Bahrain, Mexico, USA, Austria, India, and Australia. These cafés are aimed at breaking down the stigma around menopause and increasing awareness of the impact of the menopause on those experiencing it, their family, friends, and their colleagues. For further information on these Cafés and feedback on their effectiveness in supporting people during menopause, please refer to Appendix A.

My submission relates to the Inquiry’s Terms of Reference (a) to (i), with the following key points:

1. Wellbeing of an individual impacts, and is impacted by, all the people, workplaces, groups, societies, cultures within which it takes part 1, there is complexity in understanding the conditions that help wellbeing thrive 2,3, and there is shared responsibility of individuals, organisations, and communities to improve wellbeing of all.4
2. A woman’s menopause continuum is influenced at the individual level by her biological and psychological functioning, demographics, and lifestyle choices. Her menopause continuum is also influenced through her relationships, work and the society and culture in which she lives. The influences of these factors means that every woman’s menopause continuum is unique, acknowledging the multiplicity of individual and socio-factors impacting a woman’s menopause continuum that may affect her quality of life. 5,6
3. Women’s positive menopause continuum experiences are rarely sought.6
4. The menopause continuum is not experienced the same worldwide, given the influence of psychosocial and sociocultural factors on a woman’s wellbeing. 7,8 Geographical and racial backgrounds of women appear to determine their likelihood of having symptoms and how they are experienced: the reasons why, in addition to the six factors that may influence every woman’s experience, are not yet fully understood.9
5. The menopause continuum is not experienced the same within a country, as even if women’s demographics are similar in other ways, the experience of women who lived through a particular cultural era may not be comparable to a woman from a different generation.10
6. Women who migrate to a new country appear to report similar menopause continuum symptoms and attitudes that are dominant in their new country as opposed to their previous country. 11
7. There is a scarcity of research on how a woman’s menopause experience affects the wellbeing of her family unit and her communities, and vice versa.

I make the following recommendations to the Inquiry (in no order of priority):

A. Capture women’s positive menopause continuum experiences and start sharing their

B. Educate children in high school about menopause.

C. Ensure that there is a standard approach in measuring and evaluating vasomotor and genitourinary symptoms, including the efficacy and effectiveness of clinical and non-clinical interventions.

D. Have information targeted at women’s partners about menopause, and this includes same-sex partners.

E. Have not-for-profit community-based support groups where all ages and genders can come and discuss all things menopause by adopting nationally the pop-up Menopause Cafés (for further information on these Cafés and feedback on their effectiveness in supporting people during menopause, please refer to Appendix A.)

F. Normalise menopause and destigmatise it through embracing women’s aging through promoting that women are valued as they age, and that menopause is a natural part of life.

G. Promote evidence-based wellbeing pathways to support wellbeing during the menopause continuum at work, so that women grow through it rather than just getting surviving and/or being resilient.

H. Provide evidenced-based information to all families about menopause to destigmatise it. Have this information in multiple languages and culturally appropriate.

I. Provide information on menopause to service businesses who are in close contact with women so they can promote fact and evidence-based menopause information. For example, hairdressers, beauticians, and shop assistants in women focused stores.

J. Provide women from 35 onwards information about the menopause continuum to help her support her wellbeing before and during it based on evidence-based information, ensuring it discusses the reasons why each experience is unique due to her biological and psychological functioning, demographics, and lifestyle choices, and influenced through her relationships, work and the society and culture in which she lives.

K. Research how a woman’s menopause experience impacts the wellbeing of her family unit and her communities, and vice versa.

L. Research the effect on family wellbeing during menopause and identify evidence-based wellbeing pathways to support it both proactively and reactively.

M. Women from 35 years of age are eligible for subsidised bone density screening to identify any potential impact on bone loss during menopause continuum and action to address any concerns found.

Terms

In this submission I use the following terms:

• Family unit, includes a couple, inclusive of a woman with children; a woman who is a single parent; and a woman who may or may not be in a relationship, and has close friendships that are active, loving, emotionally intimate, trusting, supporting, and long term.
• Family wellbeing, a multifaceted construct, including an individual assessment of their family’s wellbeing along with the family’s interdependent sense of wellbeing. 12,13
• Menopause continuum encapsulates a woman’s lived experience in transitioning to being non-reproductive naturally with the commencement of perimenopause, or by it being induced through medication or surgery, to the end of experiencing postmenopausal symptoms.
• Wellbeing pathways are events, interventions, and/or actions that positively impact a person’s wellbeing experience.
• Women are inclusive of people who are transitioning genders from female to male and non-binary people.

What is Wellbeing?
Wellbeing, from the lens of positive psychology, is at the heart of helping individuals and communities thrive and surprisingly there is no agreed definition for wellbeing. 14 I have chosen to use a definition that focuses on the individual wellbeing: “wellbeing can be understood as how people feel and how they function both on a personal and social level, and how they evaluate their lives as a whole”. 15 Research suggests that the wellbeing of an individual impacts, and is impacted by, all the people, workplaces, groups, societies, cultures within which it takes part1, there is complexity in understanding the conditions that help wellbeing thrive 2,3, and there is shared responsibility of individuals, organisations, and communities to improve wellbeing of all. 4 Wellbeing science “is the scientific investigation of wellbeing, its antecedents and consequences”. 16 As this field grows, so has the identification of evidence-based ways to guide, support and educate people to create the best possible wellbeing journeys for themselves, their families, workplaces and groups. Wellbeing through the lens of positive psychology excludes wellness concepts that require clinical support such as medical healthcare, health products such as nutritional supplements and medication, food, and personal care products. 17

Menopause Continuum Impact on a Woman’s Wellbeing
There six factors that may impact a woman’s lived experience through her menopause continuum (refer Figure 1). At the individual level, there are four factors: biological and psychological functioning, demographics, and lifestyle choices. 10,18-21 Fifth, psychosocial refers to how her social structures and practices influence her social, spiritual, emotional and mental health. 5 Finally, sociocultural refer to how her socioeconomic status and her cultural and societal influences that may impact her health, behaviours, thoughts and feelings. 22 These factors may influence a woman’s biological and psychological symptoms during her menopause continuum.

Figure 1
Model of Six Factors That May Impact Women’s Menopause Continuum Experience

Note. These symptoms may be due to more than hormonal changes

As woman’s biological changes may result in vasomotor symptoms, hot flushes and night sweats, and physical symptoms such as joint pain, fatigue, and brain fog. 10,21 She may also be affected by genitourinary symptoms, such as vulvovaginal dryness and pain during sex. 23 Psychologically, she is more likely to suffer from depression and vasomotor and genitourinary symptoms if she has a history of mood disorders, views menopause negatively, had adverse experiences during childhood, lacks effective coping mechanisms, and/or has a low level of self-compassion. 18-20

Her risk of experiencing biological and/or psychological symptoms is also influenced by the other four factors: lifestyle, demographics, psychosocial, and sociocultural. For example, this risk may be due to a lifestyle that includes limited exercise, cigarette smoking, significant alcohol intake and/or being overweight. 10,19 Demographically it may be due to having lower literacy and education levels 24,25 and/or their geographical and racial background. 9 Psychosocially it may be due to a negative attitude toward menopause and/or aging, being under stress, and/or having limited support. 18 Socioculturally, it may be due to unemployment or experiencing workplace issues. 24

Recent surveys of women’s quality of life during their menopause continuum indicate that they do not always feel good nor function well as they are bothered by biological, psychological, and social symptoms including: dissatisfaction with their personal life, feeling depressed, having difficulties in sleeping, and accomplishing less than before the start of their menopause continuum. 26,27 The length of time a woman may experience biological and/or psychological symptoms could also impact a woman’s wellbeing during her menopause continuum. For women who experience menopause continuum biological and psychological symptoms, it is suggested they are experienced on average for 7.5 years during menopause transition and 4.5 years after a woman’s final menstrual period. 28,29 However, these findings may not be reliable, as there has been no standard approach in
measuring and evaluating symptoms, including the efficacy and effectiveness of clinical and non-clinical interventions. 11,30,31 Finally, it is posited that symptoms may last longer given there is limited cross-sectional data available and postmenopause symptoms are not often followed up.9

Conversely, positive experiences for some women are that it is a relief to be in her menopause continuum and embracing the menopause continuum as a normal life transition with no need to be concerned about pregnancy and menstruation postmenopausal. 6,11 Women’s attitude towards her menopause continuum may even be more positive after they have finished it, counter to their perceptions beforehand. 32 However, a woman’s positive menopause continuum experiences are rarely sought. 6 The menopause continuum is also not experienced the same worldwide, given the influence of psychosocial and sociocultural factors on a woman’s wellbeing. 7,8 Geographical and racial backgrounds of women appear to determine their likelihood of having symptoms and how they are experienced: the reasons why, in addition to the six factors that may influence every woman’s experience, are not yet fully understood. 9 Further, it is also not experienced the same within a country, as even if women’s demographics are similar in other ways, the experience of women who lived through a particular cultural era may not be comparable to a woman from a different generation. 10 Women who migrate to a new country appear to report similar menopause continuum symptoms and attitudes that are dominant in their new country as opposed to their previous country. 11 Wellbeing pathways with research suggesting that may alleviate menopausal symptoms at the individual layers include:

• Reducing psychological symptoms through self-compassion33-35 , family and social support 36,37 , practicing yoga 38,39, and increasing physical fitness 35,40.
• Improving vasomotor and/or urogenital symptoms by practicing yoga 38, increasing physical fitness 35,40, and self-compassion 41.
• Improving anxiety, fatigue, and sleep through foot massage 42.

In summary, a woman’s menopause continuum is influenced at the individual level by her biological and psychological functioning, demographics, and lifestyle choices. Her menopause continuum is also influenced through her relationships, work and the society and culture in which she lives. The influences of these factors means that every woman’s menopause continuum is unique, acknowledging the multiplicity of individual and socio-factors impacting a woman’s menopause continuum that may affect her quality of life.5,6

Recommendations

• Capture women’s positive menopause continuum experiences and start sharing their
  stories.
• Ensure that there is a standard approach in measuring and evaluating vasomotor and genitourinary symptoms, including the efficacy and effectiveness of clinical and non-clinical interventions.
• Provide women from 35 onwards information about the menopause continuum to help her support her wellbeing before and during it based on evidence-based information, ensuring it discusses the reasons why each experience is unique due to her biological and psychological functioning, demographics, and lifestyle choices, and influenced through her relationships, work and the society and culture in which she lives.
• Promote evidence-based wellbeing pathways to support wellbeing during the menopause continuum, so that women grow through it rather than just getting surviving and/or being resilient.
• Normalise menopause and destigmatise it through embracing women’s aging through promoting that women are valued as they age and that menopause is a natural part of life.
• Women from 35 years of age are eligible for subsidised bone density screening to identify any potential impact on bone loss during menopause continuum and action to address any concerns found.
• Have not-for-profit community-based support groups where all ages and genders can come and discuss all things menopause, as per the pop-up Menopause Cafés (for further information on these Cafés and feedback on their effectiveness in supporting people during menopause, please refer to Appendix A).