Friday, 14 March 2025
Sofitel Sydney, Darling Harbour
Her Excellency the Honourable Margaret Beazley AC KC

Bujari Gamarruwa

Diyn Babana, Gamarada Gadigal Ngura

In greeting you in the language of the Gadigal, Traditional Owners of these lands and waterways, I pay my respects to their Elders past, present, and emerging. I extend that respect to the Elders of all parts of our country from which you have travelled today.

Scientific evidence supports the existence of Australia’s indigenous peoples on our vast continent for 65,000 years. One doesn’t need to speculate to say that about half of the indigenous population over that time were women, having a reproductive life cycle just as women continue to have in modern Australia.

And here we are today, a quarter of the way through the 21^st century attending what can rightfully be described as a landmark summit on women’s life cycle.

So, between that time and this, what have we learned? In some respects, the answer is a great deal, but the lawyer in me tells me the answer is ‘it all depends’—in particular it depends upon the context in which we ask the question—a matter to which I will return, but will say at this point, for those of you who have read Madam Tan’s Circle of Women by the American writer Lisa See, you will understand why I say it depends on the context; and for those of you who haven’t, I can highly recommend it as a fascinating read of a different era—15^th century China during the Ming Dynasty—in many respects relevant to today’s discussion—because the women of the Ming Dynasty also had reproductive life cycles.

But before I turn this into a book club discussion, I need to add a few more dates to develop the context for today’s summit, with its discussion around menopause, perimenopause, endometriosis, fertility, and other women’s health issues across the span of their lives.

Although menopause has always been part of the female life cycle, the word itself did not come into the medical lexicon until 1821, first used by the French Physician Charles-Pierre Louis de Gardanne.^[1]  The word ‘perimenopause’ was a particularly late starter, not used until the 1960’s in the writings of J K Frost^[2], an American physician and so far as I am aware was not a common expression in the social lexicon of women currently in the 70’s and older age bracket.

Endometriosis was first presented as a specific diagnosis to the medical profession by John Sampson in a paper delivered in 1927, but built on earlier work particularly of Thomas Cullen, whose views nearly half a century before had been rejected by a significant number of his peers.^[3]

The medical treatment of endometriosis has advanced with the advancement in research, diagnostic and surgical techniques—which makes the recent comments^[4] of a male radio journalist that endometriosis was a non-existent disease as baffling, uneducated, ill-informed—and they are words of kindness in the circumstances… I need not say more.

But let me keep to the chronology. In 2018, some 91 years after John Sampson introduced the word endometriosis into the medical lexicon, the Australian Government’s 2018 National Action Plan for Endometriosis recorded that:

Endometriosis has been historically under-recognised amongst both the medical community and the public, and subsequently underdiagnosed. The delay between onset and diagnosis is, on average, between seven and twelve years. This is influenced by the fact that symptoms can vary significantly from person to person, making clear assessment difficult, and that an invasive operation is required for formal diagnosis. The delay in diagnosis is also influenced by stigma and cultural taboo […] as well as low education or miseducation about menstrual health. This means that many individuals living with endometriosis and associated chronic pelvic pain are not receiving adequate treatment and management until they have had the condition for many years.^[5]

Five years later in 2023, the landmark Australian Longitudinal Study on Women’s Health^[6] noted that 1-in-7 of the oldest cohort of the Australian women it was tracking, those born in the years 1973-1978—a mean age of around 50—had been diagnosed with endometriosis by the age of 49.^[7] That’s the same rate of diagnosis as breast cancer and we know how normal discussion is around that, although it took decades for that to be the case. 

In that same year, 2023 the Australian Burden of Disease Study found endometriosis to be the third leading cause of non-fatal disease burden due to female reproductive and maternal conditions in Australia, accounting for an estimated 8,213 YLD (Years Lost due to a Disability).^[8] That figure of itself speaks to the impact on national productivity.

However, it is the financial and social impact on women individually which is alarming and must be treated as a matter of national importance.

In a 2021 survey of 389 Australian women with confirmed endometriosis diagnoses, nearly two thirds said that they’d taken unpaid time off work to manage their symptoms, 1-in-3 felt these personal management strategies had led them to being passed over for promotion, and 1-in-6 that they had lost their jobs because of them.^[9]

Although endometriosis is a medical condition, menopause^[10] is not. It is a natural part of every woman’s life cycle, as inevitable as loss of testosterone for men.^[11]  Or aging.

In 1989, the Australian Government announced the National Women’s Health Policy,^[12] in recognition not only of the need to understand the specific health needs and priorities of women, but also that these needs change over a woman’s lifetime.^[13]

In Australia, on average, women reach menopause in their early 50s^[14]; many, however, experience the beginning of these changes, as perimenopause, up to a decade earlier^[15].

Of course, the degree to which every woman is affected by these changes, as well as how they present, varies widely.

Although I am unsure as to the scholarly basis for this figure, in terms of the number of possible menopause symptoms, the internet seems to have settled on 34.^[16] As I speak, we can all rattle off the first half dozen without thinking: hot flushes, night sweats, migraines, irritability—even rage (the wife of one of my work colleagues told him he was lucky he was such a lovely man because at times she felt like killing him!). And so it goes on.

And a good news story: another work colleague went to the doctors to have HRT prescribed. She was referred for a breast scan as a preliminary, and she was found to have breast cancer—a tiny tumour, but still breast cancer. THAT is the good medicine we want to see in every woman’s life.

In the most recent National Women’s Health Survey, a quarter of Australian women aged 45-64 reported that menopause symptoms “made it hard to do daily activities”. Another quarter, however, and indicative of the diversity of menopause experiences, reported their symptoms “had no substantial impact on their daily lives.”^[17]  As those who read the recent article in the Australia will know I fell into that latter category.

In terms of the intersection of menopause and the Australian workplace—and I again return to the impact on national productivity and individual financial and social harm—there is much work to be done. As a survey of the research undertaken by the Office of Women in 2023, summarised: 

there was evidence to suggest that menopause is having a negative impact on women’s participation in the workforce, including correlations between menopausal symptoms and work satisfaction, intent to stay in the workforce and women’s early retirement.^[18]

However, to put the Office of Women’s survey into context, Australian women currently retire nearly 11 years before their average intended retirement age and nearly 5-and-a-half years earlier than men’s average retirement age… which is interesting, given that women’s life expectancy is more than 4 years higher than men.^[19]

Much of the research reviewed was small-scale, and insufficient to distinguish whether what was being seen was mere correlation rather than causation, but still not surprising revelations so far as it went.^[20]

Whatever menopause’s effects, in the past, women were expected to deal with them on their own. At best, menopause was ignored; at worst it was stigmatized.

Today, at least according to a recent article in Women’s Health, we are in something of a menopause ‘boom’. Two years ago, the Super Bowl aired its first menopause-focused commercial, and, in the words of the author, Courtney Rubin, we have gone “from zero menopause products to menopause hair-care treatments and a $20 black throw pillow that says in flame-coloured capital letters I’M STILL HOT. ONLY NOW IT COMES IN FLASHES.”^[21]

Although experts are wary of aspects of this explosion of interest—particularly the dangers of misinformation through social media influencers and the monetization, often unregulated, of so-called menopause treatments (often just beauty products in disguise), bringing the matter as something to be discussed openly after so much silence, overall is a good thing.^[22] 

BUT… here is the $64 dollar question—although given the impact on productivity, it is more likely a $64 billion question—how do we improve the working lives of women so that they are not penalised and stigmatised because they are women in their workplaces?

I said I would come back to that phrase ‘it depends on the context’; it depends on the nature and size of the workplace; it depends on the circumstances of the individual person, on the nature of her symptoms or diagnosis, on her personal wishes.

As a judge, I had two or three staff reporting directly to me—and there was always staff of another judge who could and would help out if a staff member was away—for whatever reason. A factory with a production line would be different from an office with international Merger and Acquisition deals being done overnight right down to the wire. Retail would be different again.

The one constant however is NOT the need to manage—because we must create the circumstances in our individual workplaces where that is taken as a given—but how to manage. How to create the workplace where each individual woman can have a supported voice to allow her to perform optimally—without denigration, without loss of opportunity.

The recent announcement by Health Minister Mark Butler of significant financial initiatives relating to women’s health, and you will all be familiar with those, is of course hugely welcomed.^[23]

However, we shouldn’t kid ourselves that all is or will be well solely because of that. I have deliberately focussed on dates because it has been my experience in any advancement for women, there are decades and decades between recognition and advancement, between policy and action.

We can’t allow that to continue. Our leadership as women is on the line on this question, which is why I have called this Summit a landmark summit. Woman’s Menopause Alliance is to be congratulated as are today’s panellists and you the audience. None of us would be here if we weren’t prepared to learn more, occasionally to be outrageous as I give a nod to Kathy Lette, to think and to act. And courageously, if need be, to take the entire workplace with us. 

Many thanks to Natalie and the team from for organising this important forum, to Ellen for facilitating, and to all the presenters, who bring lived-experience and humour, expertise and knowledge, so engagingly to the table.

[1] Amarjeet Singh, Sukhwinder Kaur, and Indarjit Walia, ‘A Historical Perspective on Menopause and Menopausal Age’, Bulletin of the Indian Institute of the History of Medicine vol.32 no.2, July-December 2002, available here

[2] Oxford English Dictionary online, available here

[3] Adi E Datsur and P D Tank, ‘John A Sampson and the Origins of Endometriosis’, Journal of Obstetrics and Gynaecology India, vol.60 no.4, 13 March 2011, pp. 299–300.

[4] Georgie Hewson, ‘Experts Slam “Disappointing” Comments about Endometriosis from Marty Sheargold”, ABC News online, 28 February 2025, available here

[5] Australian Government Department of Health, National Action Plan for Endometriosis, July 2018, available here, p.2

[6] “The Australian Longitudinal Study on Women’s Health (known as Women’s Health Australia to its participants) is the largest, longest-running project of its kind ever conducted in Australia. The population-based survey explores the factors contributing to the health and wellbeing of over 57,000 Australian women* in four cohorts. Their data provides invaluable information about the health of women across the lifespan. Since its inception in 1996, ALSWH has informed federal and state government policies across a wide range of issues. The Australian Government Department of Health and Aged Care funds the Study, and it is jointly managed by the University of Queensland and the University of Newcastle”: Women’s Health Australia website, available here

[7] ‘Endometriosis’, Australian Institute of Health and Welfare website, 14 December 2023, available here

[8] ‘Endometriosis: Burden of Disease’, Australian Institute of Health and Welfare website, 14 December 2023, available here

[9] Caitlin Zillman, ‘1 in 6 Women Have Lost Their Jobs Due to Managing Endometriosis’, 26 November 2021, Southern Cross University website, available here, citing Mike Armour, Donna Ciccia, Chelsea Stoikos, Jon Wardle, ‘Endometriosis and the Workplace: Lessons from Australia’s Response to COVID-19’, Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG), 22 November 2021, available here

[10] menopause marks the point 12 months after a woman’s final menstrual cycle. The physical, physiological, and psychological changes leading up to menopause, and resulting from fluctuations in hormone levels as ovaries “shrink, stop releasing eggs, and shift into low gear,”[10] however, can span many years.

[11] “Total testosterone levels [in men] fall at an average of 1.6% per year whilst free and bioavailable levels fall by 2%–3% per year”: Roger D Stanworth and T Hugh Jones, ‘Testosterone for the Aging Male; Current Evidence and Recommended Practice’, Clinical Interventions in Aging, vol.3, no.1, 2008, available here

[12] ‘Launch of the National Women’s Health Policy at Westmead Hospital’, transcript of speech by the Prime Minister Bob Hawke, 20 April 1989, available here

[13] See, for instance: G. Gray, ‘How Australia Came to Have a National Women’s Health Policy’, International Journal of Health Services, vol.8, no.1, 1998, available here

[14] ‘Menopause’, Health Direct website, available here. Up to 8% of Australian women have had their final period by the time they are 45; if before 40, it is termed premature menopause, 40-45 is termed early menopause: ‘Premature and Early Menopause’, Jean Hailes for Women’s Health website, available here

[15] ‘Perimenopause’, Health Direct website, available here

[16] For instance: Lindsey Todd, ‘What are the 34 Symptoms of Menopause, and What Helps?’, Medical News Today website, 15 November 2023, available here. A sample, alphabetical, list: anxiety, bloating, breast tenderness, body odour changes, brain fog, burning mouth syndrome, depression, digestive issues, dizziness, electric shock sensation, fatigue, feelings of dread, formication, hot flushes, hair changes, headaches/migraines, incontinence/urinary tract infections (UTIs), insomnia, irregular or rapid heartbeat, irregular periods, irritability or rage, itchy skin, joint pain, loss of libido, mood swings, muscle tension, night sweats, oral problems, osteoporosis, paresthesia, vaginal dryness, weakened fingernails, weight gain: Jennifer Moore, ‘The 34 Common Symptoms of Perimenopause (& Counting)’, 7 August 2024, Menome website, available here

[17] Australasian Menopause Society, Women’s Health Research Program (Monash University), and Jean Hailes for Women’s Health, The Impact of Symptoms Attributed to Menopause by Australian Women Jean Hailes 2023 National Women’s Health Survey, 2023, p.14, available here

[18] Office for Women, Inquiry into Issues Related to Menopause and Perimenopause: Responding to the Health, Workforce, and Economic Impacts of Menopause, 2024, p.4, available here; and Office for Women, Impacts of Menopause on Women’s Health, Workforce Participation, and Economic Security, 2024, pp.4-6, available here.

[19] Office for Women, Impacts of Menopause on Women’s Health, Workforce Participation, and Economic Security, 2024, p.5, available here.

[20] Office for Women, Inquiry into Issues Related to Menopause and Perimenopause: Responding to the Health, Workforce, and Economic Impacts of Menopause, 2024, p.4, available here; and Office for Women, Impacts of Menopause on Women’s Health, Workforce Participation, and Economic Security, 2024, pp.4-6, available here.

[21] Courtney Rubin, ‘The New Luxury Market For Menopause’, Women’s Health online, February 2025, available here

[22] Rubin, ‘The New Luxury Market For Menopause’, op. cit.

[23] The Hon Mark Butler, Minister for Health and Aged Care, Australian Parliament, ‘Australian Government Strengthening Medicare with Over $500 million for Women’s Health’, 9 February 2025, Department of Health and Aged Care website, available here. The package includes: The package of measures includes: “The first PBS listing for new oral contraceptive pills in more than 30 years; […] lower costs and better access to long-term contraceptives; […] Medicare support for women experiencing menopause; […] the first PBS listing for new menopausal hormone therapies in over 20 years; […] more endometriosis and pelvic pain clinics treating more conditions; […] contraceptives and treatment for uncomplicated UTIs directly from pharmacies”: ‘More Choice, Lower Costs, and Better Health Care For Women’, Department of Health and Aged Care Factsheet, 9 February 2025, available here