OMG: The Women's Health Brief

(From my upcoming Sydney presentation — shared here because it matters everywhere.)

I’m currently preparing for a presentation in Sydney next week on a topic that’s both personal and universal — menopause, and how women are (or aren’t) being supported when they need help.

While much of what I’ll share focuses on Australia, the themes are global — from medical training to research funding and the ongoing need for better awareness and care.

This part of my talk looks at one key question: “Who helps us when we need help?”

Because while there are over a billion of us globally navigating perimenopause or menopause, the systems meant to support us — in healthcare, research, and workplaces — still have a lot of catching up to do.

Here’s what I’ll be sharing next week — and why it matters to all of us.

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Why Getting Help isn’t as Simple as it Should Be?

There are over one billion of us globally — and yet, most doctors have had only about two hours of menopause training. Two hours. Sometimes less.
That’s one billion potential patients — and two hours just isn’t enough.

In many countries, menopause is still an elective topic in medical school — even at top universities like Johns Hopkins in the U.S.
And there’s no training at all on perimenopause.

Dr. Mary Claire Haver, one of the best-known menopause specialists, says she had just one hour on menopause during training — mostly about hot flushes — and six hours during her OB-GYN rotation.

A Mayo Clinic study of medical residents across the U.S. found that 75% didn’t feel prepared to care for menopausal women — and 90% still didn’t once they were in practice.

Here in Australia, it’s not much better.
One study found that fewer than 20% of GPs feel confident managing menopause.
And the 2024 Senate Inquiry confirmed that GP training on menopause is “limited and inconsistent.”
The Inquiry has since recommended that this training be embedded into all medical and GP curricula — which is a positive and much-needed step forward.

But all this means that too many women are still being told to “wait it out,” or prescribed antidepressants, when targeted help actually exists.

And here’s the sad irony — before 2002, that wasn’t the case.
Before the Women’s Health Initiative (WHI) study, most women who wanted HRT were able to get it.
Doctors prescribed it confidently, and women were feeling better.

Then came the WHI — one of the most expensive and influential medical studies ever conducted.
It was designed to test whether hormone replacement therapy, or HRT, could prevent heart disease in postmenopausal women — which, by the way, is the number one killer of women, not breast cancer.

But here’s the key detail: the average age of women in that study was 63 — well past the typical age of menopause.
Many already had cardiovascular risk factors, so they weren’t the group most likely to benefit from HRT in the first place.

When the early results came out, the headlines were alarming — claiming that HRT increased the risk of heart disease, stroke, and breast cancer.
But those findings were later shown to be overstated and misinterpreted — especially for women who start HRT around the time of menopause.

Further analysis has since found that, for most healthy women under 60 — or within ten years of menopause — HRT can actually reduce the risk of heart disease and support bone and brain health.

And when it comes to breast cancer, the picture is much more complex than early reports suggested.
Estrogen-only HRT has actually been shown to decrease breast cancer risk.
For combined estrogen-and-progestogen therapy, the results are viewed by many experts as inconclusive at best and wrong at worst — and where any increase exists, it’s comparable to other everyday factors such as having one alcoholic drink per day, being overweight, or not exercising regularly.

Unfortunately, the panic changed everything overnight.
Prescriptions plummeted, and in medical schools, menopause was barely mentioned for nearly two decades.
Two generations of doctors — and millions of women — were left with misinformation and fear.

Before that study, HRT — or MHT as it’s sometimes now called — was common:
40% of women in the U.S., 30% in the U.K., and about the same here in Australia used it.
After the study, prescriptions dropped to 2% in the U.S., 4% in the U.K., and 5–6% here.
Now, those rates are climbing again — around 4–8% in the U.S., 14% in the U.K., and 11–13% in Australia — as the science has been properly revisited.

But the damage was done. For nearly two decades, many doctors stopped prescribing HRT — and menopause virtually vanished from medical education.
And during that time, women were largely left to fend for themselves.
There was no conversation about hormones, no recognition of perimenopause, and barely any advice on how lifestyle or nutrition could help.
It’s only in more recent years that we’ve begun to understand just how much things like diet, exercise, and stress management can support women’s health through menopause and beyond.

Thankfully, the conversation is changing.
In Australia, both the NHMRC and the Australasian Menopause Society now recommend that HRT be discussed and offered where appropriate.
In the U.K., NICE guidelines make HRT a first-line treatment.
And in the U.S., the North American Menopause Society reaffirmed in 2022 that HRT remains the most effective treatment for symptoms and helps prevent bone loss.

Even Dr. JoAnn Manson — the lead investigator of the WHI — said last year in The Washington Post:

“Women in early menopause with bothersome symptoms should not be afraid to take hormone therapy — and clinicians should not be afraid to prescribe it.”

Many of us were raised never to question our doctors — I certainly was, growing up in Ireland — but now we need to.
If you’re not getting the help you need, find a menopause-literate doctor.
You wouldn’t keep going back to a hairdresser if you didn’t like your haircut!

When you see your GP, ask:

“What menopause training have you had?”
And come prepared.
Dr. Mary Claire Haver’s book even includes a full checklist and a chapter on how to prepare for that appointment.

Finally — the research gap.
On PubMed:

• Pregnancy is mentioned 1.1 million times
• Menopause: 98,000
• Perimenopause? Only 6,800

That’s a staggering imbalance.

And the funding gap is just as bad:

• In the U.K., only 2% of medical research funding goes to women’s health.
• In the U.S., just 0.5% is dedicated to perimenopause.
• Here in Australia, the Medical Research Future Fund has finally begun investing in menopause and perimenopause — particularly around health impacts and workforce participation.

In the U.S., in 2024, Congress passed a $275 million bill to fund menopause research.
Progress is happening — but it’s fragile, and we need to keep up the momentum.

And honestly, when you stop and think about it — it’s wild.
If men were going through this, we’d have treatments, clinics, and research centres on every corner.

Instead, we have our menopause posse — incredible doctors like Louise Newson, Mary Claire Haver, and Kelly Casperson — guiding women on how to talk to their GPs, what to bring to appointments, and even what an HRT prescription might look like.

It’s fine for confident, well-read women to advocate for themselves — but what about those who can’t?
Especially the 25% who experience severe symptoms and need real help.

That’s exactly why we need to keep pushing — for better awareness, better training, and better care.

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Final Thoughts

Preparing for this talk reminded me just how far we’ve come — and how far we still have to go.
We are the first generation openly talking about menopause in boardrooms, breakrooms, and policy meetings.
It’s uncomfortable sometimes, yes — but it’s also powerful.

Because the more we talk, the more we learn, and the more we insist that women’s health deserves serious attention — not silence.

Here’s to keeping that conversation going.