Like many Hollywood stars, dedicated advocates in the field of women’s health may well borrow the oft-quoted phrase ‘It took me 20 years to become an overnight success’. 

While advocacy for recognition of important health concerns and policy reform is far from the dizzying heights of showbiz, here too the wheels of change can move at a glacial pace—only to suddenly become a tsunami.

This is what’s currently happening in one of the APA’s key advocacy priority areas—women’s pelvic health across the life span, including birth trauma, menopause and pelvic pain.

A significant window of policy opportunity has opened thanks to global and national advocacy and the dedication of our members, the Women’s and Men’s Pelvic Health National Advisory Committee and women’s pelvic health physiotherapists, along with prominent women’s health organisations.

This year, after many years of advocacy, APA board member and leading pelvic health physiotherapist Catherine Willis has given evidence at two pivotal inquiries so far. 

In June, she appeared before the Senate’s inquiry into issues related to menopause and perimenopause. 

This followed her March testimony to the New South Wales inquiry into birth trauma.

The birth trauma inquiry’s report quoted her evidence and the APA’s position statement on physiotherapy and birth trauma extensively and recommended state-based funding for physiotherapy, which may have national implications for women’s pelvic health funding.

Catherine’s is among a groundswell of voices helping to break down traditional taboos surrounding women’s pelvic health issues, increase understanding about their debilitating and far-reaching impacts, and influence governments to tackle medical misogyny and to identify and remove barriers to respectful, evidence-based care. 

The patient voice is a critical one in this space, but for too long the impact on personal lives, mental health and quality of life has not been enough to sway the debate. 

Menopause is a case in point. According to the World Economic Forum, over 450 million women experience menopause-related symptoms globally. 

Symptoms can include discomfort and pain and can reduce women’s participation in daily activities. 

The most common symptoms—hot flushes, anxiety, difficulty sleeping, low mood, problems with memory and concentration, and fainting/loss of consciousness (among some cohorts)—can impair the
ability to perform at work to the usual standard. 

The absence in the workforce of those experiencing menopause is being felt in national GDPs and action to address this has been underway in some parts of the world for a number of years.

Asian nations including Singapore, Japan and South Korea have been leading policy reform efforts to minimise economic losses resulting from menopause and have highlighted the need for more data, care and investment to understand and address the menopause ‘health gap’.

Conservative Japan is a good case study. Its government began efforts to overcome menopause-related productivity losses several years ago. 

In 2021, a national survey found that more than 460,000 Japanese women in their 40s and 50s (nine per cent of this population) dropped out of the workforce due to menopause related symptoms annually, many reporting discomfort at discussing their symptoms and needs with their managers.

This drop-off coincides with reaching the age culturally considered appropriate for advancing to management positions—meaning the disappearance of women at senior levels, financial insecurity for women and loss of corporate knowledge for employers.

The economic loss Japan incurred as a result of presenteeism, absenteeism or resignations because of menopause was estimated at 1.9 trillion yen (A$18 billion) a year.

The introduction of a national conversation about menopause to end the stigma surrounding the topic, along with policy reforms—such as menopause leave to support self-care, rest and healthcare appointment attendance; employer education; and increased access to medical solutions and healthcare—has not gone unnoticed in Western countries. 

In the UK, a number of the world’s largest multinational companies have introduced menopause
policies that offer flexibility and support and have rolled them out in offices across Europe, Africa and North America. 

It is thrilling to see governments in Australia join the global movement, work to remove the stigma and shame associated with women’s pelvic health and take a multifaceted approach to the apparent dearth of understanding, knowledge and appropriate care currently provided to many patients. 

In March, the federal government’s #EndGenderBias survey revealed key themes reported by women attempting to have their health concerns diagnosed and treated. 

They include being dismissed and disbelieved, bias and discrimination, accessibility and affordability of care, and the absence of women in research.

State and federal inquiries into women’s pelvic health issues are creating a significant policy opportunity to advocate for increase access to physiotherapy. 

The growing public conversation and awareness raising are expected to also increase demand for
care. 

The APA has been actively involved in advocating for funded access to pelvic health physiotherapy, meeting with Assistant Minister for Health and Aged Care Ged Kearney and Greens Senator Larissa Waters as well as being invited to give evidence at government inquiries. 

We have focused our advocacy on what will be most effective in diagnosing, treating and managing pelvic health symptoms and conditions to improve women’s lives.

It is pleasing to see that we are not alone in our advocacy. Rather, we are supported by a broad range of stakeholders. 

Respective inquiries have heard from individual women, the Australasian Birth Trauma Association, the Australian Medical Association and the Royal Australian College of General Practitioners about the
importance of physiotherapy. 

We have made recommendations about potential funding mechanisms for pelvic health physiotherapy but accept that a number of models should be considered that are compatible with the inclusion and embedding of physiotherapy to ensure that evidence-based first-line and multidisciplinary approaches
are adopted.

Advocacy for funded physiotherapy isn’t an overnight success quite yet. 

Things are moving in the right direction, however, and there is a growing awareness and acknowledgement of the unique advanced practice skills of pelvic health physiotherapists and of the benefits of drawing on those skills to fundamentally improve women’s pelvic health.