Menopause

Backbench Business – in the House of Commons at 10:52 am on 26 October 2023.

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Photo of Peter Dowd Peter Dowd Labour, Bootle 10:52, 26 October 2023

I beg to move,

That this House
has considered the matter of the menopause.

I thank the Backbench Business Committee for granting my hon. Friend Carolyn Harris this important and timely debate in October, which is World Menopause Awareness Month. Regrettably, she is unable to attend or open the debate, so she has asked me, as a member and the treasurer of the all-party parliamentary group on menopause, to open the debate in her place. I am pleased and privileged to do so. I hope to do justice to her work, and that of the APPG and its supporters in this vital area affecting the lives of millions of women.

Photo of Eddie Hughes Eddie Hughes Conservative, Walsall North

The hon. Gentleman says that this affects millions of women but, as the husband of a menopausal woman, I feel it is incredibly important that men, in their role as colleagues, friends or family members, have a deep understanding of the challenges of menopause, so that they can best support the women in their lives. Does he agree?

Photo of Peter Dowd Peter Dowd Labour, Bootle

The hon. Member is absolutely spot on. That is why the APPG is working across so many areas to develop people’s understanding of menopause—not just women but, importantly, men as well.

The days of whispering the word “menopause” and keeping the changes in women’s bodies a secret and just getting on with it, so to speak, are thankfully beginning to be a thing of the past. The “Manifesto for Menopause” was launched last week at a celebratory breakfast in Parliament to mark World Menopause Day. Alongside the publication of the group’s “Manifesto for Menopause”, the reception featured new findings from a recent survey by Menopause Mandate of over 2,000 women. It found—it is important to get this into context—that 96% of menopausal women’s quality of life suffered as a result of their symptoms and almost 50% took over a year to realise that they might be peri or menopausal.

Photo of Nick Smith Nick Smith Shadow Deputy Leader of the House of Commons

My hon. Friend is making a great contribution. Women have told me that, when they experience symptoms such as itchy skin, aching bones, depression and anxiety, their GPs advise them on how to treat those symptoms, although the cause could be the menopause. Does he agree that extra training and support could help GPs to recognise menopause symptoms better, and could therefore help many women across the country?

Photo of Peter Dowd Peter Dowd Labour, Bootle

That is a valid point and I shall be touching on it later.

According to the survey, only 12% of menopausal women were diagnosed by healthcare professionals, with a huge 60% discovering through their own research that they might be menopausal, and only 20% having had a positive GP experience. Among working women, 64% said that the menopause had a negative impact on them, but only 29% of their employers had a menopause policy.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I commend the hon. Gentleman for raising this issue. It is a massive issue for my constituents and the personal experience through my own wife is very clear. Given that 10% of women leave work during the menopause, saying that they feel and have felt unsupported and unable to continue—which really should not be the case—does he agree that there should be a greater obligation on businesses to help women?

Photo of Peter Dowd Peter Dowd Labour, Bootle

That is another point that I will touch on later, but the hon. Gentleman is spot on.

Anyone who happened to be in Westminster Hall on Wednesday last week will be able to testify to the work that the APPG has done. More than 100 Members and others gathered for a photograph to mark and celebrate World Menopause Day. My hon. Friend the Member for Swansea East said she was not sure that visitors to Westminster Hall were ready to see so many women parliamentarians and others doing impromptu exercise squats. However, she also said that, if it was a good enough location for Henry VIII to play real tennis, it was certainly good enough for a group of menopausal women to highlight the benefits of exercise to their physical health and mental wellbeing.

The fact that those influential women, grassroots campaigners and clinical experts were brought together in Parliament showed the world that Westminster was listening; but listening alone is not enough while women continue to suffer. Listening will not help them get a diagnosis or access to treatment, or find the support they need. That requires action, and on World Menopause Day the APPG, which is chaired by my hon. Friend the Member for Swansea East, launched the menopause manifesto. Based on evidence that the group gathered by speaking to those affected by the menopause and experts in the field, the manifesto sets out seven recommendations, which we are urging all parties to adopt in their own manifestos ahead of the next general election.

I cannot stress enough how important it is to the 13 million women in the UK who are currently perimenopausal or menopausal, and to all around them who are indirectly affected—Jim Shannon raised that point—to know that those in power will support them. The first recommendation in the manifesto is for health checks. Every time that is mentioned in conversation, people are genuinely surprised that it does not already happen. Many will remember receiving, on turning 40—along with the cards, gifts and the good wishes—an invitation to a 40+ NHS health check. Those “MOTs” monitor our weight and blood pressure, and are used to assess the risk of developing conditions such as diabetes, heart disease and strokes. What they do not include for women, at present, are any questions about, advice on or reference to the menopause, which is at best a surprise and at worst quite shocking.

There is strong evidence showing that many women are accessing primary care and being treated for individual symptoms because neither they nor their clinicians are recognising the root cause of those symptoms—a point raised earlier by my hon. Friend Nick Smith.

By raising awareness among medical professionals, who can, in turn, help to educate women at their 40-plus health checks, we can reduce the number of extra visits that women make to surgeries and prevent further misdiagnosis and inaccurate prescribing. We can also dramatically increase the number of women who get prompt and correct diagnoses and access to treatment pathways. We know that this would save the NHS money in the long run.

Many healthcare providers are now starting to include menopause in their standard packages, having identified the fact that patients are being sent for appointments in secondary care for an array of symptoms that have not been correctly diagnosed as menopause. By including menopause treatment as standard, they are reducing the cost to the NHS of these unnecessary appointments.

The second recommendation of the APPG’s manifesto is a national formulary for hormone replacement therapy. Although HRT is not the answer for all women, millions across the country rely on this treatment to manage their symptoms. We know that, in a 10-minute consultation, prescribers do not have the capacity to go searching for alternative treatments if a patient’s usual product is out of stock, and we have seen a supply shortage for many of these products. A national formulary would resolve this issue, as all eligible products would be easily accessible on surgery systems, thus eliminating the postcode lottery and regional variations that women are currently experiencing.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

The hon. Gentleman is most gracious in giving way. He mentioned that there are sometimes disparities from, say, county to county. There are also regional disparities. I know he accepts that, and the Minister has taken note too. When it comes to providing better treatment, a recommendation has to be that every part of the United Kingdom—England, Scotland, Wales and Northern Ireland—should have an agreed strategy for helping women. Does he agree that there should be the same policy, the same strategy and the same response everywhere?

Photo of Peter Dowd Peter Dowd Labour, Bootle

I agree with the hon. Gentleman. It is crucial that women are able to go to any surgery and, although there may be marginal differences in treatment or access to treatment, the substance is that they should ultimately get more or less the same access and the same treatment, depending on their needs.

The third recommendation also relates to prescribers. The manifesto calls for the inclusion of menopause as an indicator within the GP quality and outcomes framework. This change would help to balance the deficit in knowledge and understanding among GPs by incentivising improvement in diagnosis levels and treatment provision within primary care. If clinicians were better informed, they would be more confident in discussing menopause with patients at their health checks and in prescribing appropriate treatment, which would greatly benefit patients who visit their GP to seek support.

Moving away from healthcare, I am proud to say that, earlier this year, Labour committed to the fourth recommendation: mandating that all companies with more than 250 employees introduce menopause action plans to support those experiencing symptoms. That goes some way to addressing the points raised by hon. Members.

Alongside this, the APPG would like to see the provision of specific guidance for small and medium-sized enterprises and the introduction of tax incentives to encourage companies to integrate menopause in their occupational health plans. There are great examples of companies embracing the issue, and there are some excellent tools available to help, such as the British Standards Institute’s menstruation, menstrual health and menopause in the workplace standard. With research showing that one in 10 women are leaving the workforce and thousands more are reducing their hours or avoiding promotion, it is vital that more is done to address the impact of menopause on women’s economic participation.

The APPG is not asking for women to be given special treatment; we are asking merely for an understanding that working arrangements and environments may need to be flexible. This willingness to incorporate flexibility will benefit businesses, boost the economy and give women the confidence to progress in their career.

The manifesto’s fifth requirement is about the licensing of testosterone for women. It has always struck me as odd that when women reach menopausal age, which is different for everyone, they become deficient in three hormones—oestrogen, progesterone and testosterone—yet only the first two are available to women when they are prescribed hormone replacement therapy on the NHS. As my hon. Friend the Member for Swansea East has noted previously, if a woman wants the third hormone, they have to pay for a private prescription. The all-party group is calling for an evaluation of female-specific testosterone treatments, with a view to their being licensed by the Medicines and Healthcare products Regulatory Agency.

In the sixth recommendation, we are calling for better funding for research into the potential links between menopause and other health conditions, as well as the varying experiences of women from different backgrounds and ethnicities—that is very important. We know from the evidence that the APPG has received that those with conditions such as autism and attention deficit hyperactivity disorder can struggle more with their menopausal symptoms, and that those who have been treated for cancer often experience early menopause. So it is vital that much more is done to better understand the different journeys that women from different backgrounds are experiencing. In the past week, my hon. Friend told me said that she had been lucky enough to visit two universities, one in London and the other in her own home city of Swansea. Both are keen to do more to support their staff and to bridge the significant gaps in understanding around more complex menopause experiences.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the hon. Gentleman very much for the scene he is setting. Small and micro-businesses are predominantly male-owned, so the issue for them is understanding how to put over the requests on behalf of ladies who are going through the menopause. Does he feel that the Government and the Minister should take that on board as well, to ensure that those businesses have the relevant information and guidance to do that within the small workforce that they look after?

Photo of Peter Dowd Peter Dowd Labour, Bootle

The hon. Gentleman makes a good point and sets out an excellent idea. I am sure that the Minister, as part of the expansion or integration of the manifesto, can take it on board.

As I was saying, my hon. Friend was delighted that Swansea University announced last Friday that it would be introducing menopause into the curriculum for all of its medical students, as well as launching a menopause clinic for staff and students. I truly hope that it will be the first of many universities to do this. Future policy in this area, and an improved women’s health strategy, will be possible only if more funding is dedicated to this vital research.

The seventh and final part of the manifesto calls for a review of the demand for specialist menopause care. We need to look at existing provision, evaluate where increased secondary care is needed and assess other ways in which women could seek help. That might, for example, include access to specialist nurses in primary care and pharmacists, to ease the demand on GPs. That is another simple recommendation that would be easy to achieve, while having a significant impact on the care and support that women are able to access.

Nothing in the all-party group’s manifesto is difficult to achieve; no big contracts or big budgets are needed to make the changes that will significantly improve women’s experiences. The only thing that is needed is a commitment to prioritise this area of women’s health. We need a commitment to improve support, diagnosis and access to treatment for all those who need it. Who would not want that? I know that every Member of this House would want it. We need a commitment to show the 51% of the population who will directly experience menopause that they matter—that they really matter.

Photo of Eddie Hughes Eddie Hughes Conservative, Walsall North 11:18, 26 October 2023

It is an absolute pleasure to follow my good friend Peter Dowd. I was originally excited to see that Carolyn Harris was going to be opening the debate, simply because her enthusiasm for this subject is contagious and draws people in, but he has done incredible justice to the opening of the debate.

It is marvellous to see a number of male colleagues in the Chamber. I grew up in a house with five brothers and an Irish Catholic mother, and the word “menopause” would in no circumstances ever have crossed her lips. I then went to an all-boys school and went on to do civil engineering at university. There were no girls at my school and just two women on my civil engineering course, in the whole of the department, so my exposure to women was somewhat limited until I finally got off the building site and into a traditional workplace. There I found that men whose experience was not as sheltered as mine had no greater knowledge or understanding of this topic, although I felt they had far less excuse.

So when my wife began to experience the symptoms of the menopause, originally neither she nor I, nor her GP, fully understood what was going on—certainly, menopause was not the initial diagnosis. That highlighted for me how difficult and challenging it must be for some women: they present to their GP, the GP misdiagnoses or misunderstands their symptoms, and then the problem is protracted because the appropriate treatment is not identified quickly enough.

With an understanding of that and as an MP representing the good people of Willenhall, Bloxwich and Walsall North, it was important to me to engage as much as possible with people who could help. We found a place for a menopause café—somewhere where women and men could come and sit down and talk about this topic, over a cup of tea and a slice of cake, in a relaxed environment. I think it is beholden on us, particularly male colleagues, in our role as MPs, to do everything we can to ensure that everybody is as well informed as possible. As I said in my intervention, in our male roles as family members, friends and relatives, it is incredibly important for us to first understand the symptoms and the range of appropriate treatments available, so that we can fully provide the necessary support.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

The hon. Gentleman has mentioned families, groups and work colleagues. Does he agree that women who go through early menopause may find it difficult to discuss the subject with their employers? Those conversations need to be had, to ensure that women of any age are supported and enabled to engage fully in all aspects of their workplace instead of being excluded, perhaps unintentionally.

Photo of Eddie Hughes Eddie Hughes Conservative, Walsall North

I thank the hon. Gentleman for that intervention. Given that my wife, myself and her GP did not fully understand what the symptoms were and at what age they could arise, it is completely understandable that an employer might be challenged in terms of providing such support. That is why it is vital that we do our best to ensure that everybody is as well informed as possible, because, exactly as the hon. Gentleman says, such symptoms might start to appear at any age, so it is important that their root cause is identified quickly and people can provide that support.

I am delighted to say that, now that my wife has a very senior role in her company, it is easier for her to drive that ethos throughout the company. I pay credit to phs Group for its work countrywide. I have invited the hon. Member for Swansea East to come and speak at one of its offices in the south of Wales—I hope we can arrange that soon.

I pay tribute to all colleagues in the Chamber today, particularly the men in our role as champions, fighting side by side with the women to ensure that this topic is completely understood by as many people as possible, so that we can all provide the support that is so well deserved.

Photo of Judith Cummins Judith Cummins Labour, Bradford South 11:14, 26 October 2023

It is a pleasure to speak in this debate, with my hon. Friend Peter Dowd stepping in to lead it so ably, showing that menopause is not just a woman’s issue, but a health issue that affects more than half the population. As such, it should be of concern to us all, as was so ably highlighted by Eddie Hughes, whom I am pleased to follow in this debate.

I thank my hon. Friend Carolyn Harris for all her hard work in this area, which is well known right across the House. I congratulate her on securing this debate. I am only sorry that she is unable to be in her place today, but I know how dedicated she is to this issue and I am sure that her important work will be reflected throughout the debate, because, as many of us know, there is no stopping her when she gets going.

This is a timely debate, which I will use as an opportunity to draw attention to the link between osteoporosis and the menopause. The menopause is an important time for bone health. When women reach the menopause, oestrogen levels decrease, which causes many women to develop symptoms, such as hot flushes and sweats. The decrease in oestrogen levels also causes loss of bone density, so the menopause is an important cause of osteoporosis.

While one in five men develop osteoporosis in their lifetime, half of all women over 50 will have to learn to live with it. This summer, the all-party parliamentary group on osteoporosis and bone health, which I chair, has worked in partnership with the Royal Osteoporosis Society to run the Better Bones campaign. Our campaign calls for a timely diagnosis for the 90,000 people—most of them women—who currently remain undiagnosed and untreated. I am calling on the Government to introduce universal access to fracture liaison services, the world standard for fracture prevention. We know that osteoporosis is one of the world’s most urgent health issues. Seventy five per cent of 90,000 people missing out on anti-osteoporosis medication are women. That is why the Fawcett Society and the British Menopause Society are among the many charities and organisations supporting the Better Bones campaign.

Everyone loses bone density and strength as they get older, but women lose bone density more rapidly in the years following menopause, often losing up to 20% of their bone density during this time. With this loss of bone density comes reduced bone strength and a greater risk of fractures. When treated, people can expect to live normal, healthy lives. Sadly, as it currently stands, a quarter of women have to endure more than three fractures before receiving the diagnosis that they so desperately need. Placing osteoporosis at the forefront of menopause care is paramount to ensuring that women maintain good health throughout the menopause period and beyond.

In 2021, the all-party parliamentary group produced a report highlighting the benefits of fracture liaison services in ensuring quick diagnosis and access to safe, effective medication, which can then strengthen patients’ bones. Their proven success is why the FLS model is the world standard for fracture prevention, used in more than 50 countries. However, in this country, only 57% of the eligible population have access to fracture liaison services. I am using this debate to call on the Government to provide 100% fracture liaison service coverage for people living in the UK, ending the postcode lottery once and for all.

In August, the Health Minister publicly stated that the Government would make an announcement on establishing more fracture liaison services by the end of this year. Then in September, in the other place, a Government Minister stated that the autumn statement would include a package of prioritised measures to increase the number of FLSs and their quality. I understand that, since then, there has been a walking back on this commitment, but, on behalf of the 90,000 people missing the life-saving and life-changing medication, I ask the Government to hold their nerve and to act quickly.

Full FLS coverage would cost £27 million per year in additional funding, with a total benefit of £440 million over five years. FLS delivers a return on investment of more than £3 for every £1 invested, and 100% FLS coverage would also prevent 74,000 fractures within five years, releasing 750,000 hospital bed days. Therefore, placing osteoporosis at the forefront of menopause care is essential for the future of women’s health in this country, ensuring that women going through menopause can continue to live healthy and fulfilling lives.

The decision to provide full FLS coverage in England not only is fiscally responsible and right, but would be an historic leap forward in women’s healthcare in this country.

Photo of Gerald Jones Gerald Jones Shadow Minister (Wales), Opposition Whip (Commons), Shadow Minister (Scotland) 11:19, 26 October 2023

I thank my hon. Friend Carolyn Harris for securing this important debate during World Menopause Awareness Month, and my hon. Friend Peter Dowd for his powerful opening speech.

When I first came to this place, I never imagined that I would be standing here talking about menopause, but I am delighted to say that tomorrow in my constituency of Merthyr Tydfil and Rhymney we are hosting a menopause in the workplace workshop. This is the third event of its kind in south Wales, following on from others in Swansea and Cardiff, and I am thrilled that I am able to help local businesses in our community to better understand what they can do to support the people who work for them.

As my hon. Friend the Member for Bootle mentioned, in its manifesto for menopause, launched last week, the all-party parliamentary group on menopause called on all political parties to commit to supporting those experiencing the menopause in their own manifestos ahead of the next general election. One of the calls was for future Governments to mandate companies that employ more than 250 people to introduce menopause action plans—something that Labour has already said that it will commit to.

Almost half of the UK working population are women, and those over 50 are the fastest growing group in the workplace, which highlights why this issue is such a priority. We need to retain the skills and experience that those women have and support them so that they continue to thrive in their careers as they grow older, but evidence suggests that there is a lot of work to be done. With one in 10 women leaving the workforce because of their menopause symptoms, and thousands more reducing hours and avoiding promotion, it is vital that employers are given the tools to support those women and to change that.

There is no one-size-fits-all answer. Working environments differ greatly, as do women’s experiences. With more than 40 possible symptoms, from hot flushes to brain fog, and insomnia to anxiety, women will all have their own individual needs when it comes to support at work, so we need businesses to commit to putting an action plan in place that works for them and their employees. It might include flexible working hours, if women are having to travel on busy public transport; alternative uniforms that are considerate of the symptoms that women may experience; a guaranteed desk near a window that can be opened; or the introduction of support groups, menopause champions, or management training in the business.

We need a guarantee from employers that they will support staff who are experiencing symptoms to remain in work and to progress in their careers. As I mentioned, tomorrow in my constituency of Merthyr Tydfil and Rhymney we are welcoming a host of businesses to an event at Merthyr town football club, to give them guidance on what more they can do. I am delighted to do my part to help with that, and I am grateful for the support of my hon. Friend the Member for Swansea East in making it happen. The whole House will know just how powerful an advocate my hon. Friend is. I can think of no one better to be a menopause champion than her. I pay tribute to her for all the work that she has done, and continues to do, on this and many other topics.

We have come a long way in recent years, breaking down the barriers and making the menopause something that we are now all talking about. There is still lots to do in terms of raising awareness, but a start has been made. Attending a session of menopause word bingo with my hon. Friend was not something that I had thought I would do, but it helped to raise my awareness, which in turn will help me to advocate on behalf of the constituents I represent. Now we need to take the next steps to ensure that women are supported and given the help that they need in the workplace and beyond.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Transport), Liberal Democrat Shadow Leader of the House of Commons, Liberal Democrat Spokesperson (Energy and Climate Change) 11:23, 26 October 2023

I commend the APPG on bringing this important issue to the House, and I thank the Backbench Business Committee for granting today’s debate. The menopause is a time of change for every woman. For some, it can be completely debilitating. Big physical and emotional changes in one’s body can be extremely unsettling. Some 51% of our population are women, who all go through the menopause, yet the experience of the menopause remains shrouded in mystery and stigma. That means there are far too many barriers to support. Too often, women must fight before their symptoms are taken seriously, which adds insult to injury.

The culture of silence that surrounds menopause makes bearing and dealing with symptoms even harder. Research by the Fawcett Society found that only 22% of people who experience menopause disclose it at work, because they are worried about the stigma they may face. Why should women feel too ashamed to talk? The Government’s appointment of the first menopause employment champion is a step in the right direction to start this much-needed conversation. However, it has taken far too long and there is still much to do.

As we have heard, many women choose to leave the workforce prematurely because they feel unsupported by their employer during the menopause. That is not new information: the Chartered Institute of Personnel and Development found in 2019 that almost 900,000 women in the UK had left their job because of menopause symptoms, and we have made little progress since. Women with years of experience are still forced to sacrifice their career, retire early or choose not to put themselves forward for promotion. Not only does that contribute to an absence of women in executive positions, but it lessens workplace productivity.

Eight out of 10 women say that their employer has not given them adequate support. I am pleased to hear of good examples in this space; it is important that we share them, because there are still far too many bad examples. Such support could include a menopause absence policy to help women balance their career with the major life changes associated with the menopause.

I welcome the Government’s commitment in the women’s health strategy to ensuring that employers are well equipped to support women during the menopause, but the Government have shown little interest in trialling menopause leave in England, despite the evidence presented by the Women and Equalities Committee that it would make considerable savings. The private sector is beginning to understand the economic benefit of menopause leave. The Government should explore all avenues to best support women experiencing menopause, including a trial to see the benefits of menopause leave.

Alongside difficult everyday symptoms, those who experience menopause face risks to their health. During menopause, the body produces less oestrogen, which can increase the risk of coronary heart disease, heart attack and stroke. Women also face greater risk of osteoporosis—I am pleased that Judith Cummins talked extensively about that—caused by the loss of bone density in the first few years after the menopause.

I am proud that the Royal Osteoporosis Society is based in Bath, and I congratulate it on its campaign with the Sunday Express for greater access to fracture liaison services and a good standard of services across the country. We have heard today about the Better Bones campaign. I hope that everyone in the Chamber will champion it and help it along, because we really need that gold standard across all hospital trusts. The Royal Osteoporosis Society has a very helpful helpline that everyone can access. Just by googling the Royal Osteoporosis Society, every woman can access advice, which is so necessary.

We have also heard extensively about hormone replacement therapy, which can lessen the health risks from menopause. HRT is a welcome treatment for many struggling with menopause symptoms. It can reduce hot flushes and protect cardiovascular health. However, it remains out of reach for many women across the UK. Women face a postcode lottery when it comes to accessing vital HRT treatment. A report conducted by the APPG on menopause last year found that there is a stark socioeconomic divide between women who can access HRT and those left without it. Financial struggles should not be a barrier to healthcare. I commend the APPG on menopause for all seven of its recommendations. The call for all parties to include those recommendations in their manifestos is a good one.

We Liberal Democrats welcome new measures to ensure that women in England pay less for repeat HRT prescriptions. However, the list of exemptions for prescription charges is out of date: it has not been fully updated since 1968 and contains many anomalies. The current prescription charge system is grossly unfair and must be urgently reformed.

Menopause currently affects 13 million women. We cannot continue to allow a common health issue to force women out of their jobs. It is unacceptable that accessing vital healthcare is still a postcode lottery. I have not actually experienced any adverse symptoms from menopause, but I was still completely uncertain about what to expect, and that in itself is very unsettling. Young women know what to expect when their period starts, but why are older women not given at least some advice by healthcare professionals about what to expect when the menopause starts, what the symptoms are and so on and so forth? It is very unsettling for every woman that complete mystery still surrounds the menopause, and that definitely needs to change. I hope that the debate will help to break the culture of silence and end the stigma.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 11:31, 26 October 2023

I commend Peter Dowd for setting the scene so well. I have made a few interventions, but I will add a few words to put on record my support for the motion, as I am here on behalf of my party.

Eddie Hughes made an interesting point to which I subscribe from a personal point of view. My wife Sandra went through this, and it was quite difficult for her, not just physically but emotionally. The hon. Gentleman put forward some incredibly helpful ideas: better understanding in the home, better understanding in the family and better understanding in the workplace. I employ seven girls and one fella in full-time and part-time roles, and although I am not better or more knowledgeable than anyone else, I do understand some of the issues that are apparent in the office. That understanding has to start with me and end with everyone in the staff to ensure that the right things happen.

Over the last period, we have had a menopause support group in Northern Ireland. It was created for one reason. The hon. Member for Walsall North referred to a private place. Sometimes people need a private place where they can discuss their experiences and talk about what is happening with others, sharing information on the perimenopause, the menopause and any hormone-related issues. I know the knowledge that women will be able to give each other in those private circumstances and discussions. That is so very important.

Judith Cummins, who has the Adjournment debate on osteoporosis, reminded us all of the increased risk of osteoporosis, fractures and brittle bones through menopause. She clearly and helpfully reminded us that when it comes to understanding those things better, the health sector needs to be a bigger part of the picture.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Transport), Liberal Democrat Shadow Leader of the House of Commons, Liberal Democrat Spokesperson (Energy and Climate Change)

It is important that everybody understands that osteoporosis leads to many premature deaths. That is why we need to talk more about it. I am glad that we have all been talking about osteoporosis in connection with the menopause. Does the hon. Gentleman agree that we need to raise awareness of it, because it leads to many premature deaths?

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the hon. Lady for her intervention. I referred to the groups in Northern Ireland because, in many cases, we find that it is the women themselves who are initiating the private support groups and ensuring that things are happening. I ask the Minister, is there any help from Government to ensure that these advice groups are available?

To go back to the subject of osteoporosis, the hon. Member for Bradford South is right. In my office, I have a staff member specifically tasked with looking after benefit issues, and the work for that lady is enormous; she is probably working the equivalent of a five or six-day week. She tells me that, in many cases, the issue is access to personal independence payments. I know that this does not come under the Minister’s Department, but is there a process in place to help ladies understand and apply for that benefit, which is there for a purpose? Government have created the benefits system, and people should never feel that they should not apply for a benefit if it is there for them, which I believe it is.

When people are drained and emotionally raw, which many are, and when the sweats mean they have to shower several times a day and they need prompting to eat and take care of themselves, we need a system, and we need someone there to help along the way. I am my party’s health spokesperson, and I want to add my support to all those who have spoken.

The Government need to be proactive and ensure that guidance is given to businesses, so that they can do things the right way. Some 45% of women felt that menopausal symptoms had a negative impact on their work, and 47% said they needed to take a day off work due to the menopause. That underlines the need for support.

With that, I will conclude, ever mindful that we are fortunate to have a shadow Minister, Abena Oppong-Asare, who will add her support to the debate—I look forward to hearing from her—and a Minister who well understands our requests. I am very confident that we will have the help we need, not for us, but for our constituents, for the women who contact me, for my wife and for all the other women who find it very hard to deal with these issues.

Photo of Abena Oppong-Asare Abena Oppong-Asare Shadow Minister (Women's Health and Mental Health) 11:36, 26 October 2023

I congratulate my hon. Friend Carolyn Harris on securing this important Backbench Business debate; I am sure we all agree that she has been a fantastic champion on this issue. I would also like to thank my hon. Friend Peter Dowd for opening the debate. I can say with certainty that he did this debate justice, talking powerfully about the concerns of my hon. Friend the Member for Swansea East, as well as referencing where improvements need to be made and the newly launched “Manifesto for Menopause” by the menopause APPG. They have done fantastic work.

I thank those who have contributed to today’s discussion. It has been particularly uplifting to see male colleagues also speaking in the debate. It is important that we all discuss this issue and that it is not just on the shoulders of women to raise it. As Eddie Hughes said, our role as MPs is to inform people, and particularly men, who have a powerful role to play in providing the support that is needed. He also talked about the phs Group, which has been doing great work on this issue.

I thank my hon. Friend Judith Cummins, who highlighted really well the fact that menopause is not just a women’s issue but a health issue for everyone. My hon. Friend Gerald Jones talked about how companies can play a role by ensuring that employees are supported through the menopause and about Labour’s plans for the workforce. He highlighted the fact that over half of the workforce are women, and with one in 10 women leaving work because of the menopause, we need to do more to retain their skills. Wera Hobhouse powerfully explained how women have to fight before symptoms are taken seriously, and Jim Shannon talked about how his wife went through menopause and how it is important to understand this issue at home. I thank him for sharing his personal story.

As we all know, for far too long women’s health has been a marginalised issue, and when it comes to women’s health, the issue of menopause is critical. It affects every woman, yet time and time again, we in this country have neglected doing the right and obvious thing: to support women experiencing the menopause. I will not be presenting any groundbreaking information today, since all Members present are aware of the inadequate quality of care and support that women currently receive. For instance, there is the staggering finding—which has been highlighted —that nearly one in 10 women must consult their GP on 10 separate occasions before receiving proper guidance and support regarding the menopause. Of those women who did eventually receive treatment, 44% waited at least one year, and 12% waited more than five years. I am sure Members agree that those statistics are staggering.

One in 10 women have quit their job because of menopause symptoms, despite the fact that menopause affects every woman. As my hon. Friend the Member for Swansea East has mentioned on previous occasions, although women are 51% of the UK population, only 59% of medical schools included mandatory menopause education in their curriculum. Further important findings were released last week by Menopause Mandate reinforcing the inadequacy of support. Those findings confirm that not only do nearly all women experiencing the menopause find that the symptoms have a negative impact on their quality of life, but the vast majority face negative experiences at their GP and significant barriers at work. The finding that only 24% of women have a positive experience at their GP is surely a damning indication of how much further there is to go.

I warmly welcome the release of the manifesto by the APPG on menopause and the important words that have been spoken by Members today. It is one step further in this positive campaign, and in the work my hon. Friend the Member for Swansea East has done to put the menopause on the map and act on an issue that has been in the shadows for far too long. She is a trailblazer, and I am privileged to have the opportunity in my new brief to work more closely alongside her on these issues and make sure we realise many of the changes she has been fighting for. Education on the menopause is the first important step towards progress: when seeing our GP, we rely on their knowledge and guidance, yet too often, we hear stories of women who go to their GP again and again without proper diagnosis. Some women have said that it is a gamble whether their individual doctor prescribes them the treatment they need, which has been echoed in some of the contributions to this debate.

It is therefore essential that we seek to improve the education and training of healthcare professionals across the NHS with regard to the menopause. As well as looking at those who are training now, we must look at those who are currently practising—those whom we currently rely on to diagnose and assist the millions of women experiencing the menopause today. Furthermore, as with all health concerns, early detection is essential. When it comes to menopause, early detection can prevent much unnecessary pain and suffering. That is why Labour has been so focused on making our health and care services deliver a prevention first revolution that would support our NHS, our economy and, importantly, women. If we fail to progress on awareness, early detection and prevention, we are surely failing at the first hurdle.

Turning to the availability of hormone replacement therapy products, I want first to commend the progress that has been made, and again praise the work of my hon. Friend the Member for Swansea East. It was her private Member’s Bill and her determined campaigning which, two years ago, saw the Government finally commit to reducing dramatically the cost of HRT prescriptions for women in England. I commend her on not giving up—on raising awareness and constantly pushing for change on this issue. It is also important to acknowledge the positive steps we are introducing, with a dedicated page on the NHS website for women’s health. I hope this becomes an invaluable source for women to access the latest information and advice on menopause, HRT and all women’s health issues.

But while progress has been made on access to HRT, the Minister will surely be aware that women face an HRT postcode lottery, and, as with so many health issues, those in the most deprived areas are least likely to receive support. It is important that we tackle the structural inequalities that contribute to poor health for disadvantaged groups.

Additionally, we must not forget the serious failures that have led to the continued shortage of HRT drugs. Women seeking to access HRT are still being failed by the system, with drugs unavailable and alternatives out of reach. This has left so many women with debilitating symptoms, extending unnecessary pain and suffering. Education and informing clinicians are no good if we do not also improve access to HRT and end shortages. As my hon. Friend the Member for Swansea East has said, it is a very bad sign when only 14% of the 13 million women experiencing the menopause in this country are getting treatment. I hope the Minister can update the House on the Government’s actions on ensuring that shortages of these essential treatments do not happen again and improving access to HRT for women.

Fundamental to progress for women experiencing menopause would be progress for women in the workplace. As my hon. Friend Anneliese Dodds has announced, a Labour Government would advance this issue by bringing in menopause action plans for large employers and publishing guidance for small businesses to support women suffering with menopause symptoms. These important steps are part of our plans for a new deal for working people and will make Britain work for working women. These reforms will give hope to women and significantly help all who work so hard to hold their jobs and care for their children and families while experiencing the challenges and symptoms of menopause. This is the right thing to do for these women, but it is also good for employers and the economy as a whole.

It is a tragedy that one in 10 women experiencing menopause leave their jobs and 14% reduce their hours due to lack of support in the workplace. That means hundreds of thousands of women are reducing their hours, giving up promotions or quitting their jobs because of the menopause. Labour is on the side of these women, wherever they work, and unlike the Government, we have committed to take the required action. Does the Minister not agree they are failing women in the workplace and damaging the economy as a result?

I finish by praising all who took part in the menopause revolution in our country. I am sure the whole House will agree that not only has this revolution begun but that it will continue to grow. Central to the revolution is my hon. Friend the Member for Swansea East, whom I congratulate again on championing this cause. If we get this right, the difference we can make for the millions of menopausal women will be life-changing, benefiting them and all future generations of women, so that no woman has to suffer in silence again.

Photo of Maria Caulfield Maria Caulfield The Parliamentary Under-Secretary for Health and Social Care, Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women) 11:48, 26 October 2023

I congratulate Carolyn Harris on securing this debate, and I am sad she is not here to join us this afternoon because we have held this debate on almost an annual basis and have made huge progress in achieving some of her asks. She is a tireless voice for women in this place, always raising awareness and inspiring action, and I am very proud to be working with her as co-chair of the menopause taskforce. One key piece of work by the Government has been to respond to one of her asks and reduce the cost of NHS prescriptions for HRT. Of course, there is much to be done. Our women’s health strategy has made the menopause a key priority area. For far too long, women’s health was a secondary consideration. This Government have put it top of the agenda—menopause, fertility, baby loss, dementia and osteoporosis are now priority areas for this Government—and we are the first Government to do so.

There has been a menopause revolution here this morning. I really thank Peter Dowd for presenting the debate. We have heard from four male colleagues—the hon. Members for Merthyr Tydfil and Rhymney (Gerald Jones) and for Bootle, my hon. Friend Eddie Hughes and Jim Shannon—which is twice the number of women Back Benchers contributing. It is absolutely positive news that we have made so much progress that the menopause matters to men as much as it does to women. In my own Department, to mark World Menopause Day we organised a session during which officials tried on the world’s first menopause simulator, so that men could experience some of the side effects. It was a great success, and many male colleagues went away with an enhanced appreciation of women’s experience of the menopause. I also thank the all-party parliamentary group for its important work. It does a huge amount to shine a light on the issues, particularly with its manifesto for menopause.

I hope the House will give me some time to update it on the progress we have made since our last debate in the Chamber. First, a number of Members have mentioned the HRT prepayment certificate. It has been rolled out since April, and women can pay less than £20 a year for all their HRT prescriptions for 12 months. Many women are on multiple products—they are often on dual hormones—and each of those has a prescription cost. However, just to reassure colleagues, about 89% of all prescriptions are not paid for and there are no charges, and for HRT about 60% pay no prescription charges at all. For those who do, the £20 a year absolutely makes a difference, and it could save women hundreds of pounds on the cost of their HRT. In the spring, we launched a successful campaign to alert women to these changes, and I am really pleased to say that, as of the end of September, well over 400,000 women in England had purchased a HRT prescription prepayment certificate. For anyone who has not got one yet, they can be purchased online, but they can also be purchased in some pharmacies.

The shadow Minister, Abena Oppong-Asare, mentioned HRT supply, which has been an issue over recent months. We have seen a huge wave of women coming forward asking for HRT from their GP, and GPs have been much more comfortable in prescribing HRT, which did put pressure on supplies. There are over 70 products available in the United Kingdom, and in fact the majority of them remain in good supply. We have held six roundtables with suppliers, wholesalers and community pharmacists to discuss the challenges they were facing, and these have delivered results. Since April last year, there were 23 serious shortage protocols for HRT—relevant to 23 products—but as of today only one of those remains in place. That means that at the moment there is only one product for which there is a serious shortage protocol, meaning alternative dispensing or reduced dispensing occurs. We are holding a seventh roundtable later this month, and manufacturers are confident that, in producing and securing more, there will be supplies to be used. That is a real success story, and when women have their prescription, they can be confident that their prescription will be available at their pharmacy.

A key part of our menopause taskforce has been talking about research into the menopause and management of the menopause. The National Institute for Health and Care Research has conducted an exercise to identify research priorities, which concluded in January. I cannot remember which hon. Member mentioned testosterone, but research into how testosterone can alleviate menopausal symptoms has been identified as a gap. It is not licensed for use in the menopause because there is not currently the evidence base for the Medicines and Healthcare products Regulatory Agency to allow a licence. Having that research into testosterone and the improvements it could bring is a crucial step towards any licensing of that hormone. That is why it requested bids for organisations to come forward with research proposals in this area, and we expect an update in December. I am also pleased to update that between April last year and July this year, the NIHR has invested £53 million to support women’s health. On World Menopause Day, it funded the James Lind Alliance to launch its menopause priority-setting partnership. That is crucial in developing the evidence base for better management of the menopause.

I will just touch on a number of other points that were raised. First, on health checks, I have asked the NHS health check advisory group to review the case for including the menopause in the NHS health check alongside its broader future considerations on the health check, following the delivery of the digital check next spring. I will keep the House updated on that work, particularly the hon. Member for Swansea East, as co-chair of the menopause taskforce, because it is crucial that it is included.

We have started the process to set up women’s health hubs across every ICB in the country, because our ambition is for women and girls to access services for women’s health more generally in the places where they live. That is why we are investing £25 million to expand women’s health hubs across England. Hubs will deliver a range of healthcare experiences, but we would expect the menopause and advice on it to be covered by women’s health hubs. We are meeting ICBs shortly to get an update on progress.

One other point raised was about conducting a review into specialist menopause care. It is important to remember that specialist menopause care is not funded by central Government, but is commissioned by integrated care boards and implemented at a local level. They have a statutory responsibility to commission healthcare that meets the needs of whole populations, including for the menopause, but we know that is not always happening on the ground.

Photo of Nick Smith Nick Smith Shadow Deputy Leader of the House of Commons

I acknowledge that the Government are making good progress on this topic, and I thank the Minister for that. Having said that, my hon. Friend Abena Oppong-Asare spoke from the Labour Front Bench about training and development for GPs on supporting women with menopause symptoms. Can I press the Minister to tell us more about the Government’s plans to boost training and development for clinicians to help women experiencing the menopause?

Photo of Maria Caulfield Maria Caulfield The Parliamentary Under-Secretary for Health and Social Care, Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

The hon. Gentleman makes a valid point, and I will come on to that in a moment, because we are making huge progress there. If I may, I will touch on specialist support for the menopause. We will be working with ICBs, and when we meet shortly to ask for updates, we will be looking at the progress being made at the local level in providing that support. We have tried to ensure that information for women is as accessible as possible. We launched our dedicated women’s health area on the NHS website recently, where there is advice and support on the menopause, as well as for other health conditions. That will be updated regularly. Women now have a trusted source to go to for healthcare and advice. That includes a new HRT medicines hub, providing information about the different types of HRT and other options, because HRT does not work for every woman, and sometimes women have to try several types to get one that works for them.

Workplace support has also come up. As Employment Minister, my hon. Friend Mims Davies has made huge progress. In March, we appointed Helen Tomlinson, who is the menopause employment champion. This month, she published a report with a four-point plan to improve menopause support in the workplace. Organisations such as Wellbeing of Women offer support to businesses, small and large, on how to improve their offer to women. Many of the suggestions that have been made in this place are being taken up, and they do make a difference. We hear from women all the time about the difference they make. This month we launched a new space for guidance on the helptogrow.campaign.gov.uk website. Large or small, businesses can get advice there about the difference they can make in the workplace not only in retaining women, but in having open conversations in the workplace. Flexible working is a key part of that.

To touch on the GP point, we are looking this year to consult on the future of the quality and outcomes framework, which is one of the measures used to look at health conditions, to see whether the menopause should be included. We fully recognise the importance of ensuring that GPs ask the right questions so that women get the right support. We intend to have those conversations with GPs about the QOF framework.

We are also, rightly, looking at staff training and developing education and training materials for healthcare professionals across the board, not just GPs, so that healthcare professionals have better awareness of the menopause. My hon. Friend the Member for Walsall North and the hon. Member for Strangford pointed out that women often go and ask for help, but their signs and symptoms are not recognised as being related to the menopause. Our women’s health ambassador, Professor Dame Lesley Regan, is doing crucial work on engagement in this place. We are also ensuring that GPs are assessed on menopause as a measure in their training. From next year, all medical students will have to complete a module that includes menopause so that doctors, whether GPs in primary care or in secondary care, have better awareness of the signs and symptoms and management of the menopause, so that when women approach for help, they will be better supported.

I thank all hon. Members for their contributions to the debate. We have taken great strides in the last 12 months in supply of HRT and reducing the cost, rolling out women’s health hubs, but I know that there is more work to be done. I know also that the hon. Member for Swansea East will be back to hold my feet to the fire, and I look forward to working with her as co-chair of the menopause taskforce.

Photo of Peter Dowd Peter Dowd Labour, Bootle 12:01, 26 October 2023

I thank all hon. Members who took part in the debate. I also thank my hon. Friend the Member for Swansea East, who regrettably cannot be here. I hope that I have been able to do justice to the points she raised with me.

I thank Eddie Hughes for relating his personal experiences and reinforcing the need to provide the support that women so rightly deserve. I also thank my hon. Friend Judith Cummins, who has done sterling work in relation to the Better Bones campaign and the inextricable links between osteoporosis and menopause.

My hon. Friend Gerald Jones is, as ever, working in his constituency. He referred to his menopause workshop. I am really interested in the word bingo. I am intrigued about that and will speak to him about it in due course. Wera Hobhouse referred among other things to the review of the prescription regime, which is really needed. As ever, the interventions by Jim Shannon were spot-on, clear and precise. I am pleased to have his party’s support on this matter. My hon. Friend Nick Smith, who intervened a couple of times—once on me—was focused on the key element of clinical awareness.

I thank the shadow Minister, my hon. Friend Abena Oppong-Asare, for her response, particularly in relation to Labour’s workplace charter. I am pleased about the reaffirmation of that. I also thank the Minister for referring to the four-point plan for the workplace that is in progress, to the QOF review and to training in menopause.

We have covered a wide-ranging area. The seven recommendations or asks in the manifesto are out there for all to see. No doubt, we will return to this matter time and again. I hope that in the next 12 to 18 months we can make even more progress than we have in the past couple of years.

Question put and agreed to.

Resolved,

That this House
has considered the matter of the menopause.