Disclaimer: This article is intended as policy analysis and advocacy content for a general audience. It does not constitute individual medical advice. People with health concerns should consult a qualified healthcare professional.
A Senate Inquiry That Could Not Be Ignored
In November 2023, the Australian Senate referred an inquiry into issues related to menopause and perimenopause to the Community Affairs References Committee, with a report due by September 2024. The inquiry was not convened in a vacuum. It was convened in response to years of sustained advocacy from women's health organisations, clinicians, and lived-experience advocates who had documented, in granular detail, a health system that was failing women at one of the most consequential physiological transitions of their lives.
The resulting Senate committee report, released in September 2024, confirmed what advocates had long argued: that menopause and perimenopause are systematically under-resourced in Australia. GP training is inadequate. Pharmaceutical access is inequitable. Workplace protections are absent. Research funding is insufficient. And the cost burden on women who seek appropriate care falls disproportionately on those least able to bear it.
The Government's February 2025 response acknowledged the findings and announced $12.8 million over two years for a public awareness campaign, new Medicare rebates for menopause health assessments from July 2025, and funding for GP training. These are meaningful steps. They are also insufficient to close the structural gaps the inquiry identified. This analysis examines those gaps and the policy architecture required to address them.
What the Inquiry Found: A System Failing at Every Level
The Senate committee heard evidence from more than 100 submissions, including from the Royal Australian College of General Practitioners (RACGP), the Australasian Menopause Society (AMS), the Australian Institute of Health and Welfare (AIHW), consumer advocates, and women with direct experience of the system's failures. The breadth of the evidence base makes the committee's conclusions difficult to contest.
GP training is inadequate and inconsistent. The committee found that GPs receive limited and highly variable education on menopause and perimenopause in both undergraduate medical training and vocational training pathways. Survey data consistently shows that a significant proportion of GPs lack confidence in menopause management — in counselling women on MHT risk-benefit profiles, in identifying perimenopause in women presenting with mood disturbance, cognitive changes, or sleep disruption, and in distinguishing genitourinary syndrome of menopause (GSM) from other urogenital conditions.
This is not a criticism of individual practitioners. It is a structural observation about what medical curricula prioritise and what they do not. Menopause affects every woman who lives long enough to experience it — approximately half the Australian population, affecting an estimated 3.5 million women at any given time. Yet it has occupied a marginal position in clinical training, with the consequence that GP confidence and practice varies enormously depending on individual initiative rather than systematic education.
MHT access is inequitable. Before the reforms announced in early 2025, several highly effective menopausal hormone therapy formulations — including progesterone (Prometrium) and estradiol gel (Estrogel) — were not listed on the Pharmaceutical Benefits Scheme (PBS). Women paying out-of-pocket for these medications faced costs of up to $670 per year. For women on low incomes, in regional and remote areas, or managing multiple chronic conditions, that cost was a genuine barrier to treatment that has a strong evidence base for symptom relief and long-term health protection.
The PBS listings that took effect from 1 March 2025 brought Prometrium and Estrogel onto the subsidised schedule, reducing costs to $31.60 per script ($7.70 for concession cardholders). This is a significant improvement. But the Senate inquiry also identified that supply chain disruptions — global shortages of HRT patches, in particular — continue to create access gaps that PBS listing alone cannot resolve. Compounding pharmacy access, where it fills those gaps, remains subject to regulatory inconsistency that the TGA has yet to fully address.
Workplace policy is non-existent at the national level. The inquiry heard substantial evidence about the workforce impacts of menopause. Women experiencing severe vasomotor symptoms, cognitive disruption, sleep impairment, and mood dysregulation — without adequate diagnosis or treatment — reported reduced productivity, increased absenteeism, and in significant numbers, early exit from the workforce. There is no national framework requiring employers to make reasonable adjustments for menopause-related impairment in the way that disability, pregnancy, and carer responsibilities are addressed in workplace legislation.
The United Kingdom introduced Menopause Employment Champions in 2022 and has seen growing adoption of workplace menopause policies. Australia has no equivalent initiative at the federal level, and the Fair Work Act 2009 does not explicitly address menopause as a basis for workplace accommodation.
The PBS Gap: More Than Just Affordability
The Senate inquiry's attention to PBS listings addressed an issue that is more complex than affordability alone. The PBS listing of a medication is, in the Australian health policy context, also a signal of clinical legitimacy. When effective, evidence-based treatments are not on the PBS, GPs may be less likely to prescribe them, patients may be less likely to ask about them, and the system implicitly undervalues the conditions they treat.
For the better part of two decades following the misinterpretation of the 2002 Women's Health Initiative (WHI) study, MHT was prescribed at rates substantially below what the evidence supported. The WHI study reported elevated risks of breast cancer, cardiovascular events, and stroke — but in a population with an average age of 63, well outside the therapeutic window. Subsequent re-analysis demonstrated that these risks were substantially attenuated or absent in women who initiated MHT within ten years of menopause onset or before the age of 60. RANZCOG updated its position statement accordingly. The RACGP's guidelines were revised. Yet prescribing rates lagged, in part because the initial risk messaging had penetrated both clinical and public consciousness more effectively than the corrective evidence.
The Senate inquiry found that this confidence gap persists. The RACGP's submission to the inquiry identified that GPs frequently lack the structured time to conduct thorough perimenopausal assessments under existing Medicare rebate structures, and that the absence of a long-consultation Medicare item specifically for menopause was a concrete barrier to quality care. The new Medicare rebate for menopause health assessments, commencing July 2025, addresses this — but implementation will depend on GP awareness and uptake, which in turn depends on training.
The remaining PBS gap concerns certain formulations and delivery routes that remain unlisted. Transdermal estrogen patches, which are preferred for women with certain cardiovascular or thromboembolic risk factors because they avoid first-pass hepatic metabolism, are subject to supply disruption and inconsistent availability. The TGA's regulatory framework for compounded bio-identical hormones — which some women access when listed formulations are unavailable or unsuitable — lacks the consistency and quality assurance of the standard PBS pathway. Closing this gap requires both expanded PBS listings and a clearer regulatory framework for compounding, not as competing solutions but as complementary ones.
GP Training: The Linchpin Reform
Every other reform in the menopause policy space depends, to a significant degree, on what happens in the GP consultation room. The Senate committee's recommendation that the Australasian Menopause Society be funded to oversee a structured GP menopause training program reflects a recognition that voluntary, ad hoc continuing professional development has not been sufficient to close the knowledge and confidence gap.
The RACGP has announced enhancements to menopause training within the Australian General Practice Training (AGPT) program and the Fellowship Support Program (FSP). These are important commitments. But training for registrars currently in vocational training does not immediately address the knowledge gap in the existing GP workforce — estimated at more than 35,000 active GPs across Australia, the majority of whom completed their training before menopause management received substantive curriculum attention.
Mandatory continuing professional development (CPD) on menopause management, structured within the RACGP's existing re-credentialing framework, offers the most direct route to closing the practice gap in the existing workforce. This does not require legislative change — it requires a policy decision by the RACGP, supported by adequate educational resources and accredited providers. The AMS, Menopause Australia, and RANZCOG all have the clinical expertise to contribute to curriculum content. What has been lacking is the funding and coordination to deploy that expertise at scale.
The Senate inquiry also identified specific training gaps around perimenopause — the transitional phase that can begin up to a decade before the final menstrual period, and which is frequently misdiagnosed as anxiety, depression, or burnout. Women in their early to mid-40s presenting with mood instability, cognitive changes, irregular cycles, and sleep disruption are not routinely assessed for perimenopause. The consequences of missed diagnosis include unnecessary antidepressant prescribing, delayed access to appropriate hormonal management, and prolonged symptom burden at a stage of life that, for many women, involves peak career and caregiving demands.
Cost Barriers Beyond Pharmaceuticals
Even with the PBS listings that took effect in 2025, the cost barriers facing women seeking comprehensive menopause care extend well beyond the price of a prescription. Specialist consultation — with a gynaecologist, endocrinologist, or menopause specialist — is not bulk-billed in the great majority of cases. Out-of-pocket costs for specialist menopause consultations range from $100 to $350 per visit, with multiple consultations typically required to establish an appropriate management plan.
The broader women's health funding gap in Australia provides essential context here: the financial architecture of the health system places disproportionate cost burden on women seeking management of conditions that are not adequately serviced at the GP level. When GP training is insufficient to manage complex menopause presentations, women are referred to specialists. When specialist consultation is not rebated adequately, women pay out-of-pocket. When they cannot afford to, they go untreated.
This is not an abstract equity concern. AIHW data consistently shows that cost is among the most commonly cited barriers to accessing healthcare for women aged 45 to 65 — the core perimenopause and early menopause demographic. The preventive health funding gap analysis on this site documents the broader pattern: conditions that could be managed cost-effectively in primary care become more expensive when primary care lacks the training and infrastructure to manage them.
Telehealth has partially democratised access to specialist menopause care for rural and regional women, and the permanency of telehealth provisions is directly relevant to menopause equity. But telehealth does not eliminate the out-of-pocket cost barrier; it reduces the geographic barrier while leaving the financial barrier largely intact.
Workplace Policy: The Missing Reform
The Senate inquiry found that menopause imposes significant productivity costs on Australian employers — though quantifying these costs precisely is difficult because there is no systematic national data collection on menopause-related workforce impacts. The inquiry heard evidence that women experiencing severe menopausal symptoms who lack adequate treatment are at elevated risk of reducing hours, taking extended sick leave, or leaving the workforce entirely.
The demographic concentration of this risk is significant. Women in their late 40s and early 50s are, in the current Australian workforce, among the most experienced and senior cohort in many industries. Early workforce exit — driven not by choice but by unmanaged symptoms and inadequate workplace accommodation — represents a loss of human capital that extends well beyond individual careers.
The inquiry recommended that the Australian Government develop a national workplace menopause strategy, including model policies that employers could adopt. It also recommended that the Fair Work Commission consider whether existing general protections provisions adequately address menopause-related discrimination and disadvantage, and whether amendments are required.
These are modest recommendations. They do not mandate employer action; they create frameworks within which employers can act and within which employees have clearer rights. Implementation would require coordination between the Department of Health, the Department of Employment and Workplace Relations, and the Fair Work Commission — a modest inter-agency effort relative to the scale of the problem it would address. The mental health Medicare reform precedent is instructive: that reform demonstrated that targeted Medicare investment, combined with workforce training, can shift population-level health outcomes when the policy architecture is coherent.
What a Comprehensive Reform Package Looks Like
The Senate inquiry produced a set of recommendations that, taken together, constitute a coherent reform agenda. The Government's February 2025 response accepted or partially accepted most of them, but implementation timelines and funding commitments remain uneven. The following framework reflects what the evidence supports.
Expand PBS listings to cover all evidence-based MHT formulations, including remaining unlisted transdermal options, and establish a clearer regulatory pathway for compounded hormones where listed products are unavailable. This closes the treatment gap that current PBS listing has not yet fully resolved.
Fund structured GP training at scale through the RACGP and AMS, with mandatory CPD requirements for the existing workforce rather than relying solely on registrar training pathways. Accredited, short-form training modules deliverable via the existing CPD infrastructure can reach the majority of the active GP workforce within two to three years if adequately resourced.
Introduce a national workplace menopause framework, developed by the Department of Employment and Workplace Relations in consultation with employer peak bodies, unions, and women's health organisations. Model policies, awareness resources, and explicit guidance on existing anti-discrimination obligations would constitute a minimum viable framework without requiring legislative amendment.
Commission longitudinal research on menopause workforce and health outcomes, coordinated through the AIHW, to establish the evidence base that policy decisions in this area currently lack. The absence of systematic national data on menopause prevalence, severity, treatment rates, and workforce impacts is itself a policy failure that enables continued underinvestment.
Ensure the new Medicare menopause health assessment item is adequately resourced and promoted, including through the RACGP's practice support infrastructure, so that the item translates into measurable improvements in assessment rates rather than remaining a theoretical entitlement.
The Structural Argument
Menopause is not a niche health issue. It is a universal biological transition experienced by approximately half the Australian population, beginning, on average, at age 51 but often preceded by years of perimenopausal symptoms that carry their own significant burden. The failure to invest adequately in menopause healthcare — in training, in pharmaceutical access, in specialist rebates, in workplace accommodation — is not a women's health failure alone. It is a workforce productivity failure, a health system efficiency failure, and an equity failure with compounding costs.
The 2024 Senate inquiry, the Government's February 2025 response, and the PBS listings that took effect in March 2025 represent genuine progress. They establish a policy foundation that did not exist three years ago. But the history of incremental reform in women's health in Australia counsels against assuming that first steps become second steps without continued advocacy.
The reforms outlined here are not radical. They work within existing institutional frameworks — the PBS, the Medicare schedule, the RACGP's CPD architecture, the Fair Work Act — and require coordinated investment rather than structural reinvention. What they require, above all, is sustained political priority in a policy environment where many urgent demands compete for finite attention.
The Coalition for Better Health will continue to advocate for the full implementation of the Senate inquiry recommendations and for the additional structural measures — mandatory CPD, workplace frameworks, longitudinal research — that the inquiry identified as necessary but that the Government's initial response has not yet fully addressed.
Sources: Senate Community Affairs Committee — Menopause Inquiry | Government Response, February 2025 | RACGP Submission to Menopause Inquiry