Early menopause care: Women’s experiences with health services

Care for and advice about early menopause (EM) or premature ovarian insufficiency (POI) is available through a range of public and private health services in Australia. This includes menopause clinics, women’s health clinics, and Turner Syndrome clinics, as well as from GPs, specialists, allied health practitioners in both public and private practice, and complementary medicine and alternative therapy practitioners. Women with genetic mutations such as BRCA 1 / 2 or Lynch Syndrome often attend Familial Cancer clinics where EM may be discussed in relation to treatment options, though for EM care women will be referred to other services or health practitioners. For more information about these services, please see the Box at the end of this Talking Point. For women’s experiences with health practitioners, please see Experiences with GPs and Experiences with specialists and other health practitioners.

Note that women’s experiences with health services in this Talking Point mostly relate to the Victorian health care system.

Experiences with menopause clinics and women’s health clinics

About a third of the women we interviewed had attended a specialist menopause clinic or women’s health clinic. Some women found these services very helpful, and appreciated being able to talk with health practitioners with specialised knowledge about EM or menopausal symptoms after cancer. Kate said of the doctors at the menopause clinic she attended: ‘They know what they’re talking about and they have a lot of ideas that they can try and help you with.’ Others found doctors at menopause clinics ‘caring’ and ‘supportive.’

Anna described her experience of attending a women’s health clinic for advice on early menopause.

Challenging experiences at menopause clinics and women’s health clinics were recounted by a few women. Some felt that they were not given comprehensive information. Jenni mentioned that doctors at one menopause clinic she visited had focused on prescribing Hormone Replacement Therapy (HRT) without providing much other advice: ‘I feel incredibly naïve, I don’t know what the health implications are for me long term.’

A couple of others described not feeling ‘heard’ or ‘validated’ by doctors at menopause clinics, were frustrated by long waits between appointments, or did not like having to see different doctors each visit. A few women from regional areas were particularly dissatisfied with their experiences visiting city-based menopause clinics.

Julia felt the menopause clinic she attended in the city did not cater well to women from regional areas, and found some advice she received there ‘condescending.’ 

Some women said they had not attended menopause clinics or women’s health clinics because they were satisfied with their existing care, didn’t feel their symptoms were ‘disrupting’ their lives, or weren’t sure that these services were relevant to them. Others, including Debra who experienced spontaneous EM, were not aware of the existence of menopause clinics: ‘Maybe I could’ve gone to a menopause clinic but I didn’t even know there was any really.’

Although menopause clinics were mentioned at a talk Yen-Yi went to about menopause and breast cancer, she received the impression they were mainly for older women.

Access to care

Living in a regional area could complicate access to specialised care for EM. Most of the women who lived in regional areas commented that their location had made accessing EM care more challenging. Limited numbers of GPs and specialists in regional areas could mean lack of choice of doctor, long waits for appointments, or care that felt rushed or impersonal. As Anna said of the gynaecologist she saw in her country town: ‘I was just pretty much told, “Oh, just take this [HRT],” you know, it was very off-handed. They’re extremely busy, so I just don’t think they had the time to put into it.’

For others, the time, cost and inconvenience of travelling to the city for appointments was an obstacle to care; they welcomed the emergence of telehealth services. Tracey, who worked in the health sector, advised other women: ‘It’s certainly something that you can ask [your doctor], if you can do a videoconference call to have your appointment.’

Ella, who lived in a regional area, reflected on some of the reasons she had stopped travelling to the city for medical appointments.

However, not all women saw travelling for appointments as bothersome.

Naomi, from a regional area, described making ‘a bit of a day of it’ when she had to attend appointments in the city.

Language barriers or financial costs could also make accessing care difficult. Nancy, who experienced surgical menopause following breast cancer treatment then learning she carried the BRCA 1 gene mutation, appreciated the ‘easy’ communication she had with her Chinese-speaking breast surgeon. In contrast, communicating with her oncologist was ‘a little bit trouble so I always ask my husband or some friend [to] come with me.’ Women who accessed private health care, or who underwent IVF (see IVF, fertility preservation and other paths to parenthood and 8.6 Impact of early menopause on work, study and finances) were particularly likely to mention financial costs in relation to questions of access.

Louise used the private health care system. She had costs related to surgery for ovarian cancer, HRT for medically-induced early menopause, and IVF with an egg donor.

Most women who used the public health care system expressed appreciation for being able to access care at minimal or no cost, including Kirsty: ‘[my husband and I] are not high income earners and … having access to good quality free healthcare has really helped us alleviate some of our stress.’

Yen-Yi went to a public hospital for breast cancer treatment, so only faced a few extra out-of-pocket costs related to cancer treatment and the menopausal symptoms she experienced as a result of ovarian suppression therapy (goserelin and an AI).

Coordination of care

Coordination of care could be challenging for women who had more complex healthcare needs, such as cancer treatment-induced EM or menopausal symptoms, Turner Syndrome, or co-existing health conditions. Women wanted someone to coordinate their care or take a ‘holistic’ perspective, and talked about feeling frustrated when no GP or other health practitioner was available to do this.

Linda had experienced surgical menopause in her early 30s following a hysterectomy for endometriosis, developed breast cancer at 39, and also had a heart condition. She found health practitioners ‘quite factionalised.’

Women dealt with the absence of coordinated care by doing their own research or being assertive in dealings with health practitioners. After receiving ‘four different sets of advice from four different oncologists’, Kirsty reportedly insisted that they meet and decide on a single approach.

Being ‘health literate’, Tracey felt she didn’t need a GP to coordinate her care, but saw the GP’s role as important for other women having risk-reducing bilateral oophorectomies.

A few women described receiving well-coordinated or consistent care. Louise said seeing one gynaecologist for her ovarian cancer, surgical menopause, and IVF care had made things ‘very straightforward.’

The only conflicting advice Fiona experienced was about a cancer drug trial she participated in. Overall, she felt the health care system was ‘very, very good.’

What health services can provide care for or advice about early menopause?

Menopause clinics: These are outpatient services or private clinics where women can access specialist advice about ‘normal’ menopause, early menopause, or menopausal symptoms after cancer. For more information, see Menopause clinics: Health practitioners’ perspectives. Not all Australian states and territories have public menopause clinics.

Women’s Health or Family Planning / Sexual Health clinics: These clinics provide care and advice for a broad range of women’s health or sexual / reproductive health and are available across Australia, often based in women’s / maternity hospitals. Some clinics may provide advice about menopause, but not all do.

Turner Syndrome clinics: There is only one public adult Turner Syndrome clinic in Australia, though girls under 18 may be seen at children’s hospitals. Some public menopause clinics or private clinics may also see women with Turner Syndrome.

Individual health providers may have a special interest in menopause – see Find an AMS Doctor.

Further information:

Talking Points (Women)

Talking Points (Health Practitioners)

Other resources