Menopause Care in Australia: Medicare, PBS & Specialists

Why the Pathway to Menopause Care Feels So Hard to Navigate

If you’ve spent months Googling symptoms at 2am, asked friends who seem just as confused, or left a GP appointment feeling like you barely scratched the surface — you’re not alone. Many women spend a long time piecing together where to start, who to see, and what they can realistically afford. The frustration is real, and it’s common.

The good news is that there are genuine entry points in the Australian health system for menopause care. The less good news is that they’re not particularly well sign-posted — especially if you live outside a major city. This guide exists to change that. It’s a plain-English map of the actual process: from your first GP conversation through to specialist care, with honest guidance on costs along the way.

It’s also worth knowing that things have recently shifted. New Medicare support introduced from 1 July 2025 has changed what’s available to Australian women, which means information from even a year ago may no longer reflect what you can access.

“I had no idea I could just go back to my GP — I thought I needed some special referral first. Once I knew the starting point, it all made sense.” — one member of an Australian menopause community

Step 1 — Start With Your GP (It’s the Gateway to Everything Else)

In Australia, your GP is the clinical starting point for menopause care. They can talk through your symptoms, organise relevant pathology if appropriate, discuss initial options, and refer you onward if needed. For women who have been searching for a specialist to go directly to, it can feel counterintuitive — but the GP pathway is both practical and, as of mid-2025, better resourced than it used to be.

From 1 July 2025, new dedicated menopause and perimenopause health assessment items became available under Medicare, aimed at women aged 45 and over, as well as those experiencing early menopause. According to the Australian Government Department of Health and Aged Care, these assessments are designed to give women a structured, unhurried space to discuss what’s happening and explore options with their doctor.

According to the MBS Online — the official Medicare Benefits Schedule published by the Australian Government Department of Health and Aged Care — the assessment must be conducted in person (not via telehealth), by a GP, and run for at least 20 minutes. It covers your history and includes a basic physical examination such as blood pressure. It is not a quick add-on to another appointment — it’s a dedicated consultation.

A tip that comes up constantly in community spaces: write down your symptoms before you go. Everything that feels different — sleep, mood, cycle changes, brain fog, joint aches, anything — jot it down over a couple of weeks. It sounds simple, but it genuinely changes the quality of the conversation.

According to the MBS Online, the MBS item linked to this assessment is item 695. You can mention this when you call to book, which helps the practice allocate the right amount of time. And if your usual GP doesn’t have a strong interest in menopause or women’s health, it is entirely reasonable — and quite normal — to ask whether another GP at the practice does, or to seek a second opinion elsewhere.

“I came in with a written list of everything that had changed in the past few months. My GP said it was the most useful thing a patient had ever done — we actually got through everything in the time we had.” — one member of an Australian perimenopause community

What Medicare Actually Covers — and What It Doesn’t

Medicare can contribute to three main things in this context: the new dedicated menopause health assessment, standard GP consultations for ongoing symptom management and follow-up, and specialist consultations when you’ve been referred by a GP. Understanding the difference between these helps set realistic expectations.

Medicare provides a rebate — not necessarily full coverage. Whether you pay a gap (an out-of-pocket amount above the rebate) depends on whether your GP or specialist bulk-bills. Bulk-billing rates vary across Australia; for the most current information on bulk-billing availability in your area, Services Australia is the most reliable source to consult, or you can ask your GP practice directly when you book.

One important point for women in regional or rural areas: the dedicated menopause health assessment cannot be accessed via telehealth. The in-person requirement is a known friction point, and it’s worth planning for — but the assessment itself is a one-off starting point, and much of your follow-up care can happen remotely after that initial visit.

“I was shocked by the gap fee the first time. Now I always ask upfront whether the GP bulk-bills for women’s health — it saves a lot of stress.” — one member of an online perimenopause group

If you hold a Pension Concession Card or Health Care Card, your out-of-pocket costs for both GP visits and PBS-listed medicines will be lower — always worth mentioning to the practice when you book, and to your pharmacist. For current Medicare rebate amounts, the MBS Online search tool is the most reliable source, or you can call Medicare directly. Rebate amounts are indexed and can change, so specific figures quoted in articles can quickly become outdated.

HRT and the PBS: What ‘Subsidised’ Actually Means in Practice

Medicare covers health services — consultations and assessments. It does not cover the cost of medicines. That’s where the Pharmaceutical Benefits Scheme (PBS) comes in.

The PBS is a federal government program that subsidises the cost of listed medicines at the pharmacy. According to the Australian Government Department of Health and Aged Care, many menopausal hormone therapy (MHT) formulations are listed on the PBS. This means eligible women pay a government-set co-payment at the pharmacy, rather than the full price of the medicine.

According to Services Australia, there are two co-payment levels: one for general patients, and a lower one for people holding an eligible concession card. Both are set by the government and indexed over time, so rather than quoting figures here, it’s worth checking the current amounts directly with your pharmacist or via the Services Australia website.

A PBS prescription must be written by a registered Australian prescriber — your GP or a specialist. Once you have that prescription, the pharmacist automatically dispenses the medicine at the subsidised rate if the formulation is PBS-listed.

The catch: some formulations may not be listed on the PBS, in which case they would be dispensed as a private script. According to the PBS schedule — maintained by the Australian Government Department of Health and Aged Care and searchable at pbs.gov.au — whether a specific formulation is listed can be confirmed before you fill your prescription. This is absolutely worth asking about directly. A simple question — “Is this formulation on the PBS?” — can make a meaningful difference to what you pay each month.

“Without the subsidy I couldn’t have stayed on it. The PBS price is what made it sustainable for me long-term.” — one woman in an Australian menopause forum

When and How to See a Menopause Specialist

Not everyone needs to see a specialist — many women manage their menopause care very well with a knowledgeable GP. But for more complex presentations, a specialist brings additional expertise. Gynaecologists and endocrinologists are the most common specialist types for menopause-related care.

According to Services Australia, a GP referral is required to access the Medicare specialist rebate. Without one, the consultation is at full private cost. So if you feel you need specialist input, ask your GP for a referral — this is a standard and routine request.

The most reliable way to find a specialist with a genuine focus on menopause care is through the Australasian Menopause Society (AMS) Find a Doctor directory. It’s publicly accessible, searchable by state and postcode, lists both GPs and specialists with a menopause interest, and indicates whether they offer telehealth. It’s the first place to look.

A realistic note: wait times for menopause-interested specialists can be long in some parts of Australia. A wait of several months is not unusual, particularly outside major cities. If you’re waiting, returning to your GP for interim support is a completely sensible approach — you don’t have to manage on your own while you wait for the specialist appointment.

“It took me eight months to get in to see someone who actually knew what they were talking about — but when I did, it was like a light came on. Completely worth the wait.” — one member of an Australian menopause support community

Some private fertility and women’s health clinics also offer menopause consultations. These are typically not bulk-billed, but can sometimes be accessed more quickly than public specialist waitlists.

Telehealth for Menopause: What’s Available and Who It Suits Best

Telehealth has become a genuine part of how Australians access healthcare, and for menopause care specifically, it can be a practical lifeline — particularly for women in regional, rural, and remote areas.

The key thing to understand about the new Medicare items: the dedicated menopause health assessment must be conducted in person. According to the MBS Online, that’s a fixed requirement. But standard GP follow-up consultations and many specialist consultations can still happen via telehealth with a Medicare rebate, according to Services Australia.

The practical pathway this opens up: have your initial in-person assessment at a local GP, then access follow-up consultations — including with a menopause-interested GP or specialist located elsewhere in Australia — via telehealth. This is especially useful when local options are limited.

Several private telehealth platforms now offer menopause-focused GP services. These can be a useful option if you can’t access a local bulk-billing GP with menopause expertise, though they may involve a gap fee. It’s worth comparing options before booking.

“I’m four hours from the nearest specialist. Telehealth didn’t fix everything, but it meant I wasn’t just white-knuckling it on my own between appointments.” — one member of a regional Australian women’s health group

One practical tip: telehealth Medicare rebates can have eligibility criteria. According to Services Australia, eligibility conditions for telehealth rebates may vary depending on your circumstances. Checking with the practice or Services Australia before booking helps avoid any billing surprises.

Preparing for Your First Appointment: What to Bring and What to Say

A little preparation goes a long way. Here’s a practical checklist to take the stress out of your first appointment:

• Track your symptoms for two to four weeks beforehand. Sleep quality, mood, cycle changes, hot flushes, brain fog, joint changes — anything that feels different. Women in menopause communities consistently say this makes the consultation far more productive.
• Write down your questions. Memory is unreliable under pressure. A written list means you won’t leave the appointment kicking yourself for forgetting something important.
• Bring a list of your current medications and supplements. This helps your GP get a complete picture and flag any relevant considerations.
• When booking, ask specifically about the Medicare menopause health assessment and request a longer appointment — around 30 minutes — so you have adequate time. Mention MBS item 695 if it helps the receptionist allocate the right slot.
• If you hold a concession card, mention it when booking and again at the pharmacy.
• If you feel dismissed or not listened to, seeking a second opinion is valid. It’s more common than you might think, and you are entitled to advocate for yourself.

Some GP practices have a women’s health nurse or practice nurse on staff — it’s worth asking when you call whether one is available to assist with parts of the assessment process.

A Summary: Your Step-by-Step Access Roadmap

Here’s the whole journey in one place:

• Step 1: Track your symptoms for a few weeks, then book a longer GP appointment and mention the Medicare menopause health assessment (MBS item 695) when you call.
• Step 2: Attend the in-person assessment. Discuss your symptoms, any relevant pathology, and initial care options with your GP.
• Step 3: If a prescription is issued, ask your GP whether the formulation is PBS-listed, and confirm your co-payment at the pharmacy. Mention your concession card if you have one.
• Step 4: If specialist care is recommended, ask for a GP referral and use the AMS Find a Doctor directory to search for a menopause-interested practitioner near you — or one offering telehealth.
• Step 5: Use telehealth for follow-up GP consultations if getting to a clinic in person is difficult for ongoing support between appointments.
• Step 6: Use a directory like Yellow (spotyellow.com) to find menopause-informed practitioners in your area, including those offering telehealth.

The system is navigable. Knowing the steps — and knowing you’re allowed to ask questions, push for the right appointment, and seek out practitioners who take this seriously — makes an enormous difference.

Frequently Asked Questions

Does Medicare cover menopause treatment in Australia?

Medicare covers health services, including standard GP consultations and the new dedicated menopause and perimenopause health assessment available from 1 July 2025 for eligible women aged 45 and over (or those experiencing early menopause). It also provides rebates toward specialist consultations when you’ve been referred by a GP. Medicare does not cover the cost of medicines — that’s where the PBS applies. A gap fee may still apply depending on whether your GP or specialist bulk-bills.

Is HRT for menopause covered by Medicare in Australia?

HRT — more commonly referred to as menopausal hormone therapy (MHT) in Australia — is not covered by Medicare, which funds health services rather than medicines. According to the Australian Government Department of Health and Aged Care, many MHT formulations are subsidised through the PBS, meaning eligible women pay a government-set co-payment at the pharmacy rather than the full price of the medicine. It’s worth asking your GP directly whether the specific formulation being prescribed is PBS-listed, which you can also confirm via pbs.gov.au.

What is the new menopause Medicare item number in Australia?

According to the MBS Online, MBS item 695 is associated with the new menopause and perimenopause health assessment items introduced from 1 July 2025. These assessments are available to women aged 45 and over, or those experiencing early menopause. The assessment is conducted in person by a GP, runs for at least 20 minutes, and covers history and a basic physical examination. It cannot be conducted via telehealth. Mentioning item 695 when you book helps ensure the practice allocates enough time.

How do I find a menopause specialist in Australia?

The Australasian Menopause Society (AMS) Find a Doctor directory is the most reliable starting point — it’s searchable by state and postcode, covers both GPs with a menopause interest and specialists, and shows whether practitioners offer telehealth. Yellow’s directory at spotyellow.com is also a useful resource for finding menopause-informed practitioners around Australia. According to Services Australia, a GP referral is required to access the Medicare specialist rebate.

Can I access menopause care via telehealth in Australia?

According to the MBS Online, the new dedicated Medicare menopause health assessment must be conducted in person — that requirement is fixed. However, according to Services Australia, follow-up GP consultations and many specialist appointments can be accessed via telehealth with a Medicare rebate, which is particularly useful for women in regional or rural areas. Some private telehealth platforms also offer menopause-focused GP services, though these may involve a gap fee. Eligibility criteria for telehealth Medicare rebates can vary, so it’s worth checking with Services Australia or the practice before you book.

Does having a concession card reduce the cost of menopause care?

Yes. According to Services Australia, a Pension Concession Card or Health Care Card reduces the PBS co-payment for listed medicines, meaning you pay less at the pharmacy for subsidised MHT formulations. Concession card holders may also be more likely to access bulk-billing GP services. It’s worth mentioning your concession card to both your GP practice and your pharmacist at every visit to make sure the lower rate is applied.

Sources

• Australian Government Department of Health. Medicare Benefits Schedule — Item 695. MBS Online. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=695&qt=item
• Australian Government Department of Health. Menopause and perimenopause health assessment services. MBS Online. https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Menopause+and+perimenopause+health+assessment+services
• Her Health Medical. New Medicare Support for Menopause from 1 July 2025. Published 24 June 2025. https://herhealthmedical.com.au/2025/06/24/medicare-support-for-menopause/
• Australian Government Department of Health and Aged Care. A stronger Medicare for Australian women. Media release by the Hon Mark Butler MP. https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/a-stronger-medicare-for-australian-women
• North Western Melbourne Primary Health Network. New menopause MBS items: what GPs need to know. https://nwmphn.org.au/news/new-menopause-mbs-items-what-gps-need-to-know/
• Family Health Group. Is It Time for Your Menopause Health Assessment? Medicare Has You Covered. https://www.familyhealthgroup.com.au/golden/news/is-it-time-for-your-menopause-health-assessment-medicare-has-you-covered
• Australasian Menopause Society. Resources for Health Professionals. AMS Hub. https://hub.menopause.org.au/channel/resourcesforhealthprofessionals

This article is for general information only and is not medical advice. Every woman’s situation is different — please talk to your GP or a qualified menopause specialist about what is right for you.