Australian women are being misled by outdated and old-fashioned medicines for menopause on the Pharmaceutical Benefits Scheme (PBS), a women’s health physician says.
While there have been advances in menopause drugs, the list of subsidised drugs available cheaply to Australians on the PBS has not kept up, Dr Lucy Caratti says.
The women’s health expert and integrative doctor says the newer drugs have fewer serious side effects compared to the old drugs which are derived from the 1960s when menopause was first identified as a hormone deficiency syndrome.
At that time, estrogen from pregnant horses was used for hormone replacement therapy (HRT), also known as menopausal hormone therapy.
A 1998 Women’s Health Initiative (WHI) study found some of the drugs commonly used in the therapy — an oestrogen and progestin mix known as MPA, or medroxyprogesterone acetate, may increase the risk of heart attack, stroke, blood clots, dementia, breast cancer and uterine cancer.
Even so, it is one of the only progesterone-like hormone replacement therapies subsidised on the PBS.
There are others on the PBS, such as estradiol patches (commonly sold under the brand name of Estradot/Estraderm), however with recent shortages of the patches, some women are being prescribed oral estradiol, which comes with increased risk of stroke and clotting, or they can pay out of pocket for an estradiol gel.
Dr Caratti said these treatments used a non-body identical hormone but the best progesterone-based hormone replacement treatment was Prometrium, which is identical to the body’s natural hormone made when ovulating and has not been linked to breast cancer.
But Prometrium is not available on the PBS.
Dr Caratti said getting treatment was “cost prohibitive” for many women, at a time when people were struggling with cost-of-living pressures.
“In order to receive a safe progesterone that has the added benefits from our own hormone progesterone without the safety risks, women are required to pay out of pocket,” Dr Caratti said.
“Prometrium is the only available body-identical progesterone and it’s not on the PBS, so it costs women up to $60 a month.”
Newer drugs not prescribed due to education ‘gap’ among doctors
Dr Caratti said a lack of education was contributing to older menopause medication with more serious side effects still being prescribed.
“There is a huge gap in knowledge among doctors when it comes to menopause treatments, as with a lot of things in women’s health,” she said.
“There’s a lack of education for the doctors unless you are specifically trying to seek out this information, which I have done because of my area of work.”
Dr Caratti has the support of the vice-president of the Tasmanian branch of the Australian Medical Association (AMA), Annette Barratt, when it comes to the gaps in education.
“I totally agree with her,” Dr Barratt said.
“It’s tragic there is limited training. It’s not given anywhere near the same emphasis as men’s health.”
Veronica Hausknecht, 53, said the timing of her visit to her GP was critical to the help she received.
“I fell across that information [the WHI study] and it was at a time I thought I needed anti-depressants,” Ms Hausknecht said.
She said her doctor had not known about the latest menopause research until recently.
“[My doctor] said if I had come a month earlier, she hadn’t come across the research and I would have got a different answer from her,” Ms Hausknecht said.
A Senate inquiry is currently examining issues related to menopause and perimenopause.
In its submission, the Australian Medical Association (AMA) has called for a shake-up of the PBS medications as well as the creation of a National Menopause Framework.
It has also called for doctors to be adequately supported to provide comprehensive, complex and individualised care for women.
“We haven’t had a response from the Senate inquiry; they haven’t put down their findings,” Dr Barratt said.
“We are hoping they’re going to listen.”
Outdated pricing regulations hampering newer medicines
The association is backing Dr Caratti’s call for newer medications to be placed on the PBS.
The AMA said the lack of cheap access to these treatments for women was due to outdated pricing regulations and a glaring oversight of the health needs of women.
“You’re looking at somewhere between $60 and $100 a month for a woman who wants to go on to quality HRT,” Dr Barratt said.
“And the government has got to realise that they’re not only not supporting women’s health, they’re also not supporting the economy.
“We’ve got women at the peak of their learning and the peak of their earning capacity, forced by a reversible illness to give up their employment … [they] are disappearing from the workforce”.
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For Ms Hausknecht, giving up work was not an option.
“I have had friends and colleagues that have left work or dropped hours because of how [menopause] impacted them,” she said.
“I was dragging myself along thinking it was stress, grief and the usual getting older. I was a mess.”
Dr Barratt said urgent government action was needed.
“This is a federal issue and we encourage women to speak to their federal ministers and senators to push this agenda.”
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