A landmark Senate inquiry which helped catapult menopause out of the shadows and into mainstream health conversations has been accused of inadequately disclosing ties with pharmaceutical companies and other commercial interests.
In a paper published in the journal Health Promotion International in November, Australian researchers found that despite the chair of the committee inviting disclosures of conflict of interest, only three conflict of interest statements were included in 284 written submissions. Just 10 of the individuals giving evidence in person made verbal disclosures about conflicts of interest.
Yet some of those involved in the Senate inquiry – and the lobbying that led up to it – had support from pharmaceutical companies or stood to gain through menopause being given a much higher profile in health policy.
It comes as a high-profile conference on menopause treatments being held in Sydney this weekend exposed divisions among some medical practitioners over the dosage of hormone therapies and the efficacy of testosterone as a treatment for menopausal women.
The sold-out public conference at the Opera House has not been supported by the Australasian Menopause Society. A second day for medical professionals featuring the same speakers is being sponsored by several pharmaceutical companies, but organisers say there is no involvement of big pharma in the public event.
This month the Labor government responded to the Senate inquiry recommendations, putting $573m on the table for women’s health – including a new Medicare rebate for menopause health assessments, funding to train health professionals, the first-ever clinical guidelines and a national awareness campaign.
It also includes a Pharmaceutical Benefits Scheme (PBS) listing for the new menopausal hormone therapies Prometrium, Estrogel and Estrogel Pro, the first in over 20 years, meaning those therapies can be bought at a government-subsidised price. The move will save women using menopause hormone therapy (MRT) hundreds of dollars a year.
But while the additional funding is being welcomed, within some parts of the medical profession there is concern about whether the parliamentary inquiry was used by lobbyists for pharmaceutical interests and others with direct commercial stakes in the industry to advance their business interests – without proper disclosure.
“Yes, it gave voice to women in the community, but it looks like [parliament’s] institutions may have been influenced by people with agendas,” said Prof Susan Davis, a leading endocrinologist from Monash University.
“Anyone could have written the shopping list of recommendations without an inquiry. I think it was a response to a lot of lobbying.”
A similar debate has erupted in the United Kingdom over support from the pharmaceutical industry for the All Party Parliamentary Group on Menopause that has been advocating for changes to the NHS and better awareness of menopause in the workplace and in government.
Disclosures by the committee show that from 2021 until 2023 its secretariat services were provided by Interel Consulting UK and then Dentons Global Advisors. These firms in turn received £185,000 from pharmaceutical companies Theramax, Astellas Pharma, Bayer and Bristol Myers Squibb.
Lobbying is a completely legal activity and part of the process of democracy. Sometimes, the interests of consumers – in this case perimenopausal and menopausal women – can align with commercial interests.
But it is important for decision makers to know when financial interests could be having an influence.
Geoffery Watson, the director of the Centre for Public Integrity, says disclosure is essential for transparency in public inquiries. But he also notes “that disclosure doesn’t make the conflict of interest go away. It clearly still has an effect on the viewpoint being put”.
The authors of the Health Promotion International report also note that disclosure “is an important step to support trust in scientific and public discourse, and transparency in decision-making”.
One of the key people driving the establishment of the Australian Senate inquiry was Johanna Wicks, a longtime health advocate in the not-for-profit sector whose own menopause experience had got her interested in the subject.
Through a mutual contact, she was introduced to Besins Healthcare, “a family-run company with a laser focus on hormone treatments for conditions including menopause, fertility and testosterone deficiency”. It is an international company with a direct presence in 22 countries.
Wicks sat down for an extended interview with Sonya Lovell on the Dear Menopause podcast, during which she explained her involvement in the Senate inquiry. Lovell described Wicks as “99% responsible” for the Australian Senate inquiry going ahead.
Wicks’ first job for Besins was to produce a strategy and to probe why menopause had become such a big issue in the US and the UK, but had stayed in the shadows in Australia.
After the May 2022 election, she says she realised that there was a real opportunity to make change: the 47th parliament was filled with women in their 40s and 50s who would have direct experience of the struggles of perimenopause and menopause.
Wicks organised a roundtable with the help of Labor MP the late Peta Murphy, followed by a Parliament House event in February 2023 that featured eight speakers, including representatives from the Australasian Menopause Society. Nearly 20 MPs attended.
Greens senator Larissa Waters then took up the cause and a Senate inquiry was initiated. A spokesperson for Waters said it was always clear that Wicks was working for Besins, a manufacturer of hormones in Australia.
Around this time, a faultline opened between a group of social media-savvy women and doctors sometimes referred to as the “menoposse” – who are adept at using their considerable online presence to promote menopause as an issue of women’s self determination – and doctors, organisations and research bodies who hail from a more sober scientific background.
Opening the inquiry, the chairperson, the Greens senator Penny Allman-Payne, noted:
Real and perceived conflicts of interest can negatively affect public confidence in the integrity of inquiries. As such, the committee encourages all witnesses participating in the hearing today to declare to the committee any matters, whether of pecuniary or other interest, where there may be, or may be perceived to be, a possible conflict of interest.
The interests of medical practitioners who gave evidence were probably obvious. More awareness of menopause and treatments available will probably lead to more patients. Some have thriving practices and online advice sites for women.
But other interests were more opaque. For instance, some submitters had businesses that sell consultancy services to companies to help them make their workplaces more menopause friendly. Others had social media businesses that promote the issue. Some of these receive support from pharmaceutical companies for their activities.
A large number of women also gave evidence of their personal struggles with perimenopause and menopause and its impact on their mental health and relationships. Witnesses were often passionate about how MRT had changed their lives.
Those with menopause businesses often fell into this category as well, having been motivated by their own experience to start websites, podcasts, consultancies and the like. For example, Shelly Horton, who now runs a workplace consultancy, participated in the round table as a woman with lived experience.
Wicks insists on the podcast that Besins, her employer, just wanted “to activate the space” and there was never any discussion about driving sales of their products.
“Let’s just say there are some members of the establishment who have done very well out of the fact that menopause has stayed in the shadows, very financially well out of government funding, and they did not like my appearance on the scene,” she told Guardian Australia.
She says that some who have criticised the new guard and denigrated them as “influencers” – with connections to big pharma – have been on the receiving end of millions of dollars in government grants.
Wicks was involved in its written submission but parted company with Besins before the hearings in Canberra, where Besins gave evidence.
The other faction in the “menopause wars” are worried about the quality of advice and treatments and the catastrophising of menopause, which could further harm middle-aged women who already face headwinds in the workplace.
“This is a really natural phase of life and pretty much all women will have some symptoms, be they irregular periods, hot flushes and some sleeplessness. And this will coincide with a very complex phase of life, as women are often juggling multiple responsibilities,” said the chair of the Royal Australian College of GPs’ specific interest sexual health medicine group, Associate Prof Magdalena Simonis.
“So it’s a stage not just where hormones play their part but the social and cultural aspects of where women sit in society also impacts this dramatically.”
The Senate inquiry’s recommendations were widely welcomed by the pharmaceutical industry. The committee highlighted the need for more research on the experiences of women and other people going through menopause and for more education.
It called for national guidelines on treatment and more training for healthcare professionals to provide the right advice and support. It also identified a lack of access to medicines and treatments at affordable prices – mainly menopause hormone therapy.
The recent announcement of new PBS listings for hormones will be a major benefit to women. But it will also be a major benefit to Besins, the manufacturer of the three hormone products placed on the PBS.
The authors of the paper on conflict of interest say while there are highly developed protocols for declaring financial sponsorship of research, the same is not true in the area of health policy.
They pointed to a recent analysis of members of the United States 2020 dietary guidelines advisory committee, which found that 95% of members had potential conflicts of interest with the food or pharmaceutical industries.
Another study found that those who made submissions to a US inquiry into opioid use who had connections to doctors were far more likely to oppose more radical interventions to handle the crisis than those without doctor connections.
“We should all disclose what our relationships are with industry,” Simonis said. “Paying me, sponsoring me, if I had shares in the company then I should disclose it.
“There are commercial relationships and academic relationships and they should be made transparent.”
• This article was amended on 26 February 2025 because an earlier version misnamed the journal Health Promotion International, as Public Health International
