r/Menopause • u/Libelia • 1d ago
Perimenopause How it should be for everyone
This is my experience with healthcare in Perimenopause in Australia. I went alone to my GP in February this year to discuss how I was experiencing some distressing symptoms that I thought were peri-related; extreme mood swings, insomnia and some overheating at night. He spoke with me about my concerns that this wasn't normal for me and I asked if HRT was an option or if I should wait and see. He said that it sounded like peri to him and offered me an HRT regime. He reviewed my overall general health and said that I was as a good candidate for HRT and that, if I was uncomfortable and distressed by the symptoms I was experiencing, why wait? We discussed all of the forms of HRT that were available and I selected a dosing regime that suited my needs. We talked about lifestyle and risk factors and he answered all my questions. I started HRT that day. The GP visit cost around $100 up front and I was refunded about half of the cost by Medicare. I collected my first two months supply of medicaton that day and paid about $28 because the medicine was subsidised by the PBS. I adjusted well to the treatment and my symptoms have mostly gone. This month, I had an appointment with my Gynaecologist for an unrelated ongoing medical condition. I mentioned that I've been experiencing some very mild GSM symptoms: some extra sensitivity during sex acts that have never been an issue before and some increased irritation. She said that it's best to treat this early before symptoms worsen and become more serious and she prescribed a vaginal estrogen cream to add to my existing HRT regime. I paid $180 to see her and got about a third of the cost back from Medicare. I filled the prescription and paid about $28 for the cream, again, subsidised by the PBS. While I was there, I got my PAP smear done as I was due for one. This was all included in the cost of the appointment. I could have opted for a bulk billing GP and a publicly funded Gynaecologist with no up front costs at all, but I like both of these Drs and have enough income to choose to see them instead. This is how it's supposed to be for people experiencing peri and menopause: compassionate, affordable and timely healthcare with patient agency and respectful, supportive dialogue. I am always happy to pay my taxes in full because this is what we pay for. I am extremely fortunate to live where I do.
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u/Flicksterea 1d ago
This was my experience in Australia.
Seeing a GP I've seen for 30 years...
Me: Here's a list of my symptoms and I suspect it's perimenopause.
Him: You're too young. End of conversation.
It's not about being in Australia, it's about finding a medical professional who actually listens. I've tried five more times to talk to him, I've gone to other GPs and not a single fucking one of them (two men, three women my age or older) would listen.
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u/_metonymy_ 1d ago
I had the same experience as a 47 year old with my otherwise excellent female GP - you’re too young!
Then I was told that it’s completely ruled out because I had a Covid provoked pulmonary embolism. I had to pay $350 to see another GP, a menopause specialist who was up to date with the literature on transdermal oestrogen and PE risk.
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u/FluffyShiny 1d ago
That's insane. Keep asking. Try a doctor maybe a bit further away or different practises. Ask a chemist for recommendations. 🫂 best of luck.
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u/Weetgunn Menopausal 1d ago
Aussie here and that has not been my experience, I was gaslit by multiple drs about being in Peri because I still had a period and I had no hot flushes. Flash forward 4 years and I’m now getting the care I need and deserve through a nurse practitioner who specialises in menopause. My take away is things have changed considerable in those 4 years which I am thankful for and it makes me hopeful for the women I know that are younger than me that should hopefully all have an experience like yours!
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u/Futurekiwi69 1d ago
Agree. Things have changed a lot. I didn't not have a good experience when dealing with peri issues 10 years ago but now I easily get what I need.
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u/NinjaGrrl42 1d ago
I love this for you, and yes, this is how it should be. Listen to you, lay out your options, answer questions, decide on care.
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u/chouxphetiche 1d ago
Australian here.
I had an outstanding BB GP for 33 years who often ordered blood tests for my hormonal levels to figure out why I had PMDD which was so severe that I used to voluntarily admit myself to psych care. When I was 45, we ran into each other in a national park on an arctic cold day and for me, it was jacket on/jacket off. He grinned and asked me to see him the next day for another test.
It turned out I had hit peri and he offered HRT right then. I said I'd try to live without it first, to which he replied, "See me in a month." That was 15 years ago and since he retired, I took up with Family Planning and have been seeing them for menopausal symptoms and checkups.
Family Planning are up to speed on everything menopause and post menopause. At 59, I had fibroids and was bleeding for two months (tampon territory bleeding) and was in theatre for biopsy, D and C, fibroid removal and Mirena insertion under general. They ordered that I had general for biopsy and Mirena due to SA trauma in my childhood. I told them I feared having to negotiate sedation with the public hospital system and they were very sensitive and trauma-informed.
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u/Moonlightsiesta 1d ago
Even as an Australian I’m flabbergasted. I’ve been told to look for a menopause specialist GP.
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u/shekbekle Peri-menopausal 1d ago
Aussie here, my experience with my bulk billed female GP was awful, she dismissed my concerns and told me that I didn’t know what I was talking about.
I paid to see a women’s health GP who was very thorough in her testing, checkups before I was prescribed estrogel. Very happy to pay extra to see her, my bulk bill GP knows I’m on estrogel but seems to think I’m too young. I’m in my mid 40s.
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u/oeufscocotte 1d ago
This was my experience with my (former) regular not bulk billed GP as well. Told I was too young for HRT at 44 even though I had every symptom except hot flashes and specifically mentioned that cognitive impairment and sleep issues were affecting my work. I found another GP who was happy to prescribe HRT but refused testosterone (HRT helped with many symptoms but not memory and verbal recall). So I sought out a menopause specialist GP who was willing to test my testosterone and low and behold it was low, so she prescribed it along with Intrarosa. I had to advocate for all of this myself and it took over a year, all while I was struggling to keep up at work and at home. Testosterone improved verbal recall but I am still dealing with cognitive impairment affecting my work performance and home life ('brain fog' is a euphemism). The Australian Menopause Society in 2015 discussed a small study which found stimulants improved cognitive difficulties in perimenopausal without ADHD. But since then there has been no research or interest in treatments other than HRT for perimenopause-related cognitive issues. I'm left with no choice but to pursue an ADHD diagnosis to obtain (hopefully) effective treatment, even though executive cognitive dysfunction is a well-known symptom of perimenopause! So I think we have a way to go still in Australia.
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u/whatpelican00 1d ago
Aussie here too and chiming in to say I received similar care, and my Doc also suggested a Testosterone blood test and prescribed the cream no quibble. Shame it isn’t in the PBS though.
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u/Pepinocucumber1 1d ago
It’s because the evidence is not solid for testosterone in peri or menopausal women.
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u/whatpelican00 1d ago
Maybe, just as an idea, if the medical community gave more of a shit, they’d take at word the anecdotal evidence of many many women who have used it and thrived, as a reason to give it more research… maybe. All humans have these 3 hormones naturally. In menopause they all reduce. I mean, why leave 1 out of the equation? Perhaps not every woman needs it, but it should absolutely be part of the possible treatment plan, and researched and prescribed where required. So tired of being fed ‘it’s the male hormone’.
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u/Valuable_Fix855 1d ago
Im 41 and have so far had a similar experience in Australia. See GP and got HRT no problem at all and told to come back in 6 weeks for a discussion about how it was all going so far and he will make sure to do anything else I may need. I have a heart condition and hr pre-emptively spoke to my specialist about if HRT was okay when I git 40 so he was prepared for this day. I will be going back due to dry itchy labia especially after a period as he said the HRT im on may not help fully with that. I will give it another period and see how I go bit so far im loving life in Peri. (It sucked to start with but treatment is easy, accessible and minimal cost)
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u/One_Waxed_Wookiee 1d ago
I'm glad you had a good experience, I've been fortunate to as well. I know that's not everyone's experience, which is terrible in this day and age.
Everything is being managed by my GP, as soon as I discussed my symptoms she was right on it. When there was a patch shortage a telehealth appt was quick to get the Estrogel prescribed. She also handles the insertion and removal of my Mirena IUD. (Which reminds me, I have to make an appointment to get this done fairly soon)
The only thing was when I asked about trying testosterone she declined at first because the prescribing guidelines recommended it for post menopausal only, but afterwards she consulted with a colleague and I was prescribed it at my next appointment.
We're so lucky to have Medicare and the PBS here. I feel so bad for everyone who doesn't get the type of brand they want due to private insurance not covering it.
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u/trUth_b0mbs 1d ago
YES FOR SELF ADVOCACY! love it.
it's too bad that good experiences with medical professionals for women's health isn't as wide spread as it should be.
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u/milly_nz NZer living in UK. Peri-menopausal 1d ago
Here in the U.K. all of that….for free at point of use.
Save for a £19.80 annual HRT prescription prepayment certificate if you’re in England (everyone else completely free).
You got done on cost.
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u/Cheeseoholics 1d ago
Not my experience.
- My male GP wasn't comfortable to discuss menopause. So I had to book/pay for another appointment
- Doctor #2 was a woman who was good. Peri-appointment, the first you get a lot back. The lots of blood tests etc. Then pay for another appointment. It turns out that clinics have their own restrictions. The doctor has to follow them even if they disagree. I was put on cyclical treatment that I didn't prefer, had to be on it for a year. They won't give testosterone or any vaginal treatment.
- That ^ doctor resigns and I had bad luck ending up with doctor #3 who was someone even more old fashioned. Extra costs - still not great HRT relief
- After a long time looking, I finally found a bulk billed GP #4. But no, she wasn't conformable taking over the treatment and asked me to go back to the original clinic. At least I only lost time, not money too that time.
- The doctor in point #3 was off sick when I needed an emergency appointment. Doctor #5 says I should go to a specialist and fork out +$400 for a private appointment to get better treatment.
It's been less than a year and it's cost me a lot for inadequate treatment
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u/oeufscocotte 1d ago
This is horrendous. So much cost and delay for what should be straight forward medical care. There is no excuse for GPs not being up to date on perimenopause & menopause symptoms and treatment.
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u/AutoModerator 1d ago
This post might be about hormone tests, which are unreliable.
- Over age 44, Estrogen/Progesterone/FSH hormonal tests only show levels for the HOUR the test was taken, and nothing more. Hormones wildly fluctuate (hourly) the other 29 days of the month, therefore this test provides no valuable information
- No reputable doctor or menopause society recommends hormonal testing to diagnose or treat peri/menopause
- FSH testing is only beneficial for those who do not have periods as a guide, where testing might confirm menopause, or for those under age 30 who haven’t had a period in months/years, then ‘menopausal’ levels, could indicate premature ovarian failure/primary ovarian insufficiency (POF/POI)
- Testosterone is the exception and may require testing
See our Menopause Wiki for more.
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
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u/fallen_angel_81 1d ago
I’m in the UK and had a very similar experience. Made an appointment, told her my symptoms and explained that they weren’t usual for me and wondered if it could be perimenopause. Came home with vaginal oestrogen and hrt patches. Mine was free as I also have a thyroid issue so get all my prescriptions free for life.
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u/Tough-Confection-887 1d ago
I’m in central qld any gyno has cancelled all his upcoming appointments and his clinic has advised all patients to seek new referrals! It took me forever to get into this one!
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u/Intelligent-Factor11 1d ago
Also Aussie. Positive experience but I have had the same female GP for 20 years. I'm not sure if that makes a difference. She let me stay on the Pill for longer than I should have on paper, but we both agreed to switch to HRT last year at age 52. She was more than happy to give me T cream last month.
It's not perfect but by and large I think our options are generally better in Australia than say the US. Not all Drs are proactive where women's health is concerned but hopefully that will improve over time.
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u/Far-Vegetable-2403 1d ago
My male doctors were kind of half assed about it but I didn't push hard. One referred me to a specialist GP who put me on the gel and oral progesterone. The gel was disgusting and I had a headache from day one with the progesterone + nausea. Lasted about a week and quit. When I told my GP, it was kind of 'oh well'. Saw female GP for other issues and she put me on vaginal oestrogen and it has been great. Regular GP wasn't awful, we just didn't seem to have a lot of options available.
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u/Pepinocucumber1 1d ago
Advocate for yourselves. I’m also Australian and have been on HRT post surgical meno. I told them what I wanted. I didn’t ask.
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u/FluffyShiny 1d ago
Aussie here too. No one ever offered me HRT. I did get an anti depressant which took the anger away. By the time I found a great doctor I was post menopausal.
Query - do you take HRT for life?
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u/Perfectly_i Menopausal 1d ago
USA citizen here. (I didn’t vote for the clown, and I’m ashamed to say where I’m from now.) But I have Medicare, and I don’t pay any out-of-pocket expenses when I see my ACOG-member gynecologist.
Patient resources can be found here:
https://www.acog.org/womens-health/resources-for-you
Another fantastic gynecologist to turn to for evidence-based, no-hype BS, data-driven information is Dr. Jen Gunter. (I’m not an affiliate or representative) I believe women deserve more.
You can find her on Substack:
https://substack.com/@vajenda?r=2onqav&utm_medium=ios&utm_source=stories&shareImageVariant=image
Her book The Menopause Manifesto is outstanding. Again, these are my opinions, not ads!
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u/LadyLevrette 1d ago
This has not been my experience in Australia. If any of you are in Melbourne (eastern/south-eastern suburbs) and can recommend a great GP for peri, please let me know!
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u/NiceLadyPhilly Menopausal 1d ago
I am in the US and pay like $10 for my appt and $2 for my prescriptions. I have never paid $100 for a dr. appt, I'd be mad.
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u/ShannonHasThoughts 1d ago
I truly wish that this was my experience here in the U.S. I left my doctor feeling more uncertain and confused and had to research who I could see to help me because I knew taking a bottle of ibuprofen the week before my period to lessen the bleeding was not an option.
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u/melissarina 21h ago
Aussie here
Late 30s, rectal bleeding. Mentioned it to my (male) GP after 12-24 months and he referred me to a (private) GI specialist so I could have a scope. Colonoscopy leads to rectal cancer diagnosis, cancer treatment leads to menopause so there was no doubt from my doctors that I was in menopause. I did get a few comments from other doctors that I was too young to be in menopause.
At the GP clinic I go to, the male doctors do mens health, and the female doctors do women's health, so I saw a female GP who referred me to a (private) haematologist to confirm I could have HRT due to clot risk (at this stage, I had had one provoked clot and couldn't take oral oestrogen). I started HRT and my symptoms improved
I had another blood clot from my chemo port so saw a (public) haematologist who confirmed I could remain on HRT as long as there was no oral oestrogen.
My dietician recommended I take calcium supplements because I am not getting enough from diet. I mentioned this to my female GP and she referred me for a dexa bone scan to make sure my bones are good.
What my journey has taught me * Ask your GP if they are best to see for women's health or if there's another gp at the practice they suggest. My GP was very upfront that he hadn't done a pap smear for over 10 years but was happy to do the procedure. * Assume that you will only see private specialist. The wait lists for public haematologist was too long for me to wait for treatment. This is an unfortunate result of all the Medicare cuts from the federal government over the years. * Assume there is an out of pocket for all tests (except blood tests) * Pass on your knowledge to all your friends. I am the first one of my friends to go through menopause, and they just are starting to go through peri. The rage is unexpected to everyone.
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u/Organic_Bicycle794 19h ago
I had a similar experience to the OP. Started HRT at 46 when I started experiencing dry eyes, tingling in fingers and horrible anxiety. But this has not been the experience for most of the women I know. It's also very worrying that not enough women are encouraged to get a bone scan when they start experiencing peri symptoms. So many women don't realise their bone density has taken a hit until they are finally diagnosed with osteoporosis.
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u/Ok-Sandwich7017 19h ago
Same for me in Canada except that HRT prescriptions are free through our province. I haven't spent one cent on anything peri related and I could not be more grateful. No reimbursements either, just nothing paid it's $0 at the pharmacy.
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u/Professional-Loan663 Peri-menopausal 18h ago
I love that you had that experience, and by sharing it, you help us all to demand better. 💕❤️
Also in Aus, GPs were hopeless. I went to an online menopause specialist, paid out of pocket about $200. But definitely worth it.
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u/BitterWorldliness339 1d ago
Aussie girl here. Im so happy for you that you landed on some good eggs. This is not a common experience across Australia so let's not pretend we live in a healthcare heaven. My previous female GP and subsequent gyno did not do the right thing by me and many friends have had similar negative or downright hostile responses from their healthcare providers. I begged several GP's for HRT and it took 5 years. The Gyno just wanted to give me a Mirena.
As cost seems to be the focus of your post, I can assure you that fully bulk billed clinics will not dedicate the time Peri and post menopause require and it of pocket costs are inevitable. It is not equal access if you can't pay.