When Jo Caminiti began experiencing mood swings, low energy and loss of sleep, she did not know what was happening to her.
The 58-year-old worked as an environmental scientist in a job she loved, but often found herself crying while driving to work.
She felt the passion that once burned inside her had been extinguished.
Soon after, she began experiencing severe joint pain, and was struggling to walk, so she decided to take seven months off work on long service leave.
"I thought I was just getting old," Ms Caminiti said.
"I thought I had some weird inflammatory thing going on in my body … I didn't know what it was.
"It became my permanent state where I felt like the morning you wake up with the flu, where you've got no energy, everything hurts, and you can barely move."
Ms Caminiti, who lives in rural Cowwarr, 175 kilometres east of Melbourne, saw multiple GPs, but none could diagnose her problem, instead referring her to a rheumatologist.
With no remedy in sight, Ms Caminiti returned to work, but was told several months later that her position had been made redundant.
She felt as though her "life was falling apart".
It wasn't until she saw a news program on perimenopause that things clicked for her and she was suddenly filled with hope.
"They described everything that I've been going through for about eight years," she said.
"And I thought, I've got to go to a doctor and get this sorted and get on to the first line of treatment, which is menopausal hormone therapy (MHT — also known as hormone replacement therapy, HRT)."
Menopause occurs due to a natural decline in reproductive hormones, leading to the loss of menstrual periods, usually when a woman is in her 40s or 50s.
Perimenopause, the period preceding menopause, can last years during which levels of oestrogen decline, often triggering symptoms such as hot flushes, sleep problems and mood changes.
While some Australian women lose their menstrual periods without experiencing symptoms, 80 per cent suffer symptoms ranging from mild to extremely severe.
Therapy 'transforms' life
Although all women go through menopause, it's not among the top 15 conditions most frequently managed by GPs, according to research from 2013.
Ms Caminiti saw a locum GP, who recommended she take antidepressants, which can be effective in alleviating some menopausal symptoms.
But she insisted the doctor prescribe her MHT as she wanted to "treat the cause, not the symptom".
"And [the doctor] basically folded and said, 'What do you want? You've obviously looked into it,' and I started on an oestrogen and progesterone treatment," she said.
She said she felt the positive effects of the therapy immediately.
"It transformed my life," she said.
As her mental health improved and her joints stopped aching, she pursued a career as an artist, making sculptures from scrap metal.
Hormone therapy 'very safe', say experts
Previous research has linked some types of MHT to an increased risk of breast cancer, which has made some GPs wary of prescribing hormone medication.
But Monash Women's Health researcher Professor Susan Davis said GPs were focusing too heavily on this risk without considering the cost-benefit ratio.
"Doctors are wary about prescribing hormone therapy for two reasons — one, they feel that patients may not want it … or alternatively, from the outset, they don't believe hormones are necessary, or they don't feel confident prescribing hormone therapy at all," Professor Davis said.
She said GPs were skilled at managing other common conditions like hypertension or diabetes, and therefore menopause management should be a "bread and butter" practice.
Sarah Renwick-Lau, a GP in the remote eastern Victorian town of Mallacoota, said she would take MHT when the time came to maintain her quality of life.
"It's very safe. There was a lot of negative press around it which has been found to be not really substantiated," Dr Renwick-Lau said.
"I'm really surprised at how many women are reluctant to consider it when it can be really effective."
Inquiry looks at economic impact
A senate inquiry launched by Greens senator Larissa Waters is investigating the health and economic impacts of menopause and perimenopause.
Data from the Australian Institute of Superannuation Trustees revealed that even if 10 per cent of women retired early because of menopausal symptoms it would lead to a loss of earnings and super of more than $17 billion.
"I think it's time that we had some federal policy on the health impacts, the awareness in the health sector and amongst women and people who menstruate, of the symptoms of perimenopause," Ms Waters said.
A spokesperson for the Department of Health said it had invested in a practitioner tool to improve the care of women during and after menopause, and had funded research and education conducted by Jean Hailes for Women's Health.
Calls for better GP training
A group of Melbourne women, the Peripausers, is petitioning for more comprehensive menopause education for GPs and raising awareness of its symptoms.
Peripausers' core member Julia Browne said the group was concerned about the under-diagnosis of menopause and the reluctance of some GPs to prescribe hormonal therapy.
"The common theme kept being that people were feeling that they were … not really heard properly when they were going to their local GP to discuss their menopausal symptoms," Ms Browne said.
"We need somebody like RACGP to offer better training in this area and more research in this area so that our local GPs are better placed to give support and advice."
A spokesperson for the Royal Australian College of GPs said "more government funding to support and encourage participation in education and training would be valuable".
"More investment in patient rebates for longer consultations will also help GPs spend more time with patients to discuss their concerns, provide expert advice and empower patients to make informed decisions about their care," the RACGP spokesperson said.
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