June 25, 2025 • 29 mins
To HRT/MHT or not to HRT/MHT? Dr Sonia Davison – Endocrinology Lead at the Jean Hailes Clinic dispels the myths. She also tells Pats about new PBS additions to ease therapy shortages, the first in more than 20 years!
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Speaker 1 (00:00):
We've touched on the shortage of patches to treat menopause
in previous episodes of rage against the menopause and the
frustration at times at the lack of supply, especially during COVID,
but the Australian Parliamentary Inquiry has recommended that newer forms
of therapies be subsidized through the Pharmaceutical Benefit Scheme to
(00:20):
bolster supply and ensure access and lowered costs for all
women who need it. And now women have access to
the first new kind of hormone therapy to be subsidized
by the federal government in more than two decades. The
funding move has been welcome with open arms by health experts,
including doctor Sonya Davison, endochronology lead at the Gene Hale's Clinic.
(00:45):
She also dispels some of the myths surrounding hormone therapy.
Speaker 2 (00:50):
Buckle up, girls, menopause, It's coming for you no matter what.
Let's build a village of support. The damn hut in here.
Speaker 3 (01:01):
The menopause is so hot right now.
Speaker 2 (01:04):
I think I'm finally in menopause.
Speaker 3 (01:05):
Women just want to feel hurt.
Speaker 1 (01:08):
Rage against the menopause, but I'm really excited now to
welcome to the podcast, to this second series of Rage
Against the Menopause, a very highly distinguished specialist in doctor
Sonya Davison. She is the indo chronology leader gene Hale's
Clinic in Melbourne.
Speaker 3 (01:29):
Hi, Sonya, how are you very well?
Speaker 2 (01:32):
Indeed, I'm very excited to be with you today, Sonya.
Speaker 1 (01:35):
The recent Senate inquiry into menopause on Earth some key findings,
one that newer forms of therapies be subsidized through the PBS,
the Pharmaceutical Benefit Scheme, And this just very recently is
exactly what's happening?
Speaker 3 (01:53):
What can you tell us about it?
Speaker 2 (01:56):
It's amazing.
Speaker 4 (01:58):
There was a think tank about this last year and
then there was the Senate inquiry and now things are happening.
So there are two types of hormone therapy that have
been available. Ones called estrogel, it's an estrogen gel that's
applied to the arms, and one is prometrium, which is
(02:18):
body identical micronized progesterone, which two hormones. They are exactly
the same as the hormones made by the ovaries. They
were available before, but a PBS listing means that they're
significantly reduced in cost, and some women such as pensioners
or those you know, disadvantage. Women who wouldn't have had
(02:39):
access easily to these products before now have. It's much
more accessible, which is amazing.
Speaker 1 (02:45):
Well, that is such a great breakthrough. I believe that
it is in fact so long overdue. It's the first
type or first new type of menopause hormone therapy to
be subsidized by Canberra in more than two decades. It's
what was it costing women accessing it privately before, and
(03:05):
I guess ruling out a large proportion of society from
being able to affordably get relief.
Speaker 4 (03:14):
It depends if they have both estrogen and progesterone. So
some women only have estrogen, so it's less expensive if
they've had a hysterectomy. But typically if they needed both
the estrogen and progesterone, it was about six hundred and
fifty dollars per year. And now if they've got a
pensioner healthcare cardter substantially reduced, and even if they don't,
(03:35):
it's about half that half all less. So a real
you know, this is the cost of living crisis, isn't it.
We're all struggling. When you look at it in the supermarket.
A piece of meat or a piece of fish is nice.
Speaker 2 (03:50):
Insane amount it is it is insane.
Speaker 4 (03:53):
So this is just taking the pressure off women, which
is amazing.
Speaker 3 (03:57):
Absolutely.
Speaker 1 (03:58):
So did it mean before this if women couldn't afford
it like a pensioner having to pay six hundred and
fifty dollars that is a no go? So did it
mean that these women were having to suffer in silence
and not have access to these drugs?
Speaker 4 (04:16):
It meant that they had to use another form of
hormone therapy and there are luckily in Australia we do
have lots of different types of hormone therapy, but since
twenty seventeen there's been a rolling shortage of different types
of hormone therapy for various reasons. And I suspect you
and I might talk about that a little bit more.
Speaker 1 (04:37):
Absolutely, and that has been a common theme throughout.
Speaker 3 (04:41):
The first series is these patches.
Speaker 1 (04:43):
Have been a wonder drug for a lot of women
that I'm speaking to a lot of my girlfriends as well.
But in listing these new type of medications, will that
only make that backlog and access more difficult or not?
Speaker 4 (04:59):
Some women do prefer women choose what they want you
and I know that some things are not suitable for
some women. And the patches are very sort of what
we call a set and forget, So you put the
patch on on Monday, you take it off on Thursdays.
For so some women that is very easy, whereas a
gel is a daily application. So it really depends on
(05:22):
the woman, her skin, what her funds previously, depending on
what type of hormone therapy she will choose. And often
we have to go through several types anyway, so there's
a lot more to it.
Speaker 2 (05:35):
Women are complex entities.
Speaker 1 (05:39):
So who will this essentially benefit Is it women that
have already reached menopause?
Speaker 4 (05:46):
Sonya, Well, women at perimenopause when the hormone levels are
fluctuating wildly and widely.
Speaker 2 (05:54):
Those women may need hormone therapy as well.
Speaker 4 (05:57):
It's all about balancing the pros and cons for the
individual woman. And let's not forget premature menopause, which is menopause.
Speaker 2 (06:06):
Before the age of forty.
Speaker 4 (06:08):
That we know that we're giving hormones back to those women.
Speaker 2 (06:11):
If we're able to, we'll protect their.
Speaker 4 (06:14):
Bones, their heart, their brain, and also their mortality. So
that's definitely someone we want to treat.
Speaker 1 (06:22):
It seems to be that women are going through perimenopause
a lot younger, some even in their late thirties. How
common is that now and is it more common than say,
our mother's generation.
Speaker 4 (06:36):
Well, my studies actually suggest that the time of menopause
is fixed, so yeah, it's all genetically programmed.
Speaker 2 (06:44):
I don't know that there's a lot of data to
say we are.
Speaker 4 (06:47):
Undergoing menopause or perimenopause earlier. But perimenopause is a time
when the ovaries wind down, we run out of eggs,
and studies have shown that it can happen for eleven
years before the time of menopause, which is just the
last period no more eggs, estrogen dive bombs.
Speaker 2 (07:07):
So if you think you were going.
Speaker 4 (07:08):
To have menopause at the average median age at fifty one,
you'd be coming into perimenopause for some women at forty.
But if you were going to have an earlier menopause
less than forty five years of age and you're going
to have eleven years of symptoms, it could be in
the thirties. So it depends on how you actually look
at what's going on, and it is a very difficult area,
(07:33):
and women in their thirties might be struggling with being
getting their career underway, having children, having aging parents. So
there are a lot of things happening in the thirties
and forties that might be mistaken for perimenopause. But in
the forties most women will have a bit of perimenopause
(07:53):
starting to mingle in with their symptoms.
Speaker 1 (07:56):
It's a bit like life scholesion. Course, I call it
the symptoms. They're so wide and so varied. Do we
have to be careful to be so general thinking passing
something off as a symptom of perimenopause when it won't
necessarily be that. Do you find that there's a trend
(08:17):
for women to perhaps jump to that conclusion.
Speaker 2 (08:21):
Well, it's an easy blame, isn't it.
Speaker 4 (08:25):
Life is tough, Life is busy, life is expensive, there's
traffic on the road, there's children there.
Speaker 2 (08:32):
You know.
Speaker 4 (08:32):
Whatever whatever is in a woman's life between thirty five
and sixty and beyond, possibly it is challenging.
Speaker 2 (08:42):
It's like the thyroid.
Speaker 4 (08:44):
I've got a lot of ladies who come to me
and say, this has got to be my thyroid. The
thorough blood test is fine, the thoroid is fine, but
it's a hard conversation to have. No, it's not your thyroid,
it might be whatever. There's a list of symptoms on
the gene House website and on the Australasian Menopause Society.
So if a woman typically is of an age from
(09:05):
forty five plus or even forty plus, has a constellation
of those symptoms, and if they are bothering her and
periods are changing, if she's having periods, then you'd probably
put your money on that is perimenopause. It's not a
diagnosis based on blood tests. It's a diagnosis based on
a symptom.
Speaker 1 (09:25):
Complex, which is what I find really frustrating. There's nothing definitive.
I'm very black and white. It's like, can't I just
have a blood test and that will tell me definitively
am I perimenopause?
Speaker 3 (09:37):
Am I menopause?
Speaker 1 (09:38):
Where am I in this wide open space? I've found
that really quite challenging through my journey.
Speaker 2 (09:46):
A lot of women struggle.
Speaker 4 (09:47):
I had a really difficult conversation last week. A woman
wanted to come back and come back with her hormone levels,
and I said.
Speaker 2 (09:56):
Look, it can be here, it can be here, It
can be here.
Speaker 4 (10:00):
It's not going to help us. What's going to help
me is your response to the treatment I've given you,
and I will adjust things depending on that. If it's
a good story and they're the right age. We only
really do hormone levels if something's really odd, if we
suspect premature menopause, things like that. So we're saving the
(10:22):
government some money if we don't do those hormone levels unnecessarily.
Speaker 3 (10:28):
Can we dispel the myths? There's still a bit.
Speaker 1 (10:30):
Of reluctance about hormone replacement. Did we get the wrong perspective?
Is it not as dire the risks of going on
that form of treatment as perhaps our mothers might have
been taught.
Speaker 4 (10:47):
Well, it's been a really interesting journey because in two
thousand and two are really the biggest hormone study was released,
which was called the Women's Health Initiative, which involved over
twenty six thousand women in America. But the tricky thing
was they weren't symptomatic by and large, their average age
was sixty three. They were aged up until seventy nine
(11:09):
years of age, and they were given hormone therapy versus placebo.
Speaker 2 (11:14):
What we didn't.
Speaker 4 (11:17):
What we needed that study for was to rationalize hormone
therapy use, because there was a lot of hormone therapy
being used for dubious reasons in the US and around
the world before that, so it sort of put the
brakes on and made us have a good think about
why we give hormone therapy. And really there's a beautiful
statement by the International Menopause Society, but menopause experts and
(11:40):
bodies around the world have agreed that for healthy women
around the time of menopause, the benefits of hormone therapy
far outweigh the small risks associated with its use. So
I think that's a really useful statement, and there's a
beautiful information at the Australasian Menopause Society and at Genehals
(12:02):
for women's self going through the pros and cons of
hormone therapy. An individual woman needs to discuss those with
her doctor, think about them really carefully, and then opt
for it if her quality of life is not good
and she needs help.
Speaker 1 (12:18):
I have a cancer history, so I'm actually not on anything.
Speaker 3 (12:23):
I believe I'm now.
Speaker 1 (12:24):
Fully fledged into menopause. I haven't had a period for
forty months, so I would assume I'm in full blown menopause.
At what point the other thing I've found difficult, At
what point do you know that you should perhaps be
taking something. I know that's probably a silly question, but
I think as women, we tend to just push through.
(12:47):
And like you say, there's other life pressures. There's elderly parents,
there's teenage children, there's busy careers, and you never have
time to yourself, and you do put yourself last, and
you think.
Speaker 3 (12:57):
No, I'll just push through. I'll just push through. It's
nearly the week.
Speaker 1 (13:00):
I can catch up then, But at what point do
you say it's time. I think I needed some form
of help, some sort of relief for my symptoms.
Speaker 2 (13:12):
It's about quality of life I have.
Speaker 4 (13:15):
These are the sort of quotes that women come I
don't feel like me anymore. I feel dry, I feel shriveled,
I feel old. I want to go for another job,
but I can't be bothered, so I'm just going to
sit in this job that I find boring. I shout
at my children. I'm worried about the impact on my relationship.
(13:35):
I can't do the things in life that I want
to do. And what about sleeping on beach towels? Some women,
because menopause can be very vigorous for some women. Some
women drench a beach towel overnight and have to take.
Speaker 2 (13:49):
It out, ring it out, put another one.
Speaker 4 (13:51):
So if you're sleeping on a beach towel, and if
you're not sleeping, because half of menopause I think is
sleep disruption, waking up frequently, not able to sate sleep,
and you're too tired, you can't do anything, you need
to sleep. It's for that woman what tips her over
the edge. And my women come back and they say
(14:12):
three words when we're doing really well, and that is
I feel normal. So this is about taking into consideration
that there are risks associated with hormone therapy, but also knowing.
Speaker 2 (14:26):
That quality of life is very important.
Speaker 4 (14:27):
And I think the pandemic brought that out because women
sat there before, but then there was so much talk
about health in the pandemic and so much we realized
what quality of life really meant. So I think women
have just really stepped forward out of that and thought, well,
do you know what I want to feel?
Speaker 1 (14:48):
Well, that was what a risk And I know it's
obviously it's a hard question probably to answer because it's
a case by case basis, But is there any greater
risk for women with a history of cancer in going
on hormone replacement therapy? Is the advice for them different
to someone who hasn't had it.
Speaker 2 (15:07):
It depends on the type of cancer.
Speaker 4 (15:09):
So there are some gynecological and of course breast cancer
that have hormone receptors on them, so they will possibly
be at higher risk of recurrence if we give hormone therapy.
So estrogen receptors is what we're talking about, but some
also have progesterone receptors. It depends on the type of cancer,
(15:30):
It depends on the clearance, it depends on the stage
and grade.
Speaker 2 (15:33):
So it's all very difficult.
Speaker 4 (15:35):
Usually, if it's a hormone receptor positive cancer, we usually
opt to use other treatments, not hormones. If a woman
comes to me ten years after breast cancer, for example,
she said, my quality of life is terrible. I've tried
all the other options. My surgeon says, it's okay for
a trial of lo DOOS hormone therapy. My oncologist is, okay,
(15:58):
can we have a trial of hormone therapy. I'm always
reluctant about it because I know that the risk of
cancer recurring in someone who's already had cancer is higher
than the general population. And we've got to remember that
one in seven women do develop breast cancer throughout their lifetime.
So it's a really difficult area and no one wants
(16:21):
to take a treatment that might increase their risk of cancer.
But if you look at the absolute statistics, the absolute
increase in cancer incidence is very very minor, and there
is no increase in breast cancer mortality, for example, with homotherapy,
and that big study, the WHI study, was very useful
(16:43):
for that. But that big study was also really useful
because the women on estrogen only in that study who
had had a hysterectomy before they actually had a lesser
risk of breast cancer compared with those on placebo. So
we think think that the progesterone entity is the one
increasing the risk, but it depends on the type of
(17:05):
formone therapy, it depends on the woman, depends on genes,
and really there was some beautiful information that came out
recently if you're talking about breast cancer, which showed that
the biggest risk factor, apart from family history, dense versts, etc.
Speaker 2 (17:20):
Was obesity and overweight.
Speaker 4 (17:22):
So there's an extra twenty six cases of breast cancer
from statistics from the UK over five years for women
from fifty to sixty years, whereas hormone therapy combined estrogen
and progesterone increases that number by four extra cases. And
women don't realize this, so it's important to talk about.
Speaker 1 (17:44):
It is, and it's so important I think to dispel
the myths as well and just give a current snapshot
of where it's at. Another really common theme in talking
to women. My hairdresser the other day went to the
GP not knowing, not feeling themselves and thinking something's not
(18:04):
quite right when it was perimenopause and they've been put
on antidepressants.
Speaker 3 (18:11):
Is that common? Do you see a lot of that?
Speaker 4 (18:16):
So the sad thing for women is that it may
actually be the best option for them, it's the way
it's delivered. So there is a group of antidepressants that
is very useful for reducing flushes and sweats. Mood is
a really big part of perimenopause and menopause with anxiety,
(18:37):
low mood and irritability, and one of those medications at
lodos can be probably the safest option for them, but
it's the way it's delivered, because some women leave an
appointment and think I've been given a script for antidepressants.
It's the limitations of our appointment times. It's so hard
(19:00):
to convey all of the pros and cons, the benefits
and risks in a ten minute GP appointment. You just
actually can't do it to give justice to the person
in front of you. So some busy gps will just
dash out the script and hand it to them without
the explanation.
Speaker 2 (19:17):
But it's certainly a very valid way.
Speaker 4 (19:19):
If the mood symptoms are predominating and there's not many
flushes and sweats, it is a really good way to
manage very menopause.
Speaker 3 (19:27):
That's interesting.
Speaker 1 (19:28):
Another key finding to come out of the amazing Senate
inquiry into menopause was the lack of GP training on menopause.
In fact, they're given across their whole course something like
sixty minutes an hour of training. I guess, Sonya, that
would be something that you would like to see.
Speaker 4 (19:47):
Well, if we go back to that big study the
WHI in two thousand and two, that's when it was released,
gps before that were really good at managing menopause, and
they were good at prescribing hormone theory.
Speaker 2 (20:00):
But then there was a lot of fear.
Speaker 4 (20:02):
There was a lot of mismanaged media out there, and
women became very afraid. But also practitioners became very afraid.
Some practices at the time said had sort of placards
outside saying we do not prescribe hormone therapy.
Speaker 2 (20:19):
This practice gosh.
Speaker 4 (20:20):
So since then, people like me and a lot of
other sort of very active individuals have made it their
life's mission to do a lot of education. So I've
done over two hundred talks, podcasts, webinars to anyone who
will listen and anyone who asked me at lots of
(20:41):
levels from the community up to doctors and whatever and pharmacists,
et cetera, to get the message out there about menopause,
to get the message out about education. Because I started
in research and as a doctor, but now I'm doing
a lot more of education and that's the important role.
(21:02):
We need to be targeting medical students, registrars which are
training doctors, GPS specialists. We just need to make sure,
even if they don't know particularly a lot about this area,
where to get the resources. So there's a beautiful e
learning platform at gene heals for women's health. There's one
(21:22):
on the Australasian Menopause Society. It's just slotting it in
to busy demands. For example, GPS, they have to know
a lot about so many things, from babies to elderly people,
men and women. That's why a lot of gps are
now sort of sub specializing into women's health and that's
(21:43):
where you see, for example, our Australasian Menopause Society conference
every year it's packed full of women's health gps mostly
who want to be updated in this area and they're educated.
It's the ones who aren't there that we need to
be reaching.
Speaker 1 (22:01):
Yeah, we do have sex education in secondary school. Do
you think we should be talking about menopause along with
other women's health things in school?
Speaker 4 (22:12):
I think it would be great if there was a
module saying year eleven and twelve which when maybe even
younger than that, which went through.
Speaker 2 (22:20):
Periods, PMS, contraception.
Speaker 4 (22:23):
I mean, school is not designed to make good humans
who know a lot about.
Speaker 2 (22:29):
Being in a you know, a good human. After they
leave school.
Speaker 4 (22:33):
It's about getting through the hurdles of a complex system
so that they can get to university and they sort
of learn it along the way. It's really difficult to
tell a teenager about menopause. Their eyes will glaze over
and they might not get it. The only reason they
might get it is if mum is going through it.
And that's very important, because I've had some light bulb
(22:56):
moments from people in their twenties old that's what's happening
at home. I didn't quite realize it is.
Speaker 2 (23:02):
A difficult thing.
Speaker 4 (23:04):
You know. The teenagers are busy at school, finding themselves whatever.
Speaker 2 (23:08):
There's lots of competing.
Speaker 1 (23:09):
The twenties decades away, right, I remember in my twenties
that was for old women.
Speaker 4 (23:15):
That was just I just don't think the messages are
going to get in there and sit in there. From
twenty to thirty, you're establishing a career, you're trying to
find a partner. Possibly from thirty to forty that's typically
when people are having children. And it's only really from
forty plus that these messages do get through that women
(23:36):
do seek information and they're a little bit shocked about it. Actually,
they do say, why didn't I know about this whatever.
It's because it was always going to be very busy
to slot another thing that wasn't actually relevant to them
in an already really busy life. So I see the
(23:56):
pros and cons. I do think that education should be
focusing on general practitioners specialists who work in this area,
also training doctors too. I can't even remember doing a
menopause lecture when I went through medicine, so I looked
for my folder the other day to see if I
(24:17):
could find it, but I through.
Speaker 2 (24:22):
So it was a sad moment because I just wanted
proof that I hadn't or.
Speaker 1 (24:26):
Yes, well you're making up for lost time now I
am Homerfield Sonya. So just if we can cover off again.
If women are wanting more information, gene Hale's the website
is a great starting point. Can we just go through
what you would recommend to offer support for women who
(24:48):
perhaps don't have a great GP, have that relationship where
the GP may not be across what's available.
Speaker 4 (24:57):
Well, I think it's firstly getting some good information. If
you google menopause there'll be I think it's forty million
hits that you get, and finding good information there is
very difficult. So if you go to a trusted source,
so gene Hale's for Women's Health, if you just put
gene Hale's plus Menopause in as a search, you'll come
(25:20):
up to some very good information. The Australasian Menopause Society.
Better Health Channel is also a Victorian government initiative and
there's some really good information on there as well. So
it's finding the information, doing your research, but getting good
information because as we know, the Internet is fraught with
lots of trouble trying to discuss that with your doctor.
(25:43):
If your doctor doesn't have women's health as a specialty,
you might still love that doctor, but you might seek
an alternative opinion. And there is a listing of Australasian
Menopause Society members at the Australasian Menopause Society. They are
generally very good women's health gps who specialize in women's
(26:04):
health throughout the ages. So it's or just looking at
the practice. So I often look through the practice online
with a woman who's in front of me because I'm
a specialist, so she needs a GP of course, and
I look at their practice and I say, well, you're
with doctor whoever.
Speaker 2 (26:21):
But the other doctor at that practice does say.
Speaker 4 (26:24):
Women's health is an interest, and it might be because
it's easier when the file is there.
Speaker 2 (26:29):
Of course, there's always some information out there.
Speaker 4 (26:32):
It's important to not get on the bandwagon and try
and go with treatments that aren't safe. I want women
to be healthy, to be as happy as they can be,
to cope to say those three things three words, I
feel normal, And it's whatever strategy we can do.
Speaker 2 (26:53):
Women need support.
Speaker 4 (26:56):
Most women at home are like the general aren't they
organizing the bin.
Speaker 2 (27:01):
Night, the food?
Speaker 1 (27:03):
Yes, spinning a million different plates, which is why you
put yourself last. It's a wonder we even get to
work most days.
Speaker 2 (27:12):
It is.
Speaker 4 (27:12):
It is, And when your hormones can start to mistreat
you in perimenopause and menopause, that's when the support is pulled,
and especially when women aren't sleeping.
Speaker 2 (27:25):
You tell me about it.
Speaker 4 (27:25):
You want to make a difference, So the women who
want to make a difference will find a solution. But unfortunately,
perimenopause and menopause it's like being in the tumble dryer.
They just feel like they're just going round and round
and can't get out of it.
Speaker 3 (27:40):
That's so true. But there is light at the end
of the tunnel, So yeah, can you assure.
Speaker 2 (27:44):
Me there is light?
Speaker 4 (27:46):
You just need some good information, some good education and
a good option for you.
Speaker 2 (27:51):
There is that I feel normal. Three words.
Speaker 4 (27:55):
I just look when they come in back for their
return appointment, and I think, all.
Speaker 2 (28:01):
Have we done well? Have We're not done so well?
Speaker 3 (28:04):
As you hold your breath before they speed.
Speaker 1 (28:08):
Doctor Sonya Davison, endochronology lead at gene Hale's Clinic, Thank
you so so much, brilliant.
Speaker 2 (28:16):
I thank you so much for having me.
Speaker 4 (28:18):
I know your work is so important to get the
message out to women. You can do it in your way,
I can do it in my way. Together we're a
little bit of a formidable force. I hope, I hope
we've cheered someone up out there. Thank you so much
for having me, and I hope we can both say
at the end of today, I feel normal.
Speaker 1 (28:37):
You know, for far too long, menopausal women have had
their experiences dismissed and face barriers to accessing affordable treatment options.
These therapy subsidies break a twenty year drought and is
wonderful news that will make a real, meaningful difference to
the quality of life for countless Aussie women. In episode six,
I have further help with health and fitness tip from
(29:00):
personal trainer Mitchell little. He also has helpful hints for
men on how to best support a partner going through
the menopause.
Speaker 2 (29:08):
I'm Petrina Jones Rage Against the Menopause,
We've touched on the shortage of patches to treat menopause
in previous episodes of rage against the menopause and the
frustration at times at the lack of supply, especially during COVID,
but the Australian Parliamentary Inquiry has recommended that newer forms
of therapies be subsidized through the Pharmaceutical Benefit Scheme to
(00:20):
bolster supply and ensure access and lowered costs for all
women who need it. And now women have access to
the first new kind of hormone therapy to be subsidized
by the federal government in more than two decades. The
funding move has been welcome with open arms by health experts,
including doctor Sonya Davison, endochronology lead at the Gene Hale's Clinic.
(00:45):
She also dispels some of the myths surrounding hormone therapy.
Speaker 2 (00:50):
Buckle up, girls, menopause, It's coming for you no matter what.
Let's build a village of support. The damn hut in here.
Speaker 3 (01:01):
The menopause is so hot right now.
Speaker 2 (01:04):
I think I'm finally in menopause.
Speaker 3 (01:05):
Women just want to feel hurt.
Speaker 1 (01:08):
Rage against the menopause, but I'm really excited now to
welcome to the podcast, to this second series of Rage
Against the Menopause, a very highly distinguished specialist in doctor
Sonya Davison. She is the indo chronology leader gene Hale's
Clinic in Melbourne.
Speaker 3 (01:29):
Hi, Sonya, how are you very well?
Speaker 2 (01:32):
Indeed, I'm very excited to be with you today, Sonya.
Speaker 1 (01:35):
The recent Senate inquiry into menopause on Earth some key findings,
one that newer forms of therapies be subsidized through the PBS,
the Pharmaceutical Benefit Scheme, And this just very recently is
exactly what's happening?
Speaker 3 (01:53):
What can you tell us about it?
Speaker 2 (01:56):
It's amazing.
Speaker 4 (01:58):
There was a think tank about this last year and
then there was the Senate inquiry and now things are happening.
So there are two types of hormone therapy that have
been available. Ones called estrogel, it's an estrogen gel that's
applied to the arms, and one is prometrium, which is
(02:18):
body identical micronized progesterone, which two hormones. They are exactly
the same as the hormones made by the ovaries. They
were available before, but a PBS listing means that they're
significantly reduced in cost, and some women such as pensioners
or those you know, disadvantage. Women who wouldn't have had
(02:39):
access easily to these products before now have. It's much
more accessible, which is amazing.
Speaker 1 (02:45):
Well, that is such a great breakthrough. I believe that
it is in fact so long overdue. It's the first
type or first new type of menopause hormone therapy to
be subsidized by Canberra in more than two decades. It's
what was it costing women accessing it privately before, and
(03:05):
I guess ruling out a large proportion of society from
being able to affordably get relief.
Speaker 4 (03:14):
It depends if they have both estrogen and progesterone. So
some women only have estrogen, so it's less expensive if
they've had a hysterectomy. But typically if they needed both
the estrogen and progesterone, it was about six hundred and
fifty dollars per year. And now if they've got a
pensioner healthcare cardter substantially reduced, and even if they don't,
(03:35):
it's about half that half all less. So a real
you know, this is the cost of living crisis, isn't it.
We're all struggling. When you look at it in the supermarket.
A piece of meat or a piece of fish is nice.
Speaker 2 (03:50):
Insane amount it is it is insane.
Speaker 4 (03:53):
So this is just taking the pressure off women, which
is amazing.
Speaker 3 (03:57):
Absolutely.
Speaker 1 (03:58):
So did it mean before this if women couldn't afford
it like a pensioner having to pay six hundred and
fifty dollars that is a no go? So did it
mean that these women were having to suffer in silence
and not have access to these drugs?
Speaker 4 (04:16):
It meant that they had to use another form of
hormone therapy and there are luckily in Australia we do
have lots of different types of hormone therapy, but since
twenty seventeen there's been a rolling shortage of different types
of hormone therapy for various reasons. And I suspect you
and I might talk about that a little bit more.
Speaker 1 (04:37):
Absolutely, and that has been a common theme throughout.
Speaker 3 (04:41):
The first series is these patches.
Speaker 1 (04:43):
Have been a wonder drug for a lot of women
that I'm speaking to a lot of my girlfriends as well.
But in listing these new type of medications, will that
only make that backlog and access more difficult or not?
Speaker 4 (04:59):
Some women do prefer women choose what they want you
and I know that some things are not suitable for
some women. And the patches are very sort of what
we call a set and forget, So you put the
patch on on Monday, you take it off on Thursdays.
For so some women that is very easy, whereas a
gel is a daily application. So it really depends on
(05:22):
the woman, her skin, what her funds previously, depending on
what type of hormone therapy she will choose. And often
we have to go through several types anyway, so there's
a lot more to it.
Speaker 2 (05:35):
Women are complex entities.
Speaker 1 (05:39):
So who will this essentially benefit Is it women that
have already reached menopause?
Speaker 4 (05:46):
Sonya, Well, women at perimenopause when the hormone levels are
fluctuating wildly and widely.
Speaker 2 (05:54):
Those women may need hormone therapy as well.
Speaker 4 (05:57):
It's all about balancing the pros and cons for the
individual woman. And let's not forget premature menopause, which is menopause.
Speaker 2 (06:06):
Before the age of forty.
Speaker 4 (06:08):
That we know that we're giving hormones back to those women.
Speaker 2 (06:11):
If we're able to, we'll protect their.
Speaker 4 (06:14):
Bones, their heart, their brain, and also their mortality. So
that's definitely someone we want to treat.
Speaker 1 (06:22):
It seems to be that women are going through perimenopause
a lot younger, some even in their late thirties. How
common is that now and is it more common than say,
our mother's generation.
Speaker 4 (06:36):
Well, my studies actually suggest that the time of menopause
is fixed, so yeah, it's all genetically programmed.
Speaker 2 (06:44):
I don't know that there's a lot of data to
say we are.
Speaker 4 (06:47):
Undergoing menopause or perimenopause earlier. But perimenopause is a time
when the ovaries wind down, we run out of eggs,
and studies have shown that it can happen for eleven
years before the time of menopause, which is just the
last period no more eggs, estrogen dive bombs.
Speaker 2 (07:07):
So if you think you were going.
Speaker 4 (07:08):
To have menopause at the average median age at fifty one,
you'd be coming into perimenopause for some women at forty.
But if you were going to have an earlier menopause
less than forty five years of age and you're going
to have eleven years of symptoms, it could be in
the thirties. So it depends on how you actually look
at what's going on, and it is a very difficult area,
(07:33):
and women in their thirties might be struggling with being
getting their career underway, having children, having aging parents. So
there are a lot of things happening in the thirties
and forties that might be mistaken for perimenopause. But in
the forties most women will have a bit of perimenopause
(07:53):
starting to mingle in with their symptoms.
Speaker 1 (07:56):
It's a bit like life scholesion. Course, I call it
the symptoms. They're so wide and so varied. Do we
have to be careful to be so general thinking passing
something off as a symptom of perimenopause when it won't
necessarily be that. Do you find that there's a trend
(08:17):
for women to perhaps jump to that conclusion.
Speaker 2 (08:21):
Well, it's an easy blame, isn't it.
Speaker 4 (08:25):
Life is tough, Life is busy, life is expensive, there's
traffic on the road, there's children there.
Speaker 2 (08:32):
You know.
Speaker 4 (08:32):
Whatever whatever is in a woman's life between thirty five
and sixty and beyond, possibly it is challenging.
Speaker 2 (08:42):
It's like the thyroid.
Speaker 4 (08:44):
I've got a lot of ladies who come to me
and say, this has got to be my thyroid. The
thorough blood test is fine, the thoroid is fine, but
it's a hard conversation to have. No, it's not your thyroid,
it might be whatever. There's a list of symptoms on
the gene House website and on the Australasian Menopause Society.
So if a woman typically is of an age from
(09:05):
forty five plus or even forty plus, has a constellation
of those symptoms, and if they are bothering her and
periods are changing, if she's having periods, then you'd probably
put your money on that is perimenopause. It's not a
diagnosis based on blood tests. It's a diagnosis based on
a symptom.
Speaker 1 (09:25):
Complex, which is what I find really frustrating. There's nothing definitive.
I'm very black and white. It's like, can't I just
have a blood test and that will tell me definitively
am I perimenopause?
Speaker 3 (09:37):
Am I menopause?
Speaker 1 (09:38):
Where am I in this wide open space? I've found
that really quite challenging through my journey.
Speaker 2 (09:46):
A lot of women struggle.
Speaker 4 (09:47):
I had a really difficult conversation last week. A woman
wanted to come back and come back with her hormone levels,
and I said.
Speaker 2 (09:56):
Look, it can be here, it can be here, It
can be here.
Speaker 4 (10:00):
It's not going to help us. What's going to help
me is your response to the treatment I've given you,
and I will adjust things depending on that. If it's
a good story and they're the right age. We only
really do hormone levels if something's really odd, if we
suspect premature menopause, things like that. So we're saving the
(10:22):
government some money if we don't do those hormone levels unnecessarily.
Speaker 3 (10:28):
Can we dispel the myths? There's still a bit.
Speaker 1 (10:30):
Of reluctance about hormone replacement. Did we get the wrong perspective?
Is it not as dire the risks of going on
that form of treatment as perhaps our mothers might have
been taught.
Speaker 4 (10:47):
Well, it's been a really interesting journey because in two
thousand and two are really the biggest hormone study was released,
which was called the Women's Health Initiative, which involved over
twenty six thousand women in America. But the tricky thing
was they weren't symptomatic by and large, their average age
was sixty three. They were aged up until seventy nine
(11:09):
years of age, and they were given hormone therapy versus placebo.
Speaker 2 (11:14):
What we didn't.
Speaker 4 (11:17):
What we needed that study for was to rationalize hormone
therapy use, because there was a lot of hormone therapy
being used for dubious reasons in the US and around
the world before that, so it sort of put the
brakes on and made us have a good think about
why we give hormone therapy. And really there's a beautiful
statement by the International Menopause Society, but menopause experts and
(11:40):
bodies around the world have agreed that for healthy women
around the time of menopause, the benefits of hormone therapy
far outweigh the small risks associated with its use. So
I think that's a really useful statement, and there's a
beautiful information at the Australasian Menopause Society and at Genehals
(12:02):
for women's self going through the pros and cons of
hormone therapy. An individual woman needs to discuss those with
her doctor, think about them really carefully, and then opt
for it if her quality of life is not good
and she needs help.
Speaker 1 (12:18):
I have a cancer history, so I'm actually not on anything.
Speaker 3 (12:23):
I believe I'm now.
Speaker 1 (12:24):
Fully fledged into menopause. I haven't had a period for
forty months, so I would assume I'm in full blown menopause.
At what point the other thing I've found difficult, At
what point do you know that you should perhaps be
taking something. I know that's probably a silly question, but
I think as women, we tend to just push through.
(12:47):
And like you say, there's other life pressures. There's elderly parents,
there's teenage children, there's busy careers, and you never have
time to yourself, and you do put yourself last, and
you think.
Speaker 3 (12:57):
No, I'll just push through. I'll just push through. It's
nearly the week.
Speaker 1 (13:00):
I can catch up then, But at what point do
you say it's time. I think I needed some form
of help, some sort of relief for my symptoms.
Speaker 2 (13:12):
It's about quality of life I have.
Speaker 4 (13:15):
These are the sort of quotes that women come I
don't feel like me anymore. I feel dry, I feel shriveled,
I feel old. I want to go for another job,
but I can't be bothered, so I'm just going to
sit in this job that I find boring. I shout
at my children. I'm worried about the impact on my relationship.
(13:35):
I can't do the things in life that I want
to do. And what about sleeping on beach towels? Some women,
because menopause can be very vigorous for some women. Some
women drench a beach towel overnight and have to take.
Speaker 2 (13:49):
It out, ring it out, put another one.
Speaker 4 (13:51):
So if you're sleeping on a beach towel, and if
you're not sleeping, because half of menopause I think is
sleep disruption, waking up frequently, not able to sate sleep,
and you're too tired, you can't do anything, you need
to sleep. It's for that woman what tips her over
the edge. And my women come back and they say
(14:12):
three words when we're doing really well, and that is
I feel normal. So this is about taking into consideration
that there are risks associated with hormone therapy, but also knowing.
Speaker 2 (14:26):
That quality of life is very important.
Speaker 4 (14:27):
And I think the pandemic brought that out because women
sat there before, but then there was so much talk
about health in the pandemic and so much we realized
what quality of life really meant. So I think women
have just really stepped forward out of that and thought, well,
do you know what I want to feel?
Speaker 1 (14:48):
Well, that was what a risk And I know it's
obviously it's a hard question probably to answer because it's
a case by case basis, But is there any greater
risk for women with a history of cancer in going
on hormone replacement therapy? Is the advice for them different
to someone who hasn't had it.
Speaker 2 (15:07):
It depends on the type of cancer.
Speaker 4 (15:09):
So there are some gynecological and of course breast cancer
that have hormone receptors on them, so they will possibly
be at higher risk of recurrence if we give hormone therapy.
So estrogen receptors is what we're talking about, but some
also have progesterone receptors. It depends on the type of cancer,
(15:30):
It depends on the clearance, it depends on the stage
and grade.
Speaker 2 (15:33):
So it's all very difficult.
Speaker 4 (15:35):
Usually, if it's a hormone receptor positive cancer, we usually
opt to use other treatments, not hormones. If a woman
comes to me ten years after breast cancer, for example,
she said, my quality of life is terrible. I've tried
all the other options. My surgeon says, it's okay for
a trial of lo DOOS hormone therapy. My oncologist is, okay,
(15:58):
can we have a trial of hormone therapy. I'm always
reluctant about it because I know that the risk of
cancer recurring in someone who's already had cancer is higher
than the general population. And we've got to remember that
one in seven women do develop breast cancer throughout their lifetime.
So it's a really difficult area and no one wants
(16:21):
to take a treatment that might increase their risk of cancer.
But if you look at the absolute statistics, the absolute
increase in cancer incidence is very very minor, and there
is no increase in breast cancer mortality, for example, with homotherapy,
and that big study, the WHI study, was very useful
(16:43):
for that. But that big study was also really useful
because the women on estrogen only in that study who
had had a hysterectomy before they actually had a lesser
risk of breast cancer compared with those on placebo. So
we think think that the progesterone entity is the one
increasing the risk, but it depends on the type of
(17:05):
formone therapy, it depends on the woman, depends on genes,
and really there was some beautiful information that came out
recently if you're talking about breast cancer, which showed that
the biggest risk factor, apart from family history, dense versts, etc.
Speaker 2 (17:20):
Was obesity and overweight.
Speaker 4 (17:22):
So there's an extra twenty six cases of breast cancer
from statistics from the UK over five years for women
from fifty to sixty years, whereas hormone therapy combined estrogen
and progesterone increases that number by four extra cases. And
women don't realize this, so it's important to talk about.
Speaker 1 (17:44):
It is, and it's so important I think to dispel
the myths as well and just give a current snapshot
of where it's at. Another really common theme in talking
to women. My hairdresser the other day went to the
GP not knowing, not feeling themselves and thinking something's not
(18:04):
quite right when it was perimenopause and they've been put
on antidepressants.
Speaker 3 (18:11):
Is that common? Do you see a lot of that?
Speaker 4 (18:16):
So the sad thing for women is that it may
actually be the best option for them, it's the way
it's delivered. So there is a group of antidepressants that
is very useful for reducing flushes and sweats. Mood is
a really big part of perimenopause and menopause with anxiety,
(18:37):
low mood and irritability, and one of those medications at
lodos can be probably the safest option for them, but
it's the way it's delivered, because some women leave an
appointment and think I've been given a script for antidepressants.
It's the limitations of our appointment times. It's so hard
(19:00):
to convey all of the pros and cons, the benefits
and risks in a ten minute GP appointment. You just
actually can't do it to give justice to the person
in front of you. So some busy gps will just
dash out the script and hand it to them without
the explanation.
Speaker 2 (19:17):
But it's certainly a very valid way.
Speaker 4 (19:19):
If the mood symptoms are predominating and there's not many
flushes and sweats, it is a really good way to
manage very menopause.
Speaker 3 (19:27):
That's interesting.
Speaker 1 (19:28):
Another key finding to come out of the amazing Senate
inquiry into menopause was the lack of GP training on menopause.
In fact, they're given across their whole course something like
sixty minutes an hour of training. I guess, Sonya, that
would be something that you would like to see.
Speaker 4 (19:47):
Well, if we go back to that big study the
WHI in two thousand and two, that's when it was released,
gps before that were really good at managing menopause, and
they were good at prescribing hormone theory.
Speaker 2 (20:00):
But then there was a lot of fear.
Speaker 4 (20:02):
There was a lot of mismanaged media out there, and
women became very afraid. But also practitioners became very afraid.
Some practices at the time said had sort of placards
outside saying we do not prescribe hormone therapy.
Speaker 2 (20:19):
This practice gosh.
Speaker 4 (20:20):
So since then, people like me and a lot of
other sort of very active individuals have made it their
life's mission to do a lot of education. So I've
done over two hundred talks, podcasts, webinars to anyone who
will listen and anyone who asked me at lots of
(20:41):
levels from the community up to doctors and whatever and pharmacists,
et cetera, to get the message out there about menopause,
to get the message out about education. Because I started
in research and as a doctor, but now I'm doing
a lot more of education and that's the important role.
(21:02):
We need to be targeting medical students, registrars which are
training doctors, GPS specialists. We just need to make sure,
even if they don't know particularly a lot about this area,
where to get the resources. So there's a beautiful e
learning platform at gene heals for women's health. There's one
(21:22):
on the Australasian Menopause Society. It's just slotting it in
to busy demands. For example, GPS, they have to know
a lot about so many things, from babies to elderly people,
men and women. That's why a lot of gps are
now sort of sub specializing into women's health and that's
(21:43):
where you see, for example, our Australasian Menopause Society conference
every year it's packed full of women's health gps mostly
who want to be updated in this area and they're educated.
It's the ones who aren't there that we need to
be reaching.
Speaker 1 (22:01):
Yeah, we do have sex education in secondary school. Do
you think we should be talking about menopause along with
other women's health things in school?
Speaker 4 (22:12):
I think it would be great if there was a
module saying year eleven and twelve which when maybe even
younger than that, which went through.
Speaker 2 (22:20):
Periods, PMS, contraception.
Speaker 4 (22:23):
I mean, school is not designed to make good humans
who know a lot about.
Speaker 2 (22:29):
Being in a you know, a good human. After they
leave school.
Speaker 4 (22:33):
It's about getting through the hurdles of a complex system
so that they can get to university and they sort
of learn it along the way. It's really difficult to
tell a teenager about menopause. Their eyes will glaze over
and they might not get it. The only reason they
might get it is if mum is going through it.
And that's very important, because I've had some light bulb
(22:56):
moments from people in their twenties old that's what's happening
at home. I didn't quite realize it is.
Speaker 2 (23:02):
A difficult thing.
Speaker 4 (23:04):
You know. The teenagers are busy at school, finding themselves whatever.
Speaker 2 (23:08):
There's lots of competing.
Speaker 1 (23:09):
The twenties decades away, right, I remember in my twenties
that was for old women.
Speaker 4 (23:15):
That was just I just don't think the messages are
going to get in there and sit in there. From
twenty to thirty, you're establishing a career, you're trying to
find a partner. Possibly from thirty to forty that's typically
when people are having children. And it's only really from
forty plus that these messages do get through that women
(23:36):
do seek information and they're a little bit shocked about it. Actually,
they do say, why didn't I know about this whatever.
It's because it was always going to be very busy
to slot another thing that wasn't actually relevant to them
in an already really busy life. So I see the
(23:56):
pros and cons. I do think that education should be
focusing on general practitioners specialists who work in this area,
also training doctors too. I can't even remember doing a
menopause lecture when I went through medicine, so I looked
for my folder the other day to see if I
(24:17):
could find it, but I through.
Speaker 2 (24:22):
So it was a sad moment because I just wanted
proof that I hadn't or.
Speaker 1 (24:26):
Yes, well you're making up for lost time now I
am Homerfield Sonya. So just if we can cover off again.
If women are wanting more information, gene Hale's the website
is a great starting point. Can we just go through
what you would recommend to offer support for women who
(24:48):
perhaps don't have a great GP, have that relationship where
the GP may not be across what's available.
Speaker 4 (24:57):
Well, I think it's firstly getting some good information. If
you google menopause there'll be I think it's forty million
hits that you get, and finding good information there is
very difficult. So if you go to a trusted source,
so gene Hale's for Women's Health, if you just put
gene Hale's plus Menopause in as a search, you'll come
(25:20):
up to some very good information. The Australasian Menopause Society.
Better Health Channel is also a Victorian government initiative and
there's some really good information on there as well. So
it's finding the information, doing your research, but getting good
information because as we know, the Internet is fraught with
lots of trouble trying to discuss that with your doctor.
(25:43):
If your doctor doesn't have women's health as a specialty,
you might still love that doctor, but you might seek
an alternative opinion. And there is a listing of Australasian
Menopause Society members at the Australasian Menopause Society. They are
generally very good women's health gps who specialize in women's
(26:04):
health throughout the ages. So it's or just looking at
the practice. So I often look through the practice online
with a woman who's in front of me because I'm
a specialist, so she needs a GP of course, and
I look at their practice and I say, well, you're
with doctor whoever.
Speaker 2 (26:21):
But the other doctor at that practice does say.
Speaker 4 (26:24):
Women's health is an interest, and it might be because
it's easier when the file is there.
Speaker 2 (26:29):
Of course, there's always some information out there.
Speaker 4 (26:32):
It's important to not get on the bandwagon and try
and go with treatments that aren't safe. I want women
to be healthy, to be as happy as they can be,
to cope to say those three things three words, I
feel normal, And it's whatever strategy we can do.
Speaker 2 (26:53):
Women need support.
Speaker 4 (26:56):
Most women at home are like the general aren't they
organizing the bin.
Speaker 2 (27:01):
Night, the food?
Speaker 1 (27:03):
Yes, spinning a million different plates, which is why you
put yourself last. It's a wonder we even get to
work most days.
Speaker 2 (27:12):
It is.
Speaker 4 (27:12):
It is, And when your hormones can start to mistreat
you in perimenopause and menopause, that's when the support is pulled,
and especially when women aren't sleeping.
Speaker 2 (27:25):
You tell me about it.
Speaker 4 (27:25):
You want to make a difference, So the women who
want to make a difference will find a solution. But unfortunately,
perimenopause and menopause it's like being in the tumble dryer.
They just feel like they're just going round and round
and can't get out of it.
Speaker 3 (27:40):
That's so true. But there is light at the end
of the tunnel, So yeah, can you assure.
Speaker 2 (27:44):
Me there is light?
Speaker 4 (27:46):
You just need some good information, some good education and
a good option for you.
Speaker 2 (27:51):
There is that I feel normal. Three words.
Speaker 4 (27:55):
I just look when they come in back for their
return appointment, and I think, all.
Speaker 2 (28:01):
Have we done well? Have We're not done so well?
Speaker 3 (28:04):
As you hold your breath before they speed.
Speaker 1 (28:08):
Doctor Sonya Davison, endochronology lead at gene Hale's Clinic, Thank
you so so much, brilliant.
Speaker 2 (28:16):
I thank you so much for having me.
Speaker 4 (28:18):
I know your work is so important to get the
message out to women. You can do it in your way,
I can do it in my way. Together we're a
little bit of a formidable force. I hope, I hope
we've cheered someone up out there. Thank you so much
for having me, and I hope we can both say
at the end of today, I feel normal.
Speaker 1 (28:37):
You know, for far too long, menopausal women have had
their experiences dismissed and face barriers to accessing affordable treatment options.
These therapy subsidies break a twenty year drought and is
wonderful news that will make a real, meaningful difference to
the quality of life for countless Aussie women. In episode six,
I have further help with health and fitness tip from
(29:00):
personal trainer Mitchell little. He also has helpful hints for
men on how to best support a partner going through
the menopause.
Speaker 2 (29:08):
I'm Petrina Jones Rage Against the Menopause,
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