For ten years, Jo Caminiti suffered a range of symptoms she could not get diagnosed.
Her joints ached. She was constantly stiff. Exhaustion followed her everywhere. Her sleep was interrupted.
But worst of all, her mood was low; very low.
It happened gradually until she felt she had no option but to take long-service leave from her job as a scientist.
"I really needed to take a break and just try and figure out what the heck was going on," she said.
She discussed her symptoms with her doctor and spoke to a counsellor about her despondency.
Despite being in her late forties, no one suggested she might be perimenopausal.
Psychiatrist Jayashri Kulkarni said menopause was mostly recognised for its physical symptoms and the psychological effects were being neglected.
"The biggest thing that many, many women experience that really alters their quality of life is depression," she said.
'It gave me my life back'
It was only when Jo Caminiti watched a TV program about menopause that the penny dropped.
As soon as she joined an online support group for menopausal women, she got the information she needed and took it to her doctor.
Even then, she struggled to get her condition treated as a hormonal issue.
Instead, her doctor suggested anti-depressants.
She held her ground and her doctor agreed to try menopausal hormone therapy.
"It made an immediate difference, and it gave my life back," she said.
"I had nearly ten years in the wilderness there where things were just getting worse and worse and if I had known earlier, I could have done something about it earlier."
With her joint pain gone, her depressive moods under control and her drive restored, Ms Caminiti turned her back on her science career.
Instead, she took up metal sculpting and landed a public commission to create a four-metre metal sculpture of a cluster of red flowering gum blossoms.
"I can do stuff, I can live, and life is good," she said,
"It's like the weight's lifted off. I'm not angry now."
Women's hormonal health not well understood
Menopause happens when a woman reaches the end of her reproductive years and leads to a decline in the production of oestrogen and progesterone.
As well as helping to keep joints supple and bones strong, these hormones can have a significant effect on brain chemistry.
Professor Kulkarni said the mental health aspects of menopause are not well recognised among medical professionals, or spoken about in the community.
She wants to see greater understanding among doctors of how hormonal changes affect the brain and women's psychology.
"Antidepressants can be of some use, but many times I've seen in my clinical work that it doesn't actually hit the target," she said.
Professor Kulkarni wants to see women's mental health clinics established across the country.
She also wants more investment in research looking at the use of hormone therapies for depression, and better education for health professionals on the psychological components of menopause.
She said menopausal depression was an issue that had society-wide implications, because middle aged women are often caring for adolescent children, caring for elderly parents, and operating in senior professional roles.
A stigmatised topic
Over the past year, Lucy Cullinan found she couldn't find joy in anything.
"It was just a feeling of total and utter nothingness," she said.
She felt she had neither the energy nor the will to engage with her six-year-old daughter, which made her feel awful.
Nothing she did seemed to make her feel better.
And none of the four doctors she spoke to would treat her for menopausal symptoms because she had not stopped having periods yet.
Ms Cullinan said all she was offered was an anti-depressants and anti-inflammatories.
"There seemed to be a complete lack of recognition of perimenopause," she said.
After much online research, including with the Australian Menopause Society, she found a doctor that would prescribe hormone therapy.
"They fob you off with anti-depressants and opioids," she said.
Karen Magraith, a GP and president of the Australasian Menopause Society, said menopause was a stigmatised topic that people did not talk about.
"Women were told to go away and put up with it," she said.
She said it was important to consider the physical, social and psychological aspects of every patient's health, but that for women in particular, the hormonal dimension of their health needs attention.
To address this better, she said women’s mental health services are needed.
But Dr Magraith is not worried about middle-aged women being prescribed anti-depressants.
"Some people may do better with hormone therapy, some people actually might need both," she said.
In her view, one of the problems women face is getting a proper assessment from their GP.
To improve that, Dr Magraith would like to see Medicare pay higher rebates for longer consultations so doctors can better manage complex health issues.
She'd also rather see general practices better supported, than special menopause clinics set up for women.
"Half the population go through menopause, not all of these people are going to be able to see be seen in these special clinics," Dr Magraith said.
"Everyone should have access to good care in the community."
Dr Amy Moten of the Royal Australian College of General Practitioners said some GPs still had lingering concern about hormone therapies because of outdated information, but that this was becoming less common.
She said the best treatments for menopause are hormonal but these can't be used or tolerated by everyone.
Dr Moten also noted that not all mood symptoms midlife are caused by menopause and that mood dysfunction can occur at any stage of life and may respond to a variety of different treatments.
Ms Caminiti is now one of the administrators of an online group that supports women going through menopause.
She said she is shocked by how many members of the group have been dismissed by doctors, or told they have to put up with the symptoms they are experiencing.
One of the things the group is able to do is provide women with the information they need to advocate for their own health when they don't think a doctor is listening to them.
"Or to flush that doctor and find one who is actually up to date with menopause in its treatment," Ms Caminiti said.