Menopause

– in the Scottish Parliament at on 21 May 2019.

Alert me about debates like this

Photo of Linda Fabiani Linda Fabiani Scottish National Party

Are we all okay? I have heard of delaying tactics, but that is ridiculous.

The next item of business is a debate on motion S5M-17347, in the name of Christina McKelvie, on ending the stigma of the menopause.

Photo of Christina McKelvie Christina McKelvie Scottish National Party

I wanted to start the debate with a splash, which is clearly what I have done.

I am pleased and proud to open the debate on behalf of the Government. I believe that it is the first ever Government debate held in the UK on the menopause. This Parliament should be proud of itself. The debate comes at a time when menopause is finally getting the attention that it deserves—that women deserve.

We would all agree that the menopause has always been, at best, stigmatised, ignored or treated as a joke and, at worst, used as a way to degrade women. Just as women are not a homogeneous group, the impact of the menopause on women varies significantly. Some women will experience menopause at a significantly younger age, either naturally or because of surgical or medical intervention, for example as a result of cancer treatment. For many women—research says 10 per cent—the negative impact on them is life changing.

In many cases, women and girls are unprepared for the changes caused by menopause, so they suffer in silence. Invisible. They feel too ashamed, inadequate or embarrassed to seek help, and many women are even unaware that help is possible. We have to change that, support women through the menopause and end the stigma that surrounds it. We need to make it—and the women dealing with it—visible. I hope that the debate, with MSPs from all parties talking about the menopause openly and recognising the impact that it can have, will help towards that. I am proud that women and men in this Parliament are here to discuss an issue in public, on the record, that all too clearly needs to be discussed. As we mark the 20th anniversary of the Parliament, perhaps a debate such as this, on the menopause, shows just how much we have grown up.

To help to illustrate the impact of menopause, I thought that it would be useful to highlight some of the 34 known symptoms. The most common are night sweats, hot flushes, irregular or very heavy periods, fatigue, inability to concentrate, loss of libido, mood swings, hair loss, insomnia, weight gain, joint pain, depression and clumsiness.

We know that those are just a fraction of the health issues that women face. Most women will deal with multiple symptoms while juggling work and a busy family life with caring responsibilities. I am not raising the issue solely as the Minister for Older People and Equalities; I know from personal experience how the menopause feels, and I am sure that many women across the chamber do, too.

Photo of Elaine Smith Elaine Smith Labour

Does the minister recognise that the symptoms that she mentioned are also symptoms of underactive thyroid? When women have that, often they are not tested, because they are told at a certain age that it is the menopause.

Photo of Christina McKelvie Christina McKelvie Scottish National Party

I absolutely recognise that. I made the comment that women face a suite of health issues, and that is one of them.

During my time in office, I am determined to make a real difference to women who need help and support with the menopause. A big part of that is to get people talking about it—to get women talking to other women to share information on what works and what does not, to highlight issues such as the one that Elaine Smith mentioned, to listen to others who face issues and to offer support and reassurance. Some women have told me that they thought that they were losing their mind. We are not alone in that; many women feel the same way. It is case of sharing that lived experience.

However, women telling one another their war stories from a war that only they know about will not change their experience or the experiences of younger women who will face the same battles in the future. That is why it is so important that wider society pays attention, listens to women talk about their experiences and learns from them, whether those women are their partners, family members, employers or health practitioners, which is why I am so pleased to see the work that is being undertaken by elected members, trade union bodies, women’s organisations and even the media.

I know that many members will have seen the coverage broadcast as part of the menopause-themed “BBC Breakfast” programmes last week. They showed the breadth and depth of the issues that are faced by young and older women. We have also had the groundbreaking documentary by Kirsty Wark and the insightful articles by Mandy Rhodes, editor of the

Holyrood magazine, who have both opened up about their own experiences, which women have found to be absolutely relatable. They have helped to make the issue and the women who are affected by it visible.

Today’s debate, events such as the menopause festival that I spoke at last month—yes, we had a festival—and the menopause cafes, which were founded by the wonderful Rachel Weiss up in Perth, are vital, because they raise awareness and shine a light on a hidden, taboo subject. We are continuing to build on the momentum that has been started as a result of all that activity, which included the Scottish Women’s Convention’s conference that was held in February. The upcoming festival of ageing that the Scottish Government has funded, which will take place on 23 May—this Thursday—at Glasgow Caledonian University, will continue that public conversation. I am delighted that, because it is aimed at the public as well as delegates, it will extend the reach of the conversation to a much wider audience.

All that awareness-raising work will ensure that the deafening silence around the menopause is no more. Women are reclaiming the airwaves and have grabbed the foghorns. We are all prepared to make ourselves heard as well as seen. It is important to take action because women have the right to be well. The menopause affects women physically and mentally, sometimes to devastating effect. We know that most women go through the menopause between the ages of 48 and 55, that the symptoms can last for more than 10 years and that the average age at which women go through the menopause is 51. However, as I have said, it can happen to some women when they are much younger.

There is also an economic imperative for addressing the impact of the menopause. We all know that our population is ageing. On 3 April, I published “A Fairer Scotland for Older People”, which considers the changes in Scotland’s population demographics. The fact that there has been a 5.5 per cent increase in the employment rate of women aged 50 to 64 since 2008 means that we have more women in the workforce. Given that more than 60 per cent of women between 50 and 64 are in employment, more are now working through and beyond the menopause.

If we add to that the potential impact of Brexit on key areas of our workforce, we can see that it is absolutely essential that we keep our workers, whose skills and experience are so important, in employment for as long as they want to be. That means that we must change the workplace to ensure that it allows us to work flexibly and that employers really understand the needs of their employees. As well as making good business sense, that is the right thing to do. Despite the fact that employment law is reserved to the United Kingdom Government, which limits the actions that we can take, we are finding opportunities to promote the agenda of fair work and workplace equality.

That agenda includes the rights of women experiencing the menopause and I can highlight some progress here. I commend the work of the Scottish Trades Union Congress women’s committee, which, in October 2017, carried out a survey on the menopause in the workplace. The survey investigated the experiences of women, how Scottish employers are responding to the issue and what resources the STUC women’s committee could develop for women in the workplace.

Over 3,000 women participated and the survey found that 99 per cent of respondents either did not have or did not know whether they had a workplace menopause policy; 63 per cent said that the menopause was treated as a joke at work; and 32 per cent said that the menopause was treated negatively in the workplace. The women’s committee is now collating menopause policies and information from affiliate unions and members’ workplaces in order to develop a best practice model for distribution, which is very welcome indeed.

It is also welcome that, due mainly to the work of depute provost and councillor Collette Stevenson, South Lanarkshire Council has now implemented a menopause policy that is supported by all the groups. That policy is now being used by many other employers, including local authorities, as a model for developing their own guidance.

I have made sure that the Government is updating its current menopause policy and providing guidance and support for women and their managers, as we should be leading by example in Government. We had five menopause cafes across Government just a few weeks ago, all of which were oversubscribed. That means that there is a need out there. We are also encouraging all employers, including other public bodies, to update and/or provide menopause awareness training and guidance for their managers.

Our recently published “A fairer Scotland for women: gender pay gap action plan” includes actions to support women affected by the menopause. The action plan sets out our commitment to fund

“a feasibility study for a ‘Centre for Flexible Work’ for Scotland. This Centre, a UK first, would design, test, embed and scale new approaches to increase the availability of quality, flexible work in Scotland.”

We are also funding several projects through the £750,000 workplace equality fund to support the development of age-inclusive workplace practices. In partnership with Impact Funding Partners, we supported a workplace equality fund business-to-business learning event in March to share good practice, including lessons learned on the adoption of more age-inclusive working practices. We are expanding the fund further so that, importantly, it will now seek to encourage projects that provide support to female workers during the menopause.

It is a great list, and I am not finished yet, Presiding Officer. We have also refreshed the gender and diversity element of the Scottish business pledge to give employers access to information and advice on issues such as the menopause, as we know that older women are impacted by the gender pay gap. It is clear that the menopause can be one of the contributing factors to women’s lack of progression and career choices, based on their need to manage their health—both mental and physical.

We are committed to working closely with women’s organisations and trade unions to gain a clearer picture of the issues involved in order to identify other areas where action needs to be taken. I am sure that many members will tell us some of those ideas today and I am looking forward to hearing them.

In conclusion, I will read out the words of Agnes Tolmie, chair of the Scottish Women’s Convention, as she introduced the convention’s menopause survey results earlier this year. Nearly 1,000 women took part in that survey, and they cannot be ignored. She said:

“Menopause covers much more than just a physical transition. It impacts on every aspect of our lives as women, both individually and collectively. We hear about workplace discrimination on a daily basis. But we very rarely hear about this in relation to such a crucial issue as the menopause. This is for a number of reasons” including stigma, fear of demotion, and fear of being singled out as “too old”. She added:

“These women are carers, they are workers, many are the very backbone of our communities and society. And yet, they are made to feel ostracised by a perfectly normal event that every woman goes through.

What we need is information and understanding from the outset. From pre-menopause to what comes after ... We need to listen to women with direct lived experience. Policymakers and politicians must understand the impacts of the menopause in order to effect change.”

I totally agree with Agnes Tolmie. That is why I am proud to move the motion in my name.

I move,

That the Parliament acknowledges that the menopause has for too long been a taboo subject; agrees that there can often be little understanding of the symptoms of the menopause in wider society; congratulates the STUC Women’s Committee on its 2018 report,

Menopause and the Workplace

; commends the awareness raising work of Rachel Weiss, who established the Menopause Cafes and annual Menopause Festival, and the Scottish Women’s Convention, which is gathering the experiences of women across Scotland who are saying in their own words that this should no longer be viewed by society as “a women’s issue” and that there is a need to end the stigma of the menopause, and agrees that raising awareness of the menopause will help its impact be better understood and addressed.

Photo of Annie Wells Annie Wells Conservative

I thank the minister for bringing this topic to the chamber today.

Although around 50 per cent of the population will experience the menopause at some point in their lives, unfortunately the subject remains incredibly taboo. For far too long, women have felt unable to talk about the menopause openly, with the wider impact being a society that has little understanding of its symptoms. I am pleased that we are having the debate today to raise awareness of the menopause and help end the stigma that surrounds it.

What exactly is the menopause? The menopause is when a woman stops having periods and is no longer able to get pregnant naturally. It is a natural part of ageing that usually occurs between the ages of 48 and 55, as we have heard. Most women will experience menopausal symptoms, some of which can be quite severe and impact significantly on their everyday activities. Symptoms, which can begin months or even years before a woman’s periods stop and can last for up to four years after, include hot flushes, night sweats, low mood and anxiety, reduced libido and problems with memory or concentration.

The impact on women’s lives is significant. A British Menopause Society survey found that over half the women who had gone through the menopause said that it had had a negative impact on their life and over a quarter said that they felt less outgoing in social situations and more isolated. A third said that they no longer felt like good company. To hear those statistics makes me feel sad and, having spoken to many women who have experienced the menopause, I know that they feel as though no one is listening to them.

If I am completely honest, over the past few months, I have felt the start of the symptoms of the menopause and I have been a little anxious about what is to come. For me, the time is ripe for this debate as I have been able to learn more about the menopause, which I am sure will make the process easier.

It is clear from the statistics that there are significant implications for women’s mental as well as physical health, and those need to be addressed. For me, much of the taboo stems from the menopause being a part of our lives that we do not necessarily want to think about, let alone talk about. However, the danger of that is that we do not normalise talking about it and we are not mentally or physically prepared for it when it comes, or not able to support or understand the experiences of someone who is going through it. Normalising talking about it is key to the debate. It is important that that is done from an early age, particularly given that one in 100 women will experience the menopause before the age of 40.

Men, too, are incredibly important to the debate, as has been raised. The BMS found that 38 per cent of men said that they felt helpless when it came to supporting their partners through the menopause and a third said that they often ended up having arguments because they did not understand what their partners were going through. Those statistics are again significant in highlighting that the menopause is not just a women’s issue—it affects everyone in society.

How do we start the discussion? We do that through education, talking to one another or simply saying the word “menopause” in our everyday conversations. I was really pleased to see the BBC’s coverage of the issue last week as part of its wake up to the menopause campaign. Many people—friends and family—have come to me to talk about it, and there seems to have been a very wide reach. There were segments on a variety of issues. There was the story of a young woman who began early menopause at just 15; a short film by a BBC presenter, opening up about her own menopause story; and—my favourite—a clip following a group of women in Wales who found that wild-water swimming alleviated their anxiety and menopause symptoms.

We need to keep the momentum going. There are great initiatives out there already, as we have heard. World menopause day, which is held in October every year, presents an opportunity for us to mark the progress that has been made each year and to continue to raise awareness. As we have heard, the creation of menopause cafes across the United Kingdom has allowed women to discuss the menopause with no set agenda. Those cafes give women the opportunity to talk about their symptoms and share information on what has worked for them.

At the University of Leicester, a menopause-specific policy has been introduced. As well as male and female university staff being encouraged to say the word “menopause” three times a day to help normalise it, women are encouraged to announce confidently in a meeting when they are having a hot flush. I am having one the now, so that is okay.

On that last point, it is in the workplace that we need to improve vastly the support for women who are experiencing the menopause. In the same BMS survey, 47 per cent of women in employment who needed to take the day off because of the menopause said that they would feel uncomfortable with disclosing the real reason, and 45 per cent of women who experienced strong symptoms felt that that had had a negative impact on their work.

Yesterday, in Glasgow, I met a couple of ladies who had contacted me during mental health awareness week, which was last week. Over coffee and cake, we chatted about the menopause, which they felt was having a detrimental impact on their mental health. Although one of them had been signed off work by her general practitioner because of her severe menopausal symptoms, she was facing disciplinary action despite having been with her company for more than 25 years. At the same time, she was struggling to cope at home, which left her feeling isolated and not knowing where to turn. Hearing about that at first hand highlighted to me just how stressful the menopause can be for some women.

As we must do with any health problem—whether it be physical or mental—we need to embed an understanding of the menopause into workplace culture, so that women do not suffer alone. Again, this is where a better understanding of the symptoms would be helpful. Many women struggle with poor concentration. If employers do not understand that, it is easy to see how difficult situations might arise. The Equality Act 2010 establishes the importance of reasonable workplace adjustments, which might include anything from considerations of temperature control to the use of flexible or home working.

I welcome the work of the Scottish Women’s Convention. This week, I want to ask a number of employers—in both the public and private sectors—what measures they have in place to educate their managers on the menopause and to support women who are experiencing it. I will be happy to share those responses with members once I receive them. I am keen that, in years to come, we continue to build on the progress that has been achieved in the area.

Photo of Elaine Smith Elaine Smith Labour

It might add to the debate to mention the importance of providing more information on how physiotherapy can help women with stress incontinence.

Photo of Annie Wells Annie Wells Conservative

I absolutely agree with Elaine Smith on that point. We should remember that women can receive support in lots of different ways and that we should not have a one-size-fits-all approach. We should be proactive and have better discussions.

I am grateful to have had the opportunity to speak in the debate, and I am pleased that it has been so consensual. For many women, the natural process that is the menopause is a time of anxiety and distress. For that reason alone, it deserves our utmost attention. The first step towards destigmatising the menopause is to talk about it in a way that normalises it, which would allow everyone in society to become more knowledgeable about what women experience during that time. I very much hope that, by the time that we reach world menopause day in October, we will be able to talk about seeing some of the changes that we have discussed happen.

Photo of Monica Lennon Monica Lennon Labour

Around 400,000 women in Scotland are experiencing the menopause transition right now. It is a normal part of life but, as the motion states, the menopause has been

“for too long ... a taboo subject”.

As convener of the cross-party group on women’s health, I am proud that the menopause was one of the first issues on the group’s agenda. I know that it will mean a lot to women across Scotland that the minister is putting the issue front and centre. The debate is very welcome, but our actions must match our ambitions. I hope that we will see progress in the provision of menopause care across the NHS, and an end to stigma and discrimination. It is about time that we all became more clued up about the menopause. It is true that it is when women stop having periods but, through my campaigning interests around access to period products, I know that people are still embarrassed to talk about such natural processes.

The symptoms that are linked to the menopause are many—I believe that there are 34—and can last for around four years. It is important to recognise that everyone’s experience will be different and that some lucky people have few symptoms, if any. Menopause is not an illness, but its effects can be damaging to health, especially if support for sufferers is lacking. Postmenopausal women can lose up to 20 per cent of their bone density because of lack of oestrogen, and they are the group that is by far the most commonly diagnosed with osteoporosis. Women can limit the effects of the menopause by taking easy steps such as staying active, making healthy nutritional choices, getting out in the sunshine to help to build up vitamin D, and cutting down on caffeine and alcohol.

Although the transition is most commonly experienced by women in their 50s, some women experience early menopause. Campaigner Katy Johnston shared her story with the cross-party group on women’s health after she voluntarily underwent the menopause in her early 20s through medical treatment to manage the crippling symptoms of endometriosis.

On some mornings last week, many members will have tuned into the BBC while the menopause was being talked about on the breakfast news programme. We should have more of that on the telly, please. I was struck by Susan, who was featured. Susan has Down’s syndrome, and she talked about feeling up and down, depressed, teary and forgetful. She described feeling a bit scared that she did not really know what was happening. She was experiencing perimenopause. Women with Down’s syndrome tend to reach the menopause earlier than the general population—sometimes 10 years earlier. Because of that, the symptoms can sometimes be missed or overlooked. Meeting the needs of women with disabilities is an important area of work.

More generally, a survey that was conducted by the Scottish Women’s Convention highlighted that almost two thirds of women felt that not enough information was available at the beginning of their menopause and that symptoms such as fatigue and anxiety, which had been indicating perimenopause, were not linked.

As Scottish Labour health spokesperson, I have been campaigning for improved menopause care for women across Scotland, including improved access to menopause clinics. At the most recent count, only five health boards in Scotland were offering a dedicated menopause clinic. No matter where women live in Scotland, they should have access to high-quality menopause care. Perhaps the minister could give an update on that aspect later in the debate.

We should all be grateful to the many organisations that are doing fantastic work to champion the menopause agenda. The menopause conference that the Scottish Women’s Convention held in February helped to increase visibility. I have been following closely the work of the STUC women’s committee, and last year it published a groundbreaking report that looks at the experience of women in the workplace during the menopause. I want to echo the words of Sharon Edwards, who came along to our CPG. She and the STUC women’s committee are right when they say that the menopause should not be an issue that is surrounded in secrecy and we should not resign our conversations on it to a whisper.

The menopause and the workplace survey highlighted some really disheartening figures. For example, 63 per cent of women said that the menopause had been treated as a joke in their workplace. That is unacceptable, but I wonder whether any of us is actually surprised.

The minister was right to reference journalist Mandy Rhodes, who has been refreshingly open in speaking about her experience of the menopause. She said that other women have opened up to her, saying that they have felt ignored, rejected and humiliated—and that is just by the medical establishment. Many women have said that, in the workplace, they feel disregarded, overlooked and isolated, all because of the way that other people react to the menopause. We know that we have a lot of work to do.

We have all heard the comment, “She must be on her period” every time a woman is having a bit of a bad day, and it switches to, “She must be going through the change”, with jokes about hot flushes and assumptions about the menopause. I think we agree that those so-called jokes are not actually that amusing. It is almost the anniversary of the Bank of England’s deputy governor apologising for describing Britain’s sluggish, slow and underperforming economy as “menopausal”. What does that say about bankers, I wonder?

Women who are experiencing the menopause should not be put down or written off, and neither should their contribution to our economy and society. The menopause can be challenging and tiring, but it can also be liberating, signalling a new chapter and a sense of freedom.

With more and more women working into their 50s and 60s, workplace policies and practices need to catch up. Employers are not being asked to make onerous changes, but a good menopause policy should be a minimum. My member’s bill, the Period Products (Free Provision) (Scotland) Bill, would also help those who are experiencing the menopause to manage unpredictable and heavy bleeding.

The Scottish Parliament’s women’s network was instrumental in helping this Parliament to become the first in the world to make free period products available to staff and visitors, and that started from a conversation in this building about the menopause at work. I pay tribute to Sam Currie and her committee for that, and for bringing Dr Hilary Jones—also off the telly—to Parliament to educate men and women, including managers in the Parliament, about the menopause.

Like the minister, I commend Rachel Weiss, who launched her first menopause cafe in June 2017, offering women in her home town of Perth the chance to share their experiences and access peer-to-peer support. That movement is inspiring.

I am optimistic that Scotland is making progress. Only last week, North Ayrshire Council announced the development of a menopause policy, following in the footsteps of South Lanarkshire Council, which, working with the trade unions, already has a pioneering policy. Councillor Collette Stevenson should be congratulated on driving that.

I am delighted to support the motion. I fully agree that raising awareness of the menopause is a good thing and that we should all commit to doing it.

Photo of Alison Johnstone Alison Johnstone Green

In recent months, there has been increasing awareness of health issues that affect women, such as endometriosis and menopause, and some of that good work is taking place here in Parliament, including through the cross-party group on women’s health.

This debate is extremely timely and is a welcome contribution to ensuring that the menopause is not an invisible part of a woman’s life.

We know that menopausal symptoms can range from insomnia and dizziness to anxiety and even palpitations. Those symptoms can be extremely debilitating, but the old assumptions are hard to shake off. The menopause is still seen as something that women just have to go through, like painful periods, no matter the cost to their health or wellbeing.

As the motion rightly says, the menopause has for too long been seen as “a women’s issue”. The STUC’s 2018 report revealed that almost two thirds of women in the workplace are in the age bracket in which women, on average, go through the menopause, and yet—as has been mentioned—99 per cent of respondents reported that they either did not have, or did not know whether they had, a workplace menopause policy.

It is everyone’s problem. Respondents reported having to take sick days because of symptoms, which could result in disciplinary action being taken. Given that around half of the workforce is female, and that the vast

majority of women will go through the menopause while of a working age, it is incredible—frankly, it is appalling—that such a gap in provision still exists.

Nor should we assume that those who are experiencing the menopause are all of a certain age. Around one in 100 women will experience the menopause before they are 40. Some women enter early menopause because of medical treatment for conditions such as endometriosis, as a result of hysterectomies, or simply because of genetics. Transgender and non-binary people may be affected by menopausal symptoms. Therefore, it is important that workplace support is in place for all those who need it.

I thank all those who contacted me before the debate with their experiences. They welcome the debate. I was contacted by one constituent who had a full hysterectomy at the age of 26 as treatment for endometriosis. She told me about the difference that hormone replacement therapy has made to the quality of her life, but said that it is becoming increasingly difficult to get access to a prescription, due to fears about side effects. HRT is not appropriate for everyone, and there are certain risks and side effects associated with its use. However, it can be life changing for some women. The Royal College of Obstetricians and Gynaecologists advises that the effects of HRT have been studied worldwide and research shows that, for most women, HRT works and is safe. The RCOG also says that healthcare professionals should discuss individual risks, based on research evidence, at consultations. It is important that potential risks and benefits are fully explained to women, so that they can make an informed choice about treatment options.

Endometriosis UK has done some great work on the issue and has developed, in conjunction with the Royal College of General Practitioners, a menstrual wellbeing toolkit that contains top tips for managing menopause in primary care.

As the minister noted, 63 per cent of respondents to the STUC survey said that the menopause had been treated as a joke at work. There needs to be a culture change, so that women feel confident and supported to talk about their experiences without fear of ridicule or dismissal. I, too, applaud initiatives such as the menopause cafe, which I believe has led to flushfest, which is a festival that is dedicated entirely to the menopause.

It is important that the message permeates workplace culture. The STUC and the National Association of Schoolmasters Union of Women Teachers have already produced guidelines for employers. For example, NASUWT recommends that employers provide

“awareness training ... for managers”,

as well as

“paid time off for treatments such as hormone replacement therapy” and

“flexible working patterns”.

We need such provisions; they will improve working conditions for those who are experiencing the menopause, and they will allow us to retain experienced staff.

It is about equity. We cannot hope to tackle the gender pay gap until women are no longer penalised for having periods, getting pregnant or going through the menopause. The more open we are about the issues, the sooner we can dismantle old stereotypes and break down the barriers that working women—indeed, all women—still face in 2019.

Photo of Liam McArthur Liam McArthur Liberal Democrat

As the minister reminded us, this is the first opportunity that we have had to debate the menopause in Parliament. Therefore, I thank her and congratulate her on bringing the debate to the chamber, thereby giving the issue visibility, as she rightly said.

As the motion rightly states, and as women themselves are rightly and clearly stating, this is not just a “women’s issue”. The problems relating to stigma, and the implications for equality, whether in the workplace or in access to health services, need to be addressed by all, no matter their age, gender, faith and so on.

If we are to bring about full gender equality, whether that is in the struggle around equal pay, gender stereotypes or menopausal stigma, we need to start by talking about it and by raising awareness.

I freely admit that men have absolutely no comprehension of what women experience during menopause, although I assure the minister that I have come to terms with my own clumsiness over the years. Those experiences can vary enormously from one woman to the next. They can have a wide range of symptoms, reactions, causes and implications. At the very least, however, we have a responsibility to listen, to support and to respond. Anything less represents failure on our part.

Seeing menopause as a normal part of life is also key to removing the stigma and lifting the taboo. It is the strong, underlying message of Louise Minchin’s video on her menopause journey and a lot of the other programmes that we saw last week.

There are strong and compelling arguments for saying that at the root of menopausal stigma lies the issue of health inequality. Health inequalities manifest themselves every day, in all sorts of ways, but nowhere are they more obvious, perhaps, than when women go to their general practitioners with symptoms of menopause and do not get the support that they need. That is not always the case, of course, but too often it can be.

We hear of cases in which women have been misdiagnosed as having depression and been placed on antidepressants. Others have presented with palpitations and have then been referred on to cardiologists. Some patients with urinary symptoms have been referred to urologists, and others have been simply told that it is “just” the menopause so nothing can be done. To make matters worse, in certain circumstances, doctors dismiss symptoms as menopause when they are actually signs of something more serious. Clearly, that can have very grave consequences indeed.

Although the 2015 National Institute for Health and Care Excellence guidelines on the menopause are a step in the right direction, healthcare professionals need greater resources to enable them to accurately identify the menopause and better support women.

It is also fair to say that the menopause can disproportionately affect those women in our society who are already vulnerable, leading to detrimental effects on their mental and physical health. In a recent report produced by Engender that focuses purely on women who have disabilities, the overwhelming majority of respondents said that they received poor or no information about the menopause, its health implications, its symptoms or how to manage them. More worryingly, they felt that doctors were not available to give information in an accessible way or to spend time with them to discuss any reproductive health concerns that affected them. The main recommendations to emerge from the focus groups that took place highlighted how essential it is to ensure that a learning disability or specialist nurse is available to speak to women about the menopause. The lack of resources was also highlighted through that work by Engender.

Much more needs to be done in areas for which the Parliament has responsibility. To this day, GPs and health professionals remain unable to effectively support women because of a lack of training and awareness. Women who have disabilities are not incorporated into the reproductive narrative or policies and, as Alison Johnstone and Annie Wells highlighted, there is still no workplace policy surrounding the menopause. All of that can leave women feeling alone or, as the minister reminded us at the start of the debate, invisible.

We are still not doing enough to tackle menopausal stigma and it is about time that that changed. This is a shared endeavour. We all have an interest in seeing the situation improve, even if the stakes for some are higher than for others. For now, however, I once again thank the minister and congratulate her on enabling Parliament to debate this important issue and giving it the visibility that it needs and deserves.

Photo of Rona Mackay Rona Mackay Scottish National Party

I am really pleased to be speaking in today’s debate and I am delighted to hear that it is the first ever debate in this chamber, and the first in any UK Parliament, on the menopause. I congratulate the minister on bringing it forward.

For as long as I can remember, the menopause has been viewed as a bit of a joke. There are mugs, napkins, aprons, car stickers—you name it

— all emblazoned with so-called hilarious slogans about “the change”.

We have heard the statistics from the STUC women’s committee and they are worth repeating: 63 per cent of women said that the menopause had been treated as a joke at work and 32 per cent said that it had been treated negatively in the workplace. That is simply unacceptable. It is certainly not a joke if you are one of the many women—more than half—who said that they had experienced negative and distressing symptoms.

Let us be clear: the menopause is not an illness. It is a natural part of ageing for more than half the population. However, as we know, it can be debilitating and affect women’s everyday lives, and the Scottish Government wants there to be a greater understanding in society of the symptoms that can cause misery for many women. That is why we need to talk about it: to raise awareness and end the taboo.

There are increasing numbers of older women in the workplace—just ask the women against state pension inequality—and many more will experience the menopause while at work. Some will sail through it; others will not. We know that stigma is worse for women in a male-dominated workplace, and 99 per cent of the women surveyed did not know whether there was a policy in their workplace.

This is 2019. Managers and employers must be grown up enough to support women and let them know what is available to them. The Scottish Government wants to set a positive example in this area and it is currently reviewing its workplace guidance, as we heard from the minister. The menopause is just one of the barriers that women can face in the workplace because of gender and age. I hesitate to use an old cliché, but if men experienced the menopause, I doubt whether we would be having this debate.

Many subjects appear to be taboo when it comes to debating women’s health issues. Menstruation—this is period positive week, by the way—endometriosis, thyroid conditions, in vitro fertilisation treatment and many more are often swept under the carpet when it comes to talking and being open about women’s health in the workplace, but we are making some headway. The Scottish Government is currently working with women’s organisations and trade unions to gain a clearer picture of the issues faced by women going through the menopause and to identify other areas where action may need to be taken. The minister outlined those and they seem very positive.

Targeted training, awareness raising and work with employers to provide menopause-related advice are finally beginning to happen. As we have heard, the world’s first menopause cafe was held in Perth in June 2017 after the excellent television documentary presented by Kirsty Wark, which was probably the first time that the subject had been aired on a prime-time TV slot. After an inspiring debate, a resolution was passed at the Scottish National Party conference in April for employers to give menopause training. However, taking up Alison Johnstone’s point, more research needs to be done into treatment types other than HRT. HRT is fantastic for some women but has side effects for others, so we must continue to research other remedies.

It is no longer acceptable for women to attend the doctor’s surgery with a range of debilitating symptoms only to be told, “It’s just your age”, and it is not acceptable for employers to jeopardise a women’s career by showing a lack of understanding or respect about this perfectly natural process. For those employers who are not responsible enough to do that, the joke will ultimately be on them and they will be left behind as society moves on.

Photo of Maurice Corry Maurice Corry Conservative

It is a privilege to speak in this debate. My wife, too, was delighted that I would be doing so. Gosh! Having to bear children and then, later in life, being subjected to the menopausal symptoms, women have to cope with a lot. I salute them, including all those who are here today, for their enormous courage.

The menopause is a transition in life that has often been easily dismissed. It has been labelled as an unimportant or uncomfortable topic of conversation, particularly among us men. However, in my humble role as the Commonwealth Parliamentary Association’s male champion for women in Scotland—I recognise that no woman here needs me to speak on her behalf—I am keen to dispel any stigma or barrier that women may face.

In the workplace, especially, the taboo of menopause certainly exists, and it has caused a lack of understanding and sometimes even a general feeling of embarrassment. The underlying thinking is that it is solely a women’s issue and not the concern of anyone else. That simply should not be the case. I fully understand that, slightly contrary to what Rona Mackay said about men, particularly after supporting my wife during some difficult times when I was overseas with my job, some 2,500 miles away in the Balkans. I had to fly home on some occasions to support her and my four children.

The menopause can, for some women, feel like a stage of life that is unrecognised and easily dismissed. Indeed, as the Faculty of Occupational Medicine highlighted, the menopause is a hidden health concern. We can forget that it is a natural health condition that is just as deserving of clear, practical guidance and support as any other. It is important to note that menopausal symptoms are different for each woman and can vary depending on where they live, be it in Scotland or in the Commonwealth. Those different factors can affect the severity of their symptoms. With that in mind, awareness raising needs to be attuned to the spectrum of experiences that women have.

There is zero benefit in fuelling the view that the menopause is taboo, especially as part of the problem can be plain ignorance. It is encouraging, therefore, to see more readily available advice and guidance. Indeed, only through more open communication about the symptoms can we better understand how women can feel and the support that they need, especially in a workplace environment. It is alarming to note that a quarter of women who are aged over 50 have considered reducing their working hours due to their menopausal symptoms. The danger is that, without support, more women might feel that they cannot continue to work.

One of the most important areas for awareness to start is with employers, who are the key to destigmatising the menopause, especially if they implement a workplace menopause policy. The STUC women’s committee’s 2018 report on the topic showed that most of those who took part in the survey said that they either did not have, or did not know whether their employers had, such a policy in place. I am sure we all agree that all employers should have such a much-needed policy in place.

Stemming from that policy, employers need to encourage training in how best to deal with the menopause in a workplace culture. That practical training for colleagues is the key to proper education on women’s experiences, because it can foster understanding and awareness of the practical steps that we can take to help one another. Further options such as flexible working and small adjustments to the working day are definitely worth exploring. For example, the UK Government, through the women’s business council, has implemented an employer toolkit that suggests physical adaption options to the working environment that are designed to encourage flexible working. I hope that employers can be equipped and encouraged to do their part in that way.

Through all those efforts, organisations strive to raise awareness and start the conversation, and I welcome the number of campaigns that aim to do just that. For instance, this month, the BBC’s wake up to the menopause week was an eye opener, particularly about the workplace, and world menopause day is marked every October to raise awareness of the health issues that are connected with the condition. Campaigns such as those are all about opening up the conversation and encouraging active communication about how women can feel well supported and better understood. That is how we can destigmatise the menopause.

I hope for an open and supportive dialogue about the menopause that will truly validate the condition and ensure that women are supported, especially in their workplaces, in this country and throughout the Commonwealth. Efforts to raise awareness have certainly helped to break the taboo, but it will take real and practical change in the working environment—with commitment from everyone—to truly address the issue.

Photo of Gillian Martin Gillian Martin Scottish National Party

There are a raft of subjects that are firmly in a box marked “Things your granny says you should keep to yourself”. Periods are in there, although, of late, because of campaigners on period poverty and the tampon tax, among whom I count myself, the taboo around talking openly about menstruation is being eroded.

The menopause is in that box, too, and, with all due respect to our grannies, not talking about the symptoms of the menopause is doing us no favours.

As everyone has said, the menopause is a natural part of life. Women in the workplace have been coping silently forever. Although we have been managing life while keeping our symptoms hidden, we can manage it even better if those around us understand them and give us an extra bit of support when we need it. I do not want this to turn into a debate that gives people more reasons not to employ older women, because we do cope—but we cope in secret.

There is limited information about the menopause and its impact on women in the workplace, yet by law all workplaces should have an effective, gender-sensitive policy that is entirely consistent with the statutory provisions in the Health and Safety at Work Act 1974, the Workplace (Health, Safety and Welfare) Regulations 1992, the Management of Health and Safety at Work Regulations 1999 and the public sector equality duty, which was part of the Equality Act 2010. However, I wonder how many perimenopausal women, if they asked their boss about their policy on the menopause, would get any kind of an answer. I feel for the boss who has been asked. Would they even know whether they had one?

Right now, those of us who are perimenopausal—I am, and Emma Harper has made me a fan out of the

Business Bulletin

—might have extremely heavy periods that come with no warning and that cannot be dealt with very easily. We might also have debilitating and severe hot sweats that do not happen only at night. I might need to leave a room suddenly to deal with either of those things. I might not be able to sleep, so a flexible working pattern might help me to get through a period of insomnia. All of those things do not mean that I cannot do a good job; they just mean that I might have to do things a wee bit differently from time to time. Also, the symptoms are not consistent; there are peaks and troughs.

I am lucky, though, because I am the boss in my constituency office and can work round those issues. What if I was working at a till in Tesco? What if I was working a shift or managing a petrol station?

Many members have mentioned the survey by the STUC women’s committee, so I will not rehash what has been said. However, if a third of female employees feel that the menopause is treated negatively or have heard it being talked about as a joke, they are less likely to bring up the issue at work, because they do not want to be ridiculed.

I was pleased to discover that, in October last year, SNP-run South Lanarkshire Council grasped the nettle by becoming the first local authority in Scotland to introduce a menopause policy to support its female workforce. As has been mentioned, the depute provost, Collette Stevenson, said:

“It is important for an organisation of any size to recognise the support that is needed”.

Her colleague Councillor Katy Loudon and Clare Haughey, the Minister for Mental Health, brought forward a motion in line with that belief at the SNP conference, and that is now our party’s policy. I will write to Aberdeenshire Council to ask what policy—if any—it has in place. I know that some of my councillor colleagues have already raised the issue directly.

What might such a policy look like? It could consider the specific needs of menopausal women and ensure that the workplace environment does not make their symptoms worse. It could include paid time off for treatments such as hormone replacement therapy or cognitive behavioural therapy. It could also include flexible working patterns and making reasonable adjustments in workplaces such as the introduction of flexibility in breaks, remote working and flexible start times. It strikes me that smokers probably have more flexibility than women who are suffering from the menopause, as they are able to take breaks whenever they want. We also need to introduce a culture in which the menopause is talked about respectfully between colleagues. Whatever we get out of the debate, it is welcome that we have opened up the box and are talking about the menopause.

I will briefly mention clinical interventions. I would like to go into a doctor’s surgery and be offered advice instead of just being told to go on HRT. There are lots of coping mechanisms out there, so I would like our medical professionals to look beyond the clinical interventions to help us out.

Photo of Elaine Smith Elaine Smith Labour

I was not sure whether I wanted to take part in today’s historic debate. I have already spoken honestly in the chamber about my thyroid problems, so I thought it might be challenging to discuss yet another personal health and wellbeing issue. There are connections between thyroid problems and the menopause, which I will come back to if I have time.

As other members have mentioned, it was refreshing to see women on the BBC’s “Breakfast” programme talking about the menopause along with their families, who are obviously also affected. There were some innovative ideas for helping with symptoms. However, as much as I like swimming, I am not sure that I fancy swimming in freezing cold water, which Annie Wells mentioned—but, if it helps, people should go for it.

Wider media and political discussions have encouraged a new culture in which the menopause can be talked about openly. Ending the stigma of the menopause should not be necessary. Why should a natural physical process that affects half the population have a stigma attached to it at all? Sadly, it does, so we clearly need more discussion, information and understanding to ensure that the menopause is everybody’s issue, not just an issue for the women who are going through it.

I took some soundings about the debate and about what people think in the workplace. The comments that I received included: “My colleague is always sleeping in and coming in late,” “She’s tired and grumpy,” “She’s moaning about aches and pains,”,“She’s too hot, then too cold,” and, “She’s suffering from anxiety and very emotional.” Anyone who is working or living with a woman who is going through the menopause will recognise some or all of those symptoms. Instead of making such comments, it would be better if people recognised that their colleague or manager is going through the menopause; they might then better understand what women have to deal with while they are working. It might result in more support and empathy or in adjusted workplace conditions such as cool water being available, flexible hours, the relaxation of uniform policy and the provision of fans.

It obviously does not help that, whether they like it or not, women are now having to work until they are much older. For women in poverty, there is little hope of early retirement; instead, they could be doing two or more zero-hours or part-time jobs as they try to make ends meet.

This kind of debate will help to raise awareness. It is obviously the first of its kind, and I congratulate the minister for that. However, we also need action on workplace assistance and better medical help and advice. Workplace assistance is, of course, being pushed for by the STUC.

I mentioned thyroid problems, and I will briefly touch on how the menopause can be even more difficult for thyroid sufferers, who—as we know—are mainly women. As I mentioned in my intervention on the minister, women are often not tested for thyroid disorder later in life because the symptoms are similar to those of the menopause. Yet thyroid problems can increase the risk of the complications that are associated with the menopause. For example, during the menopause, women are more likely to develop osteoporosis, a condition whereby bone density is reduced. Similarly, the risk of cardiovascular disease increases during the menopause, and thyroid conditions can increase that risk further and interact with it, resulting in complications. If women who are on thyroid medication are prescribed or choose to take HRT, they need to be closely monitored, preferably by an endocrinologist.

As an area of medicine, thyroid disorder requires much more research, including into its impact during the menopause. When I was the Deputy Presiding Officer and chairing a session, I kept a fan under the desk. However, I used it only when the camera was clearly on another member—I would sneak it out, use it and hide it again. Yet, I should have felt more empowered to use that fan when I needed to, in order to do my job more comfortably. Recently, I went out with my husband, Vann, to a local bar. I was only in the door when I suffered a terrible hot flush. Without asking or saying a word, Karen, one of the members of staff, handed me a fan. That kind of sisterly understanding and help is extremely welcome.

We need flexible working solutions, more support and practical help, and specialist women’s clinics and nurses—or at least more time with the GP. What we do not need are misogynistic jokes, a lack of understanding and predominantly male doctors telling us that it is just our age and to get on with it. At the conference, Mandy Rhodes said:

“There are some subjects that wait for a generation to catch up. The menopause has now found its time. This is Generation ‘M’. Let’s get behind it. And all embrace that change.”

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party

I will say just a quick word to Monica Lennon. I have sat around the boardroom table at the Bank of England on a number of occasions. Of course, I left banking after 30 years to come into politics to improve my reputation.

I will also make a little point about something that Elaine Smith perhaps illustrated, on the topic of the advice that we all sometimes receive about things. The last thing that a woman wishes to do if they have a hot flush or are sweating, or if their temperature has risen, is take a cold drink. The reason for that is that a cold drink will actually boost their system and turn the temperature up, because when the cold drink hits the stomach, it is very close to blood vessels, and the body’s temperature rises. That is why, in the middle east, people drink masala chai, which is warm tea, because putting something warm in the stomach lowers the body temperature—it also reduces the flush. Medical advice often does not cover such very simple things.

Of course, the menopause is not simply a medical or physical issue; it is a social and employment issue. It is also not just an issue for women but an issue for we men. I am glad that—I think—four of us will speak in today’s debate. It is an issue for us perhaps simply because we are there to provide support to those who are close to us and who are affected by the issue. We may also find ourselves employed by, or employing, women who are affected by it. We will also meet, both casually and formally, women who are affected by it.

Elaine Smith very effectively concealed the use of the fan in a previous session, on which I congratulate her. However, she deserves every support.

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party

Forgive me, but I do not have time to give way.

We will meet premenopausal and perimenopausal women who are worried about how we men might react to menopausal symptoms. We have a duty to be part of an environment in which women feel comfortable about the menopause, because it will happen to all our female friends and relatives and to others we meet.

Men need to learn to deal with their hormone issues, which largely lead us to respond more aggressively to circumstances that we find uncomfortable. We must learn to be much more supportive in our relationships with people we love, people we meet and people we bump into. Neither the male nor the female should be placed in a superior or inferior position to the other; we should simply recognise that differences arise from gender.

Professor Mary Minkin of Yale medical school has done interesting research on the effects of the menopause. She found that Swedish, Danish and Norwegian women were most likely to report that going through the menopause was better than they expected, whereas women in the US, the UK and Canada were most likely to say that their experience was worse than expected. That tells us that the effect relates not simply to a physical and hormonal change but to the information that people have and how society reacts to them.

We have heard references to diet, exercise and attitudes to getting older. As the only septuagenarian to speak in the debate, I would like people to like older people a bit better. In Japan, the old are revered; here, we are more likely to be pitied.

Members have talked a bit about employment. Engender tells us that the Department for Work and Pensions has reported that the largest increases in employment rates recently have been in the 60 to 64 age group and the 55 to 59 age group.

I very much welcome the debate and the opportunity to participate in it. I hope that I leave members a little better informed and a little better prepared to deal with the effects—in men and women—of the menopause.

Photo of Christine Grahame Christine Grahame Scottish National Party

I am tempted to thank you, Dr Stevenson, for your medical advice.

Photo of Joan McAlpine Joan McAlpine Scottish National Party

I am delighted to speak in the debate, and I congratulate the minister on the energy that she has put into banishing the stigma of the menopause. Getting the topic into the chamber for the first time is a significant achievement, but the fact that we have not debated it before speaks volumes about where Parliament has placed female priorities. I also praise the STUC women’s committee and the Scottish Women’s Convention, which have done much invaluable work on the subject, as we have heard.

I highlight best practice by NHS Dumfries and Galloway, which has provided specialist menopause clinics and a helpline for more than 20 years and which regularly provides information sessions for the public and staff. This week, an edition of “BBC Breakfast”, filmed in the wonderful new Dumfries and Galloway royal infirmary, focused on the menopause. As part of the programme’s wake up to the menopause week, the show’s Jayne McCubbin interviewed clinicians, including gynaecologists, osteoporosis specialists and GPs from the region, about their excellent work. I take the opportunity to thank them for all that they do and I hope that others around Scotland will emulate them.

In doing research for my speech, I was surprised to discover that the human female menopause is almost unique. The only other comparable mammal species in which females live well beyond the child-bearing years is killer whales—I invite members to make of that what they will. I venture to suppose that that is because older women are as fierce, impressive, beautiful and determined as any pod of orcas.

A number of female academics have researched the purpose of the human female menopause and observed that the most successful societies depend on the contribution that older women make. There is even a term for that in anthropology—it is called the grandmother hypothesis. In pre-industrial societies, the presence of a grandmother vastly reduced child mortality, but anthropologists have noted that the benefits of having lots of healthy older women go beyond childcare and family responsibilities. Such women often do large amounts of physical work and other work to create social organisation and community cohesion. They were observed to be the linchpins of many successful traditional societies; of course, that observation can equally be made about our own complex modern societies.

On opening the conference on the menopause earlier this year, the chair of the Scottish Women’s Convention, Agnes Tolmie, said:

“These women are carers, they are workers, many are the very backbone of our communities and society.”

She is absolutely correct, which, of course, means that ensuring menopausal women are healthy is essential not just for the wellbeing of individual women, which is extremely important, but for society as a whole.

However, as we have heard, society as a whole often still does not get it. That is illustrated by the STUC women’s committee survey, which found that one in three women said that menopause was treated negatively in the workplace, while almost two in three found that it was treated as a joke.

In the same conference speech, Agnes Tolmie said:

“the stigma attached to” menopause illustrates

“much of the wider inequalities women experience in a variety of areas.”

Again, she is absolutely correct. The wider discrimination against women is on the basis of their biology. Younger women can experience discrimination because of their ability, or perceived ability, to get pregnant; they certainly face discrimination as a result of motherhood; and we now understand that discrimination persists into middle and older age because of the menopause.

Second-wave feminists writing from the 1960s to the 1980s had an analysis of patriarchal society that was based on that understanding of biology, which found that women suffered collective discrimination as a sex class. We have made considerable progress since then, but women—especially poorer and disabled women—still suffer discrimination, whether that is through period poverty or low pay because of motherhood.

Therefore, I welcome the comment made by the minister when she addressed the Scottish Women’s Convention earlier this year, in which she pointed out that the Equality Act 2010 protects women against workplace discrimination on the basis of sex and age and that we should use that legal framework more effectively to tackle the discrimination that they face as a result of the menopause. I agree. I suggest that it is very important that all organisations fulfil their public sector equality duty, and that it is particularly important that they gather information, as they are legally obliged to do, on the protected characteristic of sex. It is increasingly the case that many organisations, through poor training, are confusing sex with gender, or even with gender identity. Menopausal women suffer discrimination because of their biological sex, and it is vital that we recognise and record that.

I end on a positive note by returning to my point that the menopause can be a positive thing. It frees women from the fear of unwanted pregnancy and the inconvenience of menstruation, and, often, pain. Germaine Greer said that the menopause could be viewed as a liberation, because the pressure put on younger women to look beautiful and be attractive to men is a type of prison and the menopause opens the door and allows women to find a new stage in life.

As I have said, postmenopausal women are the linchpins of our community. My personal experience of that was having two older women, who had careers and were carers for disabled relatives, helping me to bring up my children. Menopausal women are extraordinary. They are not a problem; they are an asset. I am glad that we have had the debate today, in which we can celebrate them.

The Deputy Presiding Officer:

I have taken a light touch to the timings of members’ speeches because we had time in hand, but allowing a speech to run two minutes over is perhaps a little bit too light touch.

Photo of Alison Harris Alison Harris Conservative

I am grateful to be given the opportunity to speak in what is the Parliament’s first debate on the menopause, which follows the success of the debate on world menopause day in the House of Commons last October.

The menopause can affect adult women of almost all ages, although 51 is the average age that women in the UK reach it. I thank other MSPs who have listed the many symptoms already.

My first experience of the menopause was from seeing my mum’s experience. I think that she really had it quite tough, and I know that it went on for years. She was renowned for having a fan in every handbag. Now, here I am having reached that age and I must confess that, I, too, carry a fan in every handbag for those moments. I am quite happy to lend them out, should anyone need one. At night, I feel like I am constantly doing the hokey cokey in bed: my legs are in, out, in, out—all night. I try to deal with those things with a bit of humour, because I find that that approach helps me.

I do not know whether other members have ever seen “Menopause the Musical”. I have, and it was very funny, but not because the menopause is a joke—it is not. I was laughing more in empathy than anything else. I recognised myself on that stage.

The show did a good job of normalising a taboo subject. When I say that it is taboo, I mean in public or work places. It is easier to speak to my girlfriends about it, because it is what we are all experiencing. However, it is quite a different story in a business meeting or on a train or a bus during rush hour. When a woman suddenly feels one of those moments coming on, it can make them feel quite anxious and fill them with dread.

I know that it is not just me who feels that way. In 2016, an ITV “Tonight” survey found that a quarter of women had considered leaving their jobs because of the effects of the menopause. Fortunately, I have come to terms with dealing with it in a work environment. I now just come out and openly say, “I’m having a hot flush.” However, I know that not every woman feels that they work in a place where they can say that. A survey for BBC Radio 4’s “Women’s Hour” last January revealed that 70 per cent of respondents did not tell their bosses that they were experiencing the symptoms. That is a huge number of women.

We need to make workplaces more understanding of the menopause, because it really is just a fact of life. It is part of being a woman, the same as when a young woman hits puberty and their periods begin. I am a firm believer that those facts of life should not get in the way of someone’s life or career. We have to think about what we can do to help women navigate through those stages of life in the easiest possible way, from developing workplace measures that reduce the anxiety around talking about the menopause, to educating children and young people so that the topic becomes normalised in the future.

Raising awareness is one of the best ways to do that, and I join others in thanking Rachel Weiss for her work in establishing menopause cafes throughout the UK, as they have allowed women to speak with others who are going through the same experience.

There is more that we can do to reduce the stigma around the menopause. I know that, because fantastic strides have been made in the past decade towards reducing other stigmas. For example, mental health has gone from being something that we did not talk about to an issue on which there is a national focus. Tackling stigmas head on and normalising them is a proven way of making things better. On the menopause, perhaps we can begin to set those wheels in motion today.

Photo of Fulton MacGregor Fulton MacGregor Scottish National Party

I pay tribute to the minister for bringing this important issue for debate. It is fair to say that we can be proud that we are debating the issue for the first time in the chamber. I certainly agree with the motion that, for too long, the menopause has been a subject that has been treated as a joke and as something that is a bit taboo.

I was a bit worried about speaking in the debate, not because I do not think that we should talk about the subject, but because I wondered what I, as a man, knew about it. However, the conversations that I have had over the past day or so have revealed to me that I am probably exactly the person who should be standing here talking about it to my male colleagues, because I have learned a lot about how important it is that we normalise the subject of menopause.

We have made strides with regard to mental health, and I think that we are getting to a point at which people are more able to speak about it in the workplace and other places. We should be moving along a similar road in relation to the menopause. Every woman should have access to the information, education, advice and emotional support that she needs to empower her to take control of her health and wellbeing during that normal phase of life. Too many women are told that menopause is a natural phase of life that they just have to get on with. We have heard members speak powerfully about that today.

However, as we have also heard, menopause symptoms vary widely and, in many cases, little advice or support is given. There is still much fear and confusion about hormone replacement therapy among doctors and women. For example, as we have heard, 67 per cent of women who were recently surveyed said that there is a general lack of support or advice for women who are going through the menopause. Who would not be worried about hormone replacement therapy and its possible consequences? The words themselves can cause dread.

As Rona Mackay asked, what hormone replacement therapy is commonplace for men? A minority of men need androgen replacement therapy, but it is needed on nowhere near the same scale. If it was commonplace for men, we would be talking about the subject very freely and there would be support in place: it would be a different subject altogether.

We know that work presents yet another challenge. In a health survey that was published in October 2014, 70 per cent of female workers said that they felt unsupported, one in five felt that her symptoms were affecting her work, and one in 10 had considered quitting. Nine out of 10 women said that they felt unable to talk to a manager or colleague, 18 per cent said that they had needed to take time off, and one in 50 was on long-term sick leave. However, few disclosed the real reason for their absence. I find those statistics shocking.

Gillian Martin and the minister mentioned the good progress that is being made in my neighbouring council area, South Lanarkshire. I am pleased that two of our SNP councillors in North Lanarkshire, Councillors Anderson and Fotheringham, lodged a motion that was passed in October 2019, to ensure that North Lanarkshire Council is committed to ensuring that a policy be introduced to impact positively on the female workforce, with the council providing appropriate support to women who are experiencing symptoms of the menopause. However, since the motion was passed, there has been no progress on the creation of a policy by North Lanarkshire Council officials. Councillor Carragher spoke to the council, which confirmed that no work had been done on developing a policy. She said:

“I was told it was felt doing so would complicate matters as the Council already has mechanisms in place to better assist but it was accepted that better knowledge of these mechanisms was required.”

What makes that worse is that 79 per cent of North Lanarkshire Council’s workforce is female. It is simply unacceptable that the council has not even bothered to work on a policy that will affect more than three quarters of its workforce at some point. I understand that there are policies in place on a short-term basis, such as special leave and flexible working hours, but it is disconcerting and bad practice for North Lanarkshire not to take action on a policy as South Lanarkshire has done.

Photo of Fulton MacGregor Fulton MacGregor Scottish National Party

I apologise to Elaine Smith.

I can see that I am well over time. When I first decided to speak in the debate, I did not think that I would be in that position, but the debate has been very much a learning curve for me. Every woman and man deserves to understand the menopause. Too many individuals and relationships suffer because of a lack of understanding of that phase of life.

The Deputy Presiding Officer:

Before we move to closing speeches, I ask myself, “Wherefore art thou, Mr Corry?” No doubt he will give the Presiding Officer a little note. Mr Bowman, you will make sure that that happens.

Photo of Pauline McNeill Pauline McNeill Labour

It is time to end the stigma of the menopause, and I believe that we are helping to do that by debating it today. I thank Christina McKelvie for bringing the first-ever debate on the menopause to the Scottish Parliament: 20 years ago, it would have been inconceivable that people would have been prepared to take part in such a debate—never mind that a Government minister would introduce it. It shows how far we have come that we are prepared to talk publicly about such an intimate health and welfare issue. I hope that the debate will encourage women who see or read it to talk about it themselves.

I think that it was Alison Johnstone who said that it is liberating that we can talk about menopause and not “the change”. We heard from Elaine Smith and Alison Harris: perhaps we should have some Scottish Parliament fans—they would certainly be well used.

When Kirsty Wark spoke out about breaking the silence on the menopause, she talked about her experience, which had been brought on by a hysterectomy. Women having a hysterectomy early in life brings on the menopause, because the woman is no longer producing oestrogen, which has obvious consequences for health.

Sharon Edwards from the Scottish Trades Union Congress women’s committee has been mentioned many times. It is worth repeating that, as she has said, for far too long the menopause has been an issue that has been shrouded in secrecy, and confined to whispered conversations between women and many jokes about hot flushes.

Annie Wells talked about women who no longer felt that they were good company. That is a sad reflection on the situation. As Monica Lennon said, there are up to 34 symptoms of the menopause.

It struck me that if a woman does not know what she is about to face, how does she know what she needs from her partner? Work needs to be done on that. If they know what the battle ahead is, most women will be able to take it on. Services need to be based on that principle. Maurice Corry effectively summarised the pain of womanhood, which covers puberty, periods, childbirth, smear tests, mammograms, premenopause and the menopause. We should shape our services accordingly.

The menopause is meant to be a natural process, but there is a hell of a lot of pain attached to it. Despite that, we know that women come through it and remain resilient and hard working. Liam McArthur rightly described the situation as “a health inequality” that we have to put right. As others have said, that means that changes in the workforce are necessary, because demographics have changed and there are more older women in the workforce.

Many women are, naturally, reluctant to share their experience of their symptoms with their employers, GPs, friends or family because of a lack of understanding in society. It is clear that that must change.

Of the 3,500 women who responded to last year’s STUC women’s committee’s survey, 63 per cent said that the menopause had been treated as a joke at work. The largest increase in employment rates during the past 30 years has been among women aged 55 to 59—the rate having increased by about 20 per cent.

The symptoms of the menopause can have negative impacts on women’s economic participation. The workplace environment can significantly affect a woman’s ability to manage her symptoms at work; inadequate ventilation has been mentioned. Other issues that should be at the top of employers’ agendas—and trade unions’ agendas, when they are negotiating better policies in the workplace—are lack of appropriate toilet facilities, crowded work spaces and inflexible working arrangements.

Doctors, too, need better support. Nearly two thirds of GPs in the UK do not feel confident about treating the menopause. That must change, because if GPs do not feel confident, how can the women feel confident? The fact that only half of doctors have received training in managing the menopause is particularly concerning.

Almost two thirds of the women who responded to the Scottish Women’s Convention survey felt that there was not enough information available to them to help them to identify that their symptoms related to the menopause, and to support them in how to manage it. Of the 3,500 women who responded to the STUC women’s committee’s survey, more than half were already going through the menopause.

I hope that the subject of the debate is one to which we will return. It is the job of politicians in Parliament to work together not only to remove the stigma and the taboo of talking about the menopause, but to shape the kind of services that women need. We must talk to the people who need to change their attitude, primarily in the context of the workplace. If we do that, the world will be in a better place.

Photo of Rachael Hamilton Rachael Hamilton Conservative

You have missed a great debate, Presiding Officer.

In closing for the Scottish Conservatives, I thank everyone who has taken part in the debate and the minister for bringing it to the chamber.

We are starting to see society move in the right direction when it comes to the menopause, but there is still a long way to go. As many members have pointed out, the menopause is completely normal—it is as normal as pregnancy or periods. However, my mother and my grandmother never talked about their experience of the menopause, with the result that I believed that it was quite normal to walk around wearing a cotton sundress in the winter.

It is an unavoidable fact that most women go through the menopause. As we have heard, it affects women in many different ways. Despite that, there remains a stubborn stigma surrounding it. Maurice Corry highlighted that the first step towards destigmatising the menopause is to talk about it in a way that normalises it and that the sharing of experiences is important in that regard. Given that the menopause is completely normal, it should not be a taboo subject.

I thank my Conservative colleagues Annie Wells and Alison Harris for speaking about their experiences. I also thank Rachel Maclean MP, who led a menopause awareness campaign. She believes that too many women do not get the treatment that they deserve. During a speech in the House of Commons on world menopause day 2018, she highlighted the need for better education. She said that the menopause

“needs to come into the school curriculum and to be part of what schools are talking about. Let us look at how we can do that, because surely it is not that hard.”—[

Official Report, House of Commons

, 18 October 2018; Vol 647, c 851.]

I could not agree more with that statement, because it is extremely important that we teach not only young women and girls about it but young men and boys. It was refreshing to hear four men speaking in the debate.

By receiving factual education about the symptoms, whether it is from the NHS or through schools, women can prepare for what is to come and what to expect and, in turn, increase the awareness of their families, friends and work colleagues of what is happening. Certainly, I would ask the Scottish Government to provide that factual education, particularly when it comes to young people’s personal and social education lessons.

What about the workplace? Many members have talked about that today. Employers have an important role to play and should be encouraged to introduce support policies in the workplace—Alison Johnstone spoke about a workplace menopause policy. Maurice Corry also talked about the women’s business council, which has developed a toolkit for employers that enables them to make adaptations, create the right workplace environment, support flexible working hours and raise awareness of the menopause.

Alison Johnstone reminded us that half the workforce is female. Gillian Martin said that the menopause is not a reason not to employ older women; that was also highlighted by Joan McAlpine, who spoke about the benefit of older women in society, including in the workplace. Stewart Stevenson spoke about that, too.

It is really worrying that one in four women over 50 considers cutting their hours due to menopausal symptoms. It is not just something that we should load on to employers; we should do as Liam McArthur suggested and deal with the health inequalities. It is important that menopausal symptoms are correctly identified and managed by GPs—Elaine Smith is a fantastic advocate for that, as she talks about the symptoms of the menopause and their similarities with the symptoms of an underactive thyroid. It is also important that we use research for the advancement of treatment; identifying the symptoms correctly and then working alongside employers may bring the menopause to the fore, destigmatise it and allow women to stay in the workplace for longer.

Unusually, the BBC has received compliments today. Lots of members have talked about the welcome launch by “BBC Breakfast” of its wake up to the menopause campaign. It ran a week of menopause clips, looking at everything from the symptoms to workplace issues, educating the public on how women may feel and what help people can offer. That followed on from “The Menopause and Me”, a documentary by Kirsty Wark.

Kirsty Wark has been absolutely fantastic in breaking down the stigma and the documentary goes some way towards tackling the negative perceptions that women face because of menopausal effects. Her involvement in the programme came about because of her own sudden and unexpected experience. She had a medical menopause at the age of 47, after a hysterectomy and after coming off hormone replacement therapy because of fears over its link to breast cancer. Because the menopause was never spoken about, she felt isolated and unable to talk about her experiences. Perhaps this debate will allow other women to feel more comfortable in speaking about their own experiences to other women and indeed to men, to their children and to those in their workplace.

The isolation aspect of the menopause was highlighted recently by a British Menopause Society survey, which found that 23 per cent of women feel isolated as a result of menopausal effects. We need to see greater societal change in order to help women feel comfortable about speaking more openly about their experiences, and for others not to be critical, judgmental or prejudiced against women who are experiencing the menopause.

It has been encouraging to hear contributions from across the chamber. I am really scared about going through the whole thing myself after listening to everybody’s experiences but I do not think that I have ever spoken about it in public so it is amazing to hear about. I am glad that there is a strong recognition from all parties that we must do more to tackle the stigma.

I commend the British Menopause Society for its work and the support that its volunteers offer right across the country, including the cafes that we have heard about. It is such people who make a real difference to women’s experiences.

I hope that, going forward from this debate, the Scottish Government will set out its next steps in supporting Scottish women.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I thank all the members who have contributed to the debate. It is important that the Parliament has come together to send an unambiguous message that we support and value women at all stages of our lives. Before I go further, I congratulate the Parliament, which will shortly launch its policy on periods and the menopause.

Like Alison Harris and others, my first experience of the menopause was my mum. What I remember was irritability, tiredness and tearfulness, but it was never explained and it was never spoken of. I remember as a young girl being very anxious that something was wrong with my mum and, being an imaginative young girl, I had her dead and buried a couple of times. It was never spoken of.

In passing, before I turn to what members have said, I give my personal thanks to Pauline McNeill for recognising that women who have come through it are brilliant and hard working.

Annie Wells talked about the menopause as a natural part of ageing, and it is. The problem is that the experience of women, in the workplace and elsewhere, is that somehow what is happening is not natural. Somehow, it is our fault. We are being difficult and we are being troublesome. For us as women, it can also be a hard thing to face up to, because what it signals, whether we recognise it or not, is the end of our capacity to conceive naturally. Whether we rail against it or not, we have absorbed the notion that conception and the bearing of children are essential parts of our femininity. It is also a signal that our life and our lifespan are finite. Those things are hard to face up to. Yes, it is important to recognise physical symptoms and the postmenopausal impact on our physical health, but it is also important to recognise the psychological effect on our mental health of not just the symptoms, but what it sometimes feels to us that the menopause means.

Photo of Monica Lennon Monica Lennon Labour

We will all have read the helpful briefing from Engender. I had not been aware of it, but Engender points out that the mental health strategy makes no reference to the menopause and has only four references to women, two of which are in relation to perinatal mental health. Could that be looked at for the next update to the strategy?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I will come to that point in a minute. I am not sure that the mental health strategy should mention the menopause, but the delivery of our work on mental health and our work in primary care should recognise the potential impact of the menopause on women’s mental health. I am happy to take on the spirit of the intervention, if not exactly what is being asked for.

On health more widely, there is a real need for wider education. Alison Harris touched on that, and it occurred to me strongly through the debate. That is particularly so in primary care, where some of the issues that Elaine Smith raised about assumptions that are made about women, misdiagnosis, and failure to recognise the interrelationship between other conditions, the menopause and medication can be found. For the majority of women experiencing menopause symptoms, appropriate management, advice and treatment should be available through primary care services. Where there are more complex issues, for example with other medical conditions, a medication referral is made to secondary care.

People have touched on what the health service does in terms of the menopause. There are specific menopause clinics in NHS Dumfries and Galloway, Fife, Grampian, Lothian and Tayside. In health boards, specialist gynaecology services are also available for women. In addition, there are a number of clinics that are recognised by the British Menopause Society in Glasgow, Clyde, Highland, South Lanarkshire, Ayrshire and Arran, and elsewhere.

We recognise that, especially in primary care, there is a need for significant additional training so that the workforce’s understanding of the issue can be increased. I am happy to commit to looking again at our work in that area.

However, education must go further than the primary care setting or our medical workforce. Realistic medicine, which our chief medical officer and her team advocate so well, centres on meaningful conversations taking place between people and healthcare professionals. In order to have those, the individual on the other side of the desk—whether they be a GP, an advanced nurse practitioner or another professional—needs to be both more confident and more knowledgeable.

Although I want to avoid overmedicalising what is a natural part of women’s lives, I agree with the approach that Alison Harris mentioned, which is to start working much earlier with young women and girls. They need to know that menstruation is normal, but be ready to recognise the symptoms of conditions such as endometriosis, which we have mentioned in other debates, so that they do not confuse them with, for example, heavy periods. Women need to understand what is happening in their bodies, be confident in their knowledge, and be prepared to argue their cases and present their needs in primary care settings and elsewhere. Knowledge is powerful. Normalising our knowledge of natural bodily functions and changes to our bodies is critical in that regard. As Liam McArthur said, ending inequality at every level starts by talking openly and listening well.

I am very happy to commit to working across government, with colleagues in education and elsewhere, to increase the provision of information. That process must start where it needs to happen—in schools—but should extend through our health service to improve information, increase what is available, improve understanding and support women in the health-related issues that they face. There is more for us to do. I will continue the discussions that have begun with the chief medical officer and others about how much more we can do to raise awareness and strengthen menopause services in Scotland.

Much of the debate has, rightly, focused on the workplace. NHS Scotland is the largest employer in our country. Many of the issues that have been raised and discussed today and that have been faced by women in other workplaces will be faced by those in the health and social care sector. It is the case that NHS Scotland does not have a standardised policy on the menopause, but I hope that members will accept my assurance that it will have one very soon.

Photo of Elaine Smith Elaine Smith Labour

We have discussed the fact that many councils do not have workplace policies either. Does the cabinet secretary agree that, rather than simply criticising them for that, we should take a cross-party approach to encouraging them to put such policies in place?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I absolutely agree with that. I would be poorly placed to criticise another organisation for not having a workplace policy on the issue when, right at this minute, our health service does not have one. I will take Ms Smith’s point on board. It is right that we should collectively encourage all employers—whether they are in the private or public sectors—to take the issue seriously and to develop such policies, and that we should offer them support where it would be helpful to them for us to do so. We should encourage the normalising of what is part and parcel of women’s lives. Women must talk about the menopause and ask for the support that they need—whether it be from the health service, more widely from their employers or society, or, more intimately, from their partners.

Mandy Rhodes described today’s women as “generation M”. I do not want future generations to have that label; I want women of this generation to be the ones who normalise the transition, end the stigma, and work with men and others across our country so that the young women who will go through the transition in future will not have to face the issues that today’s women face.