Cilla de Lacy was in her mid-40s when her suicidal thoughts returned out of nowhere.
"It was just overwhelming, the feeling of not wanting to be here or feeling helpless or having huge anxiety," she said.
"That was the most scary, most debilitating symptom that I had during that time."
Cilla had previously been diagnosed with pre-menstrual dysphoric disorder (PMDD) — a severe form of premenstrual syndrome with a range of psychological symptoms — and was able to get her mental health issues under control once she started taking medication.
But she was unprepared for how acute her symptoms would become later in life and what would trigger their return.
"I had never heard about perimenopause," she said.
"I'd heard about menopause and hot flushes, and I thought that happened in your 50s, if not 60s, but I just ploughed blindly into this perimenopause in my mid-40s, coinciding with a particularly difficult and challenging time in my career."
It took 18 months and a telehealth call with an expert on the other side of the country for her to get answers.
"My biggest concern was the impact that my behaviour was having on relationships, on my family mostly, and so I wanted a solution to this," she said.
"The number of dead ends I went down seeing a gynaecologist, just throwing me a whole heap of scripts. I just walked away and just put the scripts in a drawer. I thought, 'You still haven't explained to me exactly what's going on with me. I don't know what all this medication's going to do, really'."
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'Brain fog' and 'mood changes'
to improve the economic, physical, and mental impacts of Australians experiencing perimenopause and menopause.
Almost 300 submissions were made from people across the country — including those with lived experience, advocates and health experts — sharing stories of stigma, dismissal of symptoms and financial barriers.
The Senate inquiry's report called for the Department of Health and Aged Care to establish an evidence base about the impacts of menopause and perimenopause on those going through it, with mental health noted as a key category.
Associate professor Caroline Gervich is a clinical neuropsychologist and deputy director of HER Centre Australia, which is dedicated to understanding and treating mental illnesses experienced by women.
She said greater awareness of the mental health challenges that can arise during perimenopause and menopause was needed, not only for the general public but for health professionals too.
"Clinically as a neuropsychologist, I see a lot of women who are post-menopausal and they have experienced changes in their thinking skills, brain fog, mood changes, often to the point that people have left work because it's been so debilitating for them, but they hadn't made the connection that it might've been part of menopause," Gervich said.
"I think sometimes people can turn to some health professionals who don't have the knowledge that they need and haven't been educated in this field, and sometimes their symptoms are dismissed, and that can be even more negatively impactful for women who try to bring it up."
A few of the inquiry's recommendations also centred on improving economic outcomes for people during perimenopause and menopause — in particular, introducing more flexible work arrangements and having the government consider reproductive leave.
Deputy chair of the inquiry, Labor senator Marielle Smith, said employers could make some small but significant changes to improve working conditions for people experiencing perimenopause and menopause, as a starting point.
"It could be as simple as a desk fan at their desk, a slightly flexible start time if they suffer from insomnia, or temperature controls and more breathable uniforms," she said.
"For women in professions like early learning, women working on the factory floor or on the checkout, those sorts of changes won't be possible, and that's where there's a question about the benefits of reproductive and sexual health leave."
Cilla de Lacy said she had never heard about perimenopause. Source: Supplied
Leave complexities, but flexibility 'hits the right note'
The Senate committee considered making menopause-specific leave available but instead opted to push for the creation of reproductive leave that could be used by all genders.
"[We have] been quite worried that if we have just a very specific menopause leave, what we do is we other women of a certain age — and we already have quite a level of gendered ageism in workplaces in — so creating leave specifically for a woman in midlife, we fear would cause some employers to look at a woman and her age and make a decision based on hiring or retaining that woman for fear of what they might need to do to cater to her needs," Dr Sarah White, CEO of Jean Hailes for Women's Health, said.
That fear is shared by most Australian women, with a recent survey conducted by the not-for-profit organisation finding 73 per cent believed some employers and colleagues would use menopause leave as an excuse to discriminate against them.
White said the recommendation to increase workplace flexibility "hits the right note".
"The challenge is we have women in so many different working environments, so it's going to be really important for employers to consult with their workforce with their women or the people who might be experiencing menopause and work out what is best for them," she said.
Several submissions to the Senate inquiry called for research around the perimenopause experiences of culturally and linguistically diverse people and First Nations people during perimenopause and menopause.
The final report referenced the government's existing $13 million funding commitment to the Health In My Language program, which provides in-language health expertise for migrant and culturally and linguistically diverse women.
Delaram Ansari is a research, advocacy and policy manager at the Multicultural Centre for Women's Health, which runs the program.
She was "particularly pleased" to see some of the centre's recommendations and "longstanding advocacy issues" mentioned in the inquiry's report.
"One is the actual establishment of a comprehensive evidence base and the need for that intersectional data and responses, which we really have been advocating for a while," Ansari said.
'Expand healthcare and support services'
But she was critical that most references to culturally and linguistically diverse communities in the report centred around research, rather than direct action to ensure culturally safe care.
"We also really want to note that that intersectional lens and analysis has to be adopted across all of the recommendations to make sure it meets the needs of migrant and refugee women and gender-diverse people," Ansari said.
"For example, we need to ensure we are extending the healthcare and support services, including Medicare, PBS, NDIS, and social security payments to include all migrants and refugees — and that's regardless of their visa status.
"That also needs to include the cost associated with diagnosis, treatment or support relating to the management of perimenopause and menopause."
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Another of the report's key recommendations was for the government to look at ways to address Australia's shortages of menopause hormonal therapy (MHT) and make it more affordable.
"So many women benefit from MHT, and so it definitely needs to be something that's accessible for women to have, and just on individual case studies, when you see women who have benefited from MHT and then suddenly can't access it, it really is quite negative for them and an awful experience. So making sure that it is something that's accessible is really important," Gervich said.
Cilla said her life was "so different" after starting MHT.
"My husband said he's got the old Cilla back," she said.
"I feel absolutely amazing, and it's all because I finally found the right treatment — but it shouldn't have been that hard, and I should have been forewarned."
Assistant Minister for Health Ged Kearney told SBS News the government welcomed the report and would work through the detailed recommendations.
The government has three months to provide its response to the inquiry.
To hear more stories like this one, examining bias and stigma around women's health, you can catch our or wherever you listen to your podcasts.
Readers seeking crisis support can contact Lifeline on 13 11 14, the Suicide Call Back Service on 1300 659 467 and Kids Helpline on 1800 55 1800 (for young people aged up to 25). More information and support with mental health is available at and on 1300 22 4636.
supports people from culturally and linguistically diverse backgrounds.
