At the happiest time in her life, Mary Coustas was suffering. It took time to work out why

Menopause – and perimenopause, the lead-up phase that can last anywhere from months to years – has become a hot topic. In an Australian first, in May the federal government launched an awareness campaign to educate women – and men – about the symptoms of these stages of life, which can begin anytime from a woman’s late 30s, and can be confusing.

Frustrated by the silence surrounding a phase that affects almost every woman, we spoke to six Australians working to make menopause mainstream.

“We are literally running on empty”: Mary Coustas, comedian and health advocate

Mary Coustas turned to women’s health awareness when she went through menopause soon after having her daughter, after more than 23 rounds of IVF. She wrote a book, MaryPause, and launched a menopause telehealth clinic, UnPause, with Xanthi Kouvatas. She brings much-needed comic relief to the “meno-sphere” of symptoms, laying down the facts from dry vaginas to hot flushes.

“I knew menopause was coming, but didn’t think it was going to come like a freight train. Menopause felt like an assassination; shooters coming at me from everywhere, and I was oblivious to it. I was getting on with my life at the happiest point in my life as I had just given birth to my daughter, but so much suffering was also happening.”

A lot of her symptoms blended with being a new mum – from mild anxiety to a sense of helplessness. “Part of solving the problem was trying to find doctors who could help. There simply aren’t enough, and the ones that can help, you can’t get in to see.”

UnPause launched in 2023 to meet the demand. “Fifty per cent of the population are shoved in the closet and the other 50 per cent [men] is wondering what happened to their mum, partner, sister,” she says. “The highest suicide and divorce rates are for women between 45 and 55. Women have less super, are rewarded less for being great at what they do, and there’s fewer hormones – we are literally running on empty, and we’re here to say we’re not depressed, we’re depleted and we need help.”

“I was having trouble getting out of bed”: Shelly Horton, TV journalist and author

For Shelly Horton, years of feeling unwell, including being treated for depression, eventually led to a diagnosis of early onset perimenopause that turned her from a bubbly TV journalist to someone who couldn’t get out of bed.

In 2025, she wrote a book based on her experience and research, I’m Your Peri-Godmother.

“My perimenopause symptoms started in 2020, which was unfortunate because the pandemic was on and I passed them off as stress,” says Horton. “I thought it was something 60-yearold ladies with grey hair went through after their periods stopped, clutching their pearls and yelling at kids to get off their lawn.”

Horton was hit with perimenopausal depression. “It floored me … I was having trouble getting out of bed, I didn’t shower and ended up wanting to quit my job. Luckily, my GP had been educated … and I got put on an antidepressant and HRT [hormone replacement therapy]. We now know that antidepressants may not be what you should be put on, particularly for perimenopausal depression, because it’s caused by the hormones, therefore treat the hormones!

“The best thing about being a journalist – and a loudmouth – is that I know how to make change. That’s why I went to [federal] parliament in 2023 as part of a first roundtable on menopause – until then the word hadn’t been said there before.”

“I wanted to fill in the gaps in care”: Sonya Lovell, health advocate and podcast host

Sonya Lovell helps women navigate menopause after cancer via her MACS (Menopause After Cancer Support) initiative, which she established in 2024. She also hosts the podcast Dear Menopause.

“I was diagnosed with breast cancer nine years ago, which put me into an induced menopause,” she says. “I spent a lot of time working everything out for myself because systemic failures and the gap in care became really evident. There was very little support for women like me.

“I decided to work in this space and fill in the gaps and bring my years of experience in health, wellness and fitness to this space. Women come to me at the beginning of their cancer treatment and are warned they’ll experience menopause, but there’s no real support for those next steps.

“Many have finished their cancer treatment and hit a wall. In the last 12 months, every conversation with a doctor around using HRT as a cancer patient would have been met with a flat no. But there is evidence and research papers that show the conversation is actually much more nuanced today.

“Every woman deserves a shared decision-making conversation that’s specific to her diagnosis, age, impact on her quality of life and longevity.”

“This is not an old-woman’s issue”: Professor Jayashri Kulkarni, medical researcher

Psychiatrist Jayashri Kulkarni is a global expert on menopausal depression and founder and director of two research centres – HER Centre Australia and the Multidisciplinary Alfred Psychiatry research centre (MAPrc). Her research has led to the development of new treatments for women, and the establishment in 2021 of Australia’s first women’s mental health hospital at Cabrini Health in Melbourne.

“More than 50 per cent of women will have some mild to moderate menopausal mental-health issues. I’m involved with the very severe end of the spectrum kind – a lot of damage can be done if depression isn’t identified and treated properly. Menopause begins in the brain in the early to mid-40s.

“This is not an old woman’s issue … depression occurs because of the gonadal hormone fluctuations – oestrogen, progesterone and testosterone. At perimenopause – a two- to 14-year transition – the brain experiences lots of symptoms from massive anxiety, sometimes panic, and then with depression comes sadness, anger, rage, irritability, hostility and a sense of isolation and plummeting self-esteem. All this is fluctuating because of hormones.

“Perimenopausal depression is not recognised as a standalone disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] and I am trying to change that. Putting women on antidepressants will give 30 per cent of the desired outcome, whereas sensible hormone treatment will get you about 90 per cent of the outcome. This is our battle, and I fear for women who are being denied these choices and being told perimenopausal depression doesn’t exist.”

“We were not trained to treat the 51 per cent”: Dr Ceri Cashell, general practitioner

Irish-born and Sydney-based specialist GP Dr Ceri Cashell co-founded Healthy Hormones, a free online service helping Australian health professionals connect with women to better understand hormonal health.

“I’ve been in Australia since 2012 and developed an interest in hormonal health in 2021, when a patient asked me to prescribe her testosterone. I had never prescribed it and thought to go and upskill, which set me off on this wonderful journey that has transformed how I practise medicine.

“I got deep into the hormonal element, and realised that as GPs, we had never really been trained how to treat 51 per cent of the population. The majority of drugs that we prescribe were never tested on women or on female animals, or female cell lines.

“There’s much gaslighting and diminishing of female symptoms in menopause, and I wanted to connect with other GPs who had a similar interest. Healthy Hormones began as a WhatsApp group and grew from wanting to spread the word. It is the only medical education platform of its kind in the world. We have multiple specialists – endocrinologists, psychiatrists, gynaecologists, rheumatologists, doctors, physios, psychologists, naturopaths, and more. It’s a community of clinicians who want the best for the women and will consider multiple factors when creating individual care.”

“I wondered what was wrong with me”: Dr Kelly Teagle, general practitioner and health advocate

Kelly Teagle is best known as the founder of WellFemme, a telehealth menopause clinic that provides expert midlife healthcare to women across Australia. What began as a side-hustle from home has grown to become one of the country’s largest telehealth services treating more than 10,000 patients.

“I went through menopause at 42; when my son was one. There was a lot of personal upheaval going on, and I was wondering what the hell was wrong with me – maybe I’m just tired and cranky. I had access to resources and was still confused. That’s when I realised my need for information; support was hard to find in one place. I began this journey in 2019 when we launched.

“It’s so gratifying as we’ve been able to reach so many women who otherwise wouldn’t have been able to get that care. Better patient care comes with longer-format consults. I’ve upskilled and become experienced in menopause because I was interested in it, but not every GP has the time or chooses to do that.

“We’re not trying to usurp someone’s normal GP – we aim to be complementary to the generalist services they provide. We write very detailed reports that women can take back to their GP, and it’s up to them whether they choose to have their GP do any prescribing as a result, or whether they would like us to manage their treatment. Having the opportunity to get estrogen therapy, if it’s appropriate at a time when it’s going to give them the biggest preventive health benefits going forward, is what matters to us.

“Women often don’t understand how much impact menopause has on their development of chronic diseases like osteoporosis, heart disease and dementia. There are a lot of women in remote areas who feel they don’t have options and would not have had access to us if it weren’t for telehealth.”

Get the best of Sunday Life magazine delivered to your inbox every Sunday morning. Sign up here for our free newsletter.