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Cilla de Lacy was in her mid-40s when her suicidal thoughts returned out of nowhere.
“It was just overwhelming. The feeling of not wanting to be here, or feeling helpless, or feeling extremely anxious,” she said.
“That was the scariest and most debilitating symptom I had during that time.”
Cilla had previously been diagnosed with premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome with a range of psychological symptoms. She was able to manage her mental health issues when she started taking medication.
However, she was not prepared for her symptoms to become so severe later in life and for them to return.
“I had never heard of perimenopause before,” she said.
“I had heard about menopause and hot flashes, and I thought that was something that happened in your 50s, maybe even your 60s, but I just blindly went into menopause in my mid-40s, and it coincided with a particularly difficult and challenging time in my career.”
It took 18 months and a teleconsultation with an expert on the other side of the country before she got answers.
“My biggest concern was the impact my behavior was having on my relationships, especially my family, so I wanted to find a solution for that,” she said.
“The number of dead ends I’ve gone down with a gynecologist, who just threw a whole bunch of prescriptions at me. I just walked away and put the prescriptions in a drawer. I thought, ‘You still haven’t explained to me exactly what’s wrong with me. I really don’t know what all this medication is going to do.'”
‘Brain Fog’ and ‘Mood Swings’
to improve the economic, physical and mental health outcomes of Australians in perimenopause and menopause.
Nearly 300 submissions were submitted from people across the country, including first-handers, advocates and health experts, who shared stories of stigma, symptom ignorance and financial barriers.
The Senate inquiry report called on the Department of Health and Aged Care to develop an evidence base on the impact of the menopause and perimenopause on people experiencing it, with mental health identified as an important category.
Associate Professor Caroline Gervich is a clinical neuropsychologist and Deputy Director of HER Centre Australia, which focuses on understanding and treating mental health conditions in women.
She said there is a need for more awareness about the mental health issues that can arise during perimenopause and menopause, not only among the general public but also among health care professionals.
“As a clinical neuropsychologist, I see a lot of women who have gone through menopause and have experienced changes in their thinking, brain fog, mood swings, often to the point where people have stopped working because the work was so draining, but they hadn’t made the connection that it could be menopause,” Gervich said.
“I think sometimes people turn to healthcare providers who don’t have the knowledge and training in this area, and sometimes their symptoms are ignored. That can be even more negative for women who are trying to bring it up.”
Some of the study’s recommendations also focused on improving the economic situation for people during perimenopause and menopause, in particular by introducing more flexible work arrangements and having the government consider reproductive leave.
According to Labor Senator and vice-chair of the inquiry, Marielle Smith, there are a number of small but important changes employers can make to improve working conditions for people going through perimenopause and menopause.
“It could be something as simple as a fan on their desk, a slightly more flexible start time if they suffer from insomnia, or temperature control and more breathable uniforms,” she says.
“For women in professions like preschool teaching, women working on the factory floor or behind the cash register, these kinds of changes are not possible. And then the question arises as to what are the benefits of leave for reproductive and sexual health.”
Cilla de Lacy said she had never heard of perimenopause. Source: Delivered
Leave complexities aside, but flexibility ‘hits the right note’
The Senate committee considered creating specific leave for menopause, but instead decided to push for the creation of reproductive leave that could be used by all genders.
“[We have] “I worry that if we only have very specific leave for menopause, we are excluding other women of a certain age – and we already have quite a bit of gender-based ageism in the workplace – so if we create specific leave for a middle-aged woman, we fear that some employers will look at a woman and her age and make a decision about hiring or retaining that woman, out of fear of what they might have to do to accommodate her needs,” said Dr Sarah White, CEO of Jean Hailes for Women’s Health.
That fear is alive and well among most Australian women. A recent survey by the non-profit organisation found that 73 per cent believe that some employers and colleagues would use transition leave as an excuse to discriminate against them.
According to White, the recommendation to increase flexibility in the workplace is “the right tone.”
“The challenge is that women work in so many different work environments, so it’s really important that employers talk to their employees, women or people going through menopause, and figure out what’s best for them,” she said.
Several submissions to the Senate inquiry called for research into the experiences of culturally and linguistically diverse and First Nations people during perimenopause and menopause.
The final report referred to the government’s existing $13 million funding commitment to the Health In My Language program, which provides language health expertise to migrant women and women from diverse cultural and linguistic backgrounds.
Delaram Ansari is a researcher, policy officer and advocate at the Multicultural Centre for Women’s Health, which manages the program.
She was “particularly pleased” that the research report identified some of the centre’s recommendations and “long-standing advocacy issues”.
“One of them is really building a comprehensive evidence base and the need for intersectional data and responses, which we’ve been advocating for for a while,” Ansari said.
‘Expand health care and support services’
However, she was critical that most of the report’s references to culturally and linguistically diverse communities were in the context of research, rather than direct action to ensure culturally safe care.
“We also want to emphasize that this intersectional perspective and analysis must be applied in all recommendations to ensure that they are responsive to the needs of migrant and refugee women and people with diverse gender identities,” Ansari said.
“For example, we must ensure that we extend health and support services, including Medicare, PBS, NDIS and social security payments, to all migrants and refugees, regardless of their visa status.
“This should also include the costs associated with diagnosis, treatment and support related to the treatment of perimenopause and menopause.”
Another key recommendation in the report was that the government should look at ways to address the shortage of menopausal hormone therapy (MHT) in Australia and make it more affordable.
“So many women benefit from MHT, so it absolutely needs to be something that is accessible to women, and just from individual case studies, when you see women who have benefited from MHT and then suddenly can’t access it anymore, it’s really negative for them and a horrible experience. So making sure that it’s something that is accessible is really important,” Gervich said.
Cilla said her life was “so different” after starting MHT.
“My husband said he has the old Cilla back,” she said.
“I feel fantastic, and it’s all because I finally found the right treatment. But it shouldn’t have been this hard, and I should have been warned.”
Assistant Minister for Health Ged Kearney told SBS News the government welcomed the report and would work on its detailed recommendations.
The government has three months to respond to the investigation.
If you’d like to hear more stories like this one, exploring biases and stigmas surrounding women’s health, please subscribe to our or wherever you listen to your podcasts.
Readers seeking crisis support can contact Lifeline on 13 11 14, the Suicide Call Back Service on 1300 659 467 and Kids Helpline on 1800 55 1800 (for young people under 25). Further information and support relating to mental health is available at and on 1300 22 4636.
supports people with diverse cultural and linguistic backgrounds.
