Menopausal Symptoms: Support

– in Westminster Hall at 4:50 pm on 9th June 2021.

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Photo of Nusrat Ghani Nusrat Ghani Conservative, Wealden 4:50 pm, 9th June 2021

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. I remind Members participating physically and virtually that they must arrive for the start of the debates in Westminster Hall and that they are expected to remain for the entire debate. I remind Members participating virtually that they are visible at all times to us in the Boothroyd Room. If they have any technical problems, they must email westminsterhallclerks@parliament.uk. Those Members attending physically must clean their spaces before they use them and as they leave the room. Mr Speaker has stated that masks should be worn in Westminster Hall, unless you are speaking.

Photo of Carolyn Harris Carolyn Harris Labour, Swansea East

I beg to move,

That this House
has considered support for people experiencing menopausal symptoms.

It is a pleasure to be opening this important debate in person, Ms Ghani, and to serve under your chairmanship. I thank the Chamber engagement team for their support in creating a dedicated webpage for anyone impacted by the menopause to share their experiences with me ahead of the debate—this is a fantastic service available to us all in the House—and the responses that I have received have been honest, insightful and true examples of why we need to open up the discussion and remove the stigma that still surrounds the menopause. In total, 728 people responded to the public survey and I will share some of their experiences with Members later.

On World Menopause Day in 2018, I made a speech in the main House of Commons Chamber calling on the Government to commit to make a difference to the lives of all women experiencing symptoms of the menopause. At present, approximately 13 million of us in the UK are either perimenopausal or post-menopausal. That is almost a fifth of the entire population. In that debate back in 2018, I spoke of the need for changes in the curriculum to better educate our young people; improved public education to help women who are suffering and those closest to them; better training for GPs to ensure that women are correctly diagnosed and given the right treatments; and mandatory workplace menopause policies, so that women may continue to work through what can be the most difficult time of their lives.

With many pressure groups and the media now shining a light on issues to do with menopause, we are starting to talk about it more, but now we also need to start taking action. Education is key here, both public education—so that women understand what is happening to their bodies and feel confident in making informed decisions about the path they choose—and professional education, which is severely lacking.

A recent survey on menopause support revealed the shocking truth about training in medical schools. An astounding 41% of UK universities do not have mandatory menopause education on the curriculum. Menopause will, at some point, directly affect half of the population, and yet it is completed overlooked when training the people that we will all turn to for help.

Women are suffering unnecessarily, and while some barely notice any changes, for others the suffering is unbearable—stressful, debilitating and completely life-changing. Despite that, many doctors complete their training and leave university with absolutely no education about menopause at all. I am fairly confident that no other medical condition set to impact the lives of more than 50% of the population would be left out in that way.

The Royal College of General Practitioners states that menopause is included in the curriculum, although not mandatory or standardised. Bearing in mind that we know more than 40% are not providing mandatory training, however, women who are suffering and turn to their GP for help cannot be assured that the doctor they visit will be competent in recognising their symptoms, let alone to provide them with the treatment plan and medication they need. In our public engagement survey, Gillian shared her experience, saying that her GP told her to ask her mother as her experience would be the same:

“I walked out with a leaflet…no support, no advice, no understanding”.

Far too many women are still being misdiagnosed and prescribed anti-depressants, and they suffer extreme symptoms without the correct treatment and support. This needs to change. GPs should follow up-to-date guidance from the National Institute for Health and Care Excellence on the menopause and hormone replacement therapy, and they should recommend such treatment if it is appropriate. Sadly, far too many women are denied this path, because many doctors are unaware or ill informed. Even those who are lucky enough to visit a GP who recognises their symptoms and understands the benefits of HRT treatment still face barriers.

In Scotland and Wales, prescriptions are free to everyone, but unfortunately women in England are forced to pay £9.35 per item. For some, their treatment may include multiple items every time. Lisa responded to our survey by saying:

“Free HRT prescriptions are needed. I’m currently charged two prescription charges for one box of medication.”

Lesley said:

“It’s a process of elimination getting the correct medication. It’s so expensive and I have found it very difficult to pay for the prescriptions.”

That is not something to be taken lightly. It is not just the odd hot flush or moment of forgetfulness. Menopausal symptoms can ruin women’s lives, and until something is done to improve the standard of diagnosis and treatment, they will continue to ruin even more.

Women deserve so much better. They are giving up their careers and ending relationships because of the severity of their symptoms and the impact on their physical and mental wellbeing. It is no coincidence that suicide rates for women peak between the ages of 45 and 54, which is the average age that most women reach the menopause or experience perimenopausal symptoms. This cannot carry on. I do not want to be standing here in another two and a half years talking about the same things.

Education on the menopause, which is slowly being incorporated into the curriculum in secondary schools, is a positive step forward, but it is just one part of a much bigger picture. Public health guidance, standardised compulsory training for those in the medical professions, and fully funded HRT treatments and workplace policies need to follow. Women should not feel inferior or incapable of doing their job because of the effects of the menopause on their health and wellbeing, but, sadly, too many do.

The situation could be so easily rectified. Simple changes in the workplace, such as flexible working hours, relaxed uniform policies and adaptations to the working environment, could all make such a difference. Dinah talked about this in her survey response. She explained that in her workplace, she was

“surprised to find no menopause policy whereas we have policies for most conceivable events.”

She added that she told her manager about her menopausal symptoms and how she felt that they were interfering with her capacity to do her job. She said:

“I was offered no support, we just talked about how I could stop making mistakes.”

The Government have alluded to that in their call for evidence for the women’s health strategy. One of the areas being considered is maximising women’s health in the workplace, with menopause being one of the female-specific conditions mentioned that impacts on women’s participation in work. I urge anyone affected to complete the public survey before the deadline of 13 June, and details can be found on the Government website.

None of the things I have mentioned are big on their own. They are all easy to rectify, but the lack of them all is having a devastating impact on so many lives. We have the power to change that, and we must seize the opportunity. I plan to set up an all-party parliamentary group on menopause support over the coming months. I have already had colleagues from across the House express an interest in joining, and I would be delighted to hear from more MPs and peers—both male and female—who I know share my passion to make a difference.

Women should not be left to suffer through a lack of awareness, inadequate support or financial restraints. Every woman experiencing menopausal or perimenopausal symptoms should be confident that they will be able to access the right treatment and support in every aspect of their lives. Women deserve to see medical schools providing appropriate training so doctors can diagnose and prescribe appropriately. Women deserve to have mandatory menopause policies in their place of work. They deserve to be given the reassurance that they can access treatment without worrying about how to pay for it and they deserve to be assured of all the support and care that they need. Women have been suffering in silence for far too long. This debate has given them a voice. Now it is up to us to listen and act.

Photo of Rosie Duffield Rosie Duffield Labour, Canterbury 5:00 pm, 9th June 2021

It is a pleasure to serve under your chairship for the first time, Ms Ghani. I thank my hon. Friend Carolyn Harris, the deputy leader of the Welsh Labour party, for securing the debate today and for all that she is doing to raise awareness of this and many other women’s health issues.

Menopause will affect the vast majority of women, with some experiencing menopause earlier as a result of cancer or other health conditions. I have friends who have gone through it who then have the added stress of having to explain to others why they are unable to have children, or to share their medical histories. There seems to be such a lack of awareness and understanding of issues around the menopause. It can still feel like a bit of a taboo subject.

The menopause is, of course, a women’s health issue, so quite why the House of Commons titled today’s debate

“support for people experiencing menopausal symptoms” is a bit of a mystery, particularly when the House of Commons Library report uses the word “women” throughout. Like all mostly women’s health issues, there is often difficulty with our being able to access the right help or support, or even the most basic information. Like many women in Parliament, I am in the age group most likely to be experiencing menopause and, like most women I know of my age, we rely on personal and professional friendship groups for sharing information and our own experiences. We talk to each other and usually find that every one of us will have had some similar, but also some very different, symptoms. It is often hearsay, rumour, second-hand or third-hand stories, shared articles or scraps of advice that are our main source of information about this major life change and huge change to our bodies.

My constituent, Elizabeth Ellis, started her campaign group 50Sense and the campaign “Know Your Menopause” to inform women after she could not get any help and support when she was first going through the menopause herself. How many times do politicians meet people like Elizabeth, who have used their own life experiences to become an expert and a champion in order to help others?

50Sense’s Pausitivity campaign produces a variety of really useful information, as well as posters that people can print out and put up in their workplaces and ask GPs to display. I encourage anyone who wants to know more to find the pausivity.co.uk website and download the great resources, including questions to ask GPs. Of course, that includes men. As husbands, partners, friends, colleagues and responsible employers, they ought to find out as much as they can, too, about this big event in the life of almost every woman they know. I hope hon. Members will note that I left sons out of that list, as, if I am being honest, I know that mine really do not want me to discuss my menopause with them, as lovely as that might sound.

Elizabeth, my constituent, and so many other women like her, should not have had to go back and forth to the GP for almost four years, with symptoms that she now knows were quite obviously the menopause. She was sent to A&E with heart palpitations and was even asked more than once if she was a cocaine user. If she had seen one of the Pausitivity posters she has now produced, it would surely have saved her a huge amount of distress, not to mention the NHS a lot of money. Another constituent, Michelle, had a surgical menopause and, because of the horrendous symptoms and lack of NHS treatment, was forced to go to a private consultant and spend a lot of money because the support she needed was not there. These women are not alone. Menopause cafés such as those mentioned by the Under-Secretary of State for Transport, Rachel Maclean, in the last menopause debate are popular places for women to support each other and share stories. It is extremely common for many women to become almost suicidal with the lack of understanding or help available.

We need to end the postcode lottery or luck element of menopause support. All GP surgeries should have someone available to advise or support women, or should display a poster, so that they know what they are going through is perfectly normal. GPs and healthcare professionals can inform women about local support groups and menopause cafés. We need easy access to fully funded HRT treatment. Men too should also familiarise themselves with some of the facts. After all, most people in the UK are female and at some point will go through the menopause. I urge everyone to log onto pausitivity.co.uk or watch the excellent documentary produced by Davina McCall for Channel 4 recently.

Photo of Nusrat Ghani Nusrat Ghani Conservative, Wealden

To ensure that all the speakers get in, we must impose a time limit of four and a half minutes.

Photo of Judith Cummins Judith Cummins Labour, Bradford South 5:05 pm, 9th June 2021

It is a pleasure to be called to speak in this important debate and I thank my hon. Friend Carolyn Harris for securing it. I know that menopause is shrouded in mystery and certainly used to be a taboo topic, but this is changing and it needs to, as its impact can be complex and numerous as regards health outcomes for women. I will speak on one aspect of menopause—its link with osteoporosis. I do this as co-chair, with Guy Black, Lord Black of Brentwood, of the newly formed all-party parliamentary group on osteoporosis and bone health.

A key factor in women’s health is the protection of bones. Menopause is a crucial time to protect our bone health. When women reach the menopause, oestrogen levels decrease, which causes many to develop the well-known systems of hot flushes and sweats. According to the Royal Osteoporosis Society, a decrease in oestrogen levels also causes a loss of bone density—so the menopause is an important cause of osteoporosis.

Everyone loses bone density and strength as they get older, but women lose it more rapidly in the years following the menopause, losing up to 20% of their bone density during this time. With that loss comes reduced bone strength and a greater risk of breaking bones. According to a survey by the ROS, a fifth of women who have broken a bone break three or more before their osteoporosis is diagnosed. Breaking a bone normally means significant short-term pain and inconvenience, but it does not stop there. Many people with osteoporosis who break a bone live with long-term pain and disability, especially if their back is affected. The reality of broken bones and the fear of falling impacts on everyday activity, stopping people from doing the activities they love. As women lose the protective effect of oestrogen at the menopause, it is a critical time for their bone health and a time to consider many factors, whether that is positive life changes to help maintain bone strength, having a health bone assessment or considering whether osteoporosis drugs are needed to strengthen bones and reduce the risk of fractures. A number of medications are available for those with a significant fracture risk, including hormone replacement therapy, which, crucially, reduces bone loss and the risk of fractures.

It is tragic that the loss of bone strength, and the associated pain and disabilities that fractures cause, is preventable in so many cases, and that is why it is important that around the time of menopause women receive the support needed to consider whether they have a fracture risk that needs treating with osteoporosis medication. To support this, the Royal Osteoporosis Society is calling for GP surgeries to be incentivised routinely to use digital tools to assess risk and prevent fractures, as recommended in the NICE guidelines. Frustratingly, accessible digital solutions already exist and are not integrated properly into IT systems in GP surgeries.

Sadly, many GPs and other healthcare professionals lack the confidence to manage osteoporosis, missing opportunities to identify people at risk early and to prevent that important first fracture. A recent study showed that 75% of older women seen in primary care at high risk of fractures were not given the medication they needed, due partly to a failure to diagnose osteoporosis. These IT solutions can identify people with risk factors for developing osteoporosis before that first fracture. Patients found to be at higher risk can be offered anti-osteoporosis treatment proactively, with a personalised pain management plan comprising medication, lifestyle advice, vitamin D supplementation and fall prevention strategies. That is why it is essential that around the time of menopause, women are properly supported to assess their risk of osteoporosis and fractures. Provided that we support GPs with education and training, including on menopause and bone health, test those at risk and provide preventive medication such as HRT and vitamin D, the vision for early intervention can become a reality.

Photo of Nusrat Ghani Nusrat Ghani Conservative, Wealden

I now call Alex Davies- Jones.

Photo of Alex Davies-Jones Alex Davies-Jones Labour, Pontypridd 5:10 pm, 9th June 2021

Diolch, Ms Ghani. It is an honour to follow my hon. Friend Judith Cummins. I am very grateful to my hon. Friend Carolyn Harris for securing a debate on this incredibly important issue, and I echo her comments on the need for greater Government action and support; for improved education in GP surgeries, the workplace and schools; and to remove the stigma.

I am pleased to see so many hon. Members from across the House participating in this debate, and I am especially grateful to those who are sharing their personal experiences with the menopause. I, too, have some familiarity with the enormous impact that the menopause can have, on not only physical health but mental health. As is the case for many people across the country, my road to motherhood was far from straightforward. I knew early on that my best chance of carrying a child was through IVF—in vitro fertilisation. What many Members may not know is that the hormones and medication that you need to take as part of the IVF process often mean that you begin to experience a kind of early menopause. I had it all, from hot flushes and headaches to fatigue and terrible concentration. My mam, who had experienced all this before, was my absolute rock.

I know that, for many women, the menopause can be an incredibly difficult and lonely time. I was lucky: I had a very supportive employer, and my fertility story thankfully has a happy ending—after just one round of IVF, I fell pregnant with my wonderful son. But I know that, tragically, for many women that will not be the case. The last thing these women need is to feel that they must deal with the symptoms of menopause alone.

My hon. Friend Rosie Duffield is completely right to raise the brilliant Pausitivity campaign and the excellent resources that it provides. Everyone who has experienced menopausal symptoms, whether they are medically induced, as in my case, or part of the natural ageing process, will know at first hand how big an impact they can have. But we are far from alone. Around one in 100 women in the UK will experience menopausal symptoms before they turn 40, and it is estimated that in total about 13 million women are currently perimenopausal or menopausal in the UK. This is a normal part of life, but sadly, many women feel a huge amount of stigma and experience difficulty in talking about and dealing with these symptoms.

I am a very proud member of Unison and a long-time supporter of its menopause awareness campaign. I know from my own experience just how much of an impact simple changes such as paid leave, flexible working policies and temperature control in offices can have when women are experiencing menopausal symptoms. Nearly eight out of 10 menopausal women are in work. Many of them will have decades of experience and huge amounts of knowledge to share. Surely it is in employers’ best interests to introduce comprehensive policies to support them staying in their jobs.

The UK Government have a vital role to play in ensuring that the protections are put in place. We were promised an employment Bill in the 2019 Queen’s Speech, but more than a year has gone by now, so where is that much-needed legislation? Worse still, we find no mention of a forthcoming employment Bill in this year’s Queen’s Speech. That legislation would not only enable the Government to introduce their long-promised policy of paid leave for parents of babies receiving neonatal care, but give us all the important opportunity to introduce protections in the workplace for women experiencing the menopause. I ask the Minister to please work with her colleagues in Government to bring forward such legislation as soon as time allows. All of us taking part in the debate today know that the menopause is far from a niche issue. It does not take a genius to work out that it will affect about half of us in our lifetimes. It is absolutely necessary that this issue is taken seriously by the Government.

Incidentally, it is the same half of the population who have periods, and while we are on that topic, may I take the opportunity to congratulate the UK Government on once again following where the devolved Governments in Wales and Scotland have led in making sanitary products free in schools?

I am very glad to say that in recent times we have seen real moves forward on visibility and awareness of the impact that the menopause can have. I have no doubt that Davina McCall’s fantastic and taboo-breaking documentary on the menopause last month will have had a major impact on the millions of women who may have been suffering in silence. But today’s debate makes it clear that far more needs to be done, so I urge the Minister to take forward the concerns and ideas of colleagues across the political divide and work with her colleagues in Government to address this all-important topic.

Photo of Ruth Jones Ruth Jones Shadow Minister (Environment, Food and Rural Affairs) 5:14 pm, 9th June 2021

It is a pleasure to serve under your chairmanship, Ms Ghani, I believe for the first time, and I very much thank my hon. Friend Carolyn Harris for securing such an important debate.

In preparation for this debate, I looked up the definition of menopause. There was a very short phrase that just described it as a natural process of ageing. Really? It does not feel very natural when you are going through it, I have to say. It also stated that there was no specific medicinal treatment. Treatment is aimed at “decreasing the signs and symptoms”, which is a very vague, non-specific definition.

I wonder why, even today, there is such a lack of knowledge and communication about such an important topic. There is lots of communication about puberty and pregnancy—they are well documented and well discussed, so people know what will happen before they experience them. It feels like menopause is the last taboo.

Having been a physiotherapist in my previous life, I thought that I knew all there was to know about the menopause, but nobody prepared me for the mental health aspects. My husband can testify to several meltdowns on my part, which left him completely taken aback, as was I. Obviously, once we realised what it was, we could put solutions in motion. But it is important that we know what is happening before it actually happens. Support is needed, whether at home or at work—I certainly benefited from the support of colleagues in the workplace—for all who go through the menopause, including before they go through it.

I feel privileged to have worked in the NHS in Wales on the menopause policy, which was issued in December 2018. The working group was all women of a certain age plus one very embarrassed man, but they produced important policy and guidance, offering specific and practical solutions for dealing with the menopause. They include simple things such as opening a window, relocating a desk or sorting out uniforms—simple things that just need to be put in practice. I urge the Minister to look at those sorts of practical solutions, because that is what we need to publicise.

In conclusion, I again thank my hon. Friend the Member for Swansea East for highlighting this important topic, and I urge the Minister to do all she can to make sure that people experiencing the menopause are supported, both here in this place and in the wider world outside Parliament, because this really is a time for action and not words.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 5:17 pm, 9th June 2021

First of all, I congratulate Carolyn Harris on securing this debate. She and I have been in so many debates together that I have almost lost count. I have always supported her and, to be fair, she has always supported me.

I am here for two reasons: to support the hon. Lady but also because my wife has gone through this in the last wee period of time. Although I cannot begin to comprehend physically what it means to a lady for it to take place, I think that, as a dutiful husband, I am able to make a wee contribution to this debate.

I am also here because I am the Democratic Unionist party’s health spokesperson. I take a particular interest in all health issues debated in this place, whether in Westminster Hall or in the main Chamber, including Adjournment debates.

Although I will never experience physically the difficulties outlined today by every one of the hon. Ladies who has spoken, I have supported my wife through her journey, and from the outside looking in, it has been a tough time. Describing it as “the change” is very apt—there are so many changes, so much change—and with change there must be support. Also, at that time my wife lost her mother. So, in addition to having the menopause, she lost someone who was very dear to her and who we all miss greatly. Those were difficult times. My wife had to go to hospital as well. My mother helped her in that regard, because I was over here and so was unable to assist her directly.

I believe that there must be a wider understanding that all of those things that are different are so difficult to understand. There may be a list of symptoms, such as anxiety, low moods, poor concentration and memory, hot flushes and night sweats, insomnia and so on. However, knowing that they things may be symptoms is one thing; dealing with them is very different. So, it is about how we deal with these things.

In Northern Ireland we have only two menopause specialists. The service is understaffed and in dire need of funding and attention. I believe that every trust must have dedicated specialised clinics to deal with the menopause and to provide information, medication and support. Women, especially those in Northern Ireland, have a “grin and bear it” mentality about most things in life, but I believe that that is not enough to see you through. We need to have the conversations and have them heard, not simply woman to woman, but with men, husbands, partners and sons—although I understand that Rosie Duffield may have a slightly different opinion on that. I suppose the question is how to help them understand and to offer them support that makes this cosmic shift bearable.

I employ seven staff—four part-time and three part-time. I have six ladies and one gentleman. As an employer, I have to be aware of my duty and understand, sympathetically and compassionately, where we are. I have learned over the years that we—and in this case I—can step outside our comfort zones when needed. This message must be clear. I believe that these discussions are needed and have to take place. I stood with my wife as she went through a particularly tough time, and I have realised that things are only as awkward or as uncomfortable as I make them. A simple, “Is there anything I can do to help today?” means the world to someone who feels they are battling the world and their own body.

I thank the hon. Member for Swansea East for raising this issue and all the hon. Ladies who have spoken. I look forward to hearing those who will follow me, especially the Minister, as I always do. We need these conversations. We also need a dedicated programme and funding. I look to the Minister, who does not have responsibility for Northern Ireland but who always answers well, to outline how the Government can ensure that we can do better—and that means everyone, male and female.

Photo of Kirsten Oswald Kirsten Oswald SNP Deputy Leader, Shadow SNP Spokesperson (Women), Shadow SNP Spokesperson (Equalities) 5:21 pm, 9th June 2021

I thank Carolyn Harris for securing this important debate. It should be clear to all of us that we do not speak nearly enough about the menopause, and that needs to change.

For far too long, a polite veil has been drawn over this and other issues facing women, young and old, so any mention of menopause, as if it were not a perfectly normal states of affairs, has been seen as a little bit distasteful. For women of a certain age, myself included, that is not okay. I am heartened that the SNP is committed to a women’s health plan and has plans in place to work with women’s organisations and the Scottish Trades Union Congress to identify areas in relation to menopause where action is needed.

Specifically female health issues have been silenced for far too long. We have recently been climbing a mountain in discussing sanitary protection. There is still more to do there, but bravo, as Alex Davies-Jones said, including to the Scottish Government and the women who pushed for change, which meant that Scotland became the first country in the world to have free period products. We need to take the same approach to menopause. Things will not change if we do not have that opportunity and take the initiative in discussing it.

That dialogue will matter, because the veil of secrecy that too often surrounds discussions about the menopause is damaging women’s lives. Why is that the case? Half the population will experience menopause. A great many of them will be unclear about symptoms, treatments and where to go for support. Rosie Duffield mentioned the work of menopause cafés. The Menopause Café in Newton Mearns was admired by the people who attended it for the frank, open and supportive discussions held. That sharing and sharing alike on menopause is really helpful.

Some employers are making important moves to increase awareness and support for the menopause, including my local council, East Renfrewshire Council, which I know is discussing that at the moment. That is really important. If employers do not take that initiative, they are in grave danger of losing out on talent and experience, as well as treating women in a way that they simply do not deserve.

As the hon. Member for Swansea East said, that is one of the reasons we wanted to see an employment Bill. Equality matters, and while employment law remains reserved to the UK Government, the Scottish Government will continue to provide and promote fairer work practices for employers to look at. We need these powers to be devolved so that we can get on with job if it is not being done here.

I accept that conversations in the workplace will not be entirely straightforward. Policy development is never straightforward or clearcut, particularly on this issue because menopause is not linear. It can be extremely variable in terms of symptoms, duration and physical and emotional impact, but women need us to tackle this, none the less. At the moment, many feel unable to seek support about the menopause at work. However, the very fact that it is so complex means that it is all the more vital that we make progress.

We all know, or perhaps we are, women who have experienced uncertainty, miserable confusion—symptoms of all kinds. I thought it was really interesting, but not in a good way, to hear the hon. Member for Swansea East talk about the challenges of being unable to afford some of the necessary prescriptions. That is not an issue for women in Scotland, who are able to avail themselves of free prescriptions. There is so much more to be done, in terms of understanding, and her points about the education of the medical profession were absolutely spot on.

Women must be able to seek assistance and support. Although some will sail relatively serenely through menopause, there are often health and wellbeing implications which, if they are acknowledged at all, are just dismissed as women’s troubles. I have to tell hon. Members what women’s troubles actually are. They are the kinds of troubles that it suits folk for us not to talk about: periods, hot flushes—I could go on. The reason we have not historically talked about them is age-old: pure and simple sexism. Let us not have that anymore, thanks very much. I know that colleagues across Scotland and across the UK are doing great work to stamp that out, and I commend them all.

As we travel down that road, and with all the challenges it brings, let us continue to talk and to push for improvements in education and employment. Let us talk about the menopause and how we can practically improve things, and about periods, too. It would be sensible for those things to be part of our normal, everyday discourse. The menopause is normal, and it is time we stopped pretending that it is not.

Photo of Charlotte Nichols Charlotte Nichols Labour, Warrington North 5:26 pm, 9th June 2021

It is a pleasure to serve under your chairship, Ms Ghani. I must begin by thanking my hon. Friend Carolyn Harris for bringing forward this important topic for debate. She has done an excellent job in helping to raise awareness and to reveal the further changes we can make to ensure that our society is more supportive of menopausal and perimenopausal women.

The menopause is natural—indeed, normal—and is experienced by more than half of the population. It should not be embarrassing or taboo, yet nor should women be required to declare when they experience it. With around 5.1 million women in the UK currently aged between 45 and 55, the menopause affects a huge population at any given time. We should seek to be a society that understands and accommodates the symptoms that menopausal women experience as a standard part of our life cycles. We should recognise that every woman experiences menopause differently, and that 1% of women experience premature menopause, before the age of 40, sometimes induced by medical procedures such as surgery, radiotherapy or chemotherapy. As they have longer years of post-menopausal life, they are at increased risk of health problems such as the early onset of osteoporosis, as detailed by my hon. Friend Judith Cummins, and heart disease.

We should also recognise that the menopause also affects black, Asian and minority ethnic women, who are too often overlooked in awareness campaigns that do not feature women who look like them. They are disproportionately likely to be diagnosed with menopausal-related conditions such as heart disease, diabetes and depression. What plans does the Minister have to address that?

Nor should we forget that some menopause treatments are incompatible with medicines taken by some disabled women, putting them in a particularly difficult position and hampering their ability to live normal lives. Can the Minister offer anything on specific support for disabled women?

Similarly, LGBT people, including trans men, may have specific issues with being able to access support and appropriate healthcare services if they are experiencing the menopause. What measures will be taken to ensure access to everyone who needs those, regardless of gender or sexuality?

The cornerstone of normalising menopause is, of course, education in schools, including in relationship and sex education classes. I welcome that those were added to the curriculum in 2019 and would like to hear from the Minister details of how widespread that teaching now is. We heard from my hon. Friend the Member for Swansea East important details about alarming gaps in medical school training. Some 41% of medical schools do not teach about the menopause, and we can only imagine how many misdiagnoses that produces. I understand that a third of women do not even seek to discuss the menopause with their GP. Let us hope that better training will lead to increased confidence. This is clearly something that needs to be improved. Will the Minister set out what steps the Government will take to require such training for doctors?

It is similarly clear that we can do better to ensure that GPs fully appreciate the benefits and proper use of HRT. Women deserve to have clear and up-to-date facts when they make such important medical decisions about their bodies. They must not suffer a postcode lottery if some GPs have unhelpful prejudices. How will the Government ensure that?

We have also heard from my hon. Friends the Members for Swansea East, for Pontypridd (Alex Davies-Jones), for Newport West (Ruth Jones) and Kirsten Oswald about how women in Wales and Scotland benefit from free prescriptions, including for HRT treatments. Will the Minister tell us the cost of making HRT available for free across the UK to address symptoms that come naturally for so many women? Is that something the Government are considering?

As retirement ages have risen, women are spending more years in the workplace during their menopausal and post-menopausal years. The average age for menopause is 51, but the retirement age for women is 60, so many women will work for at least a decade while experiencing symptoms of perimenopause and menopause. Workplaces now quite rightly have maternity policies, but too few focus on how to support and retain menopausal women. There are many reasonable adjustment that employers can make, as recommended by the National Institute for Health and Care Excellence, the Chartered Institute of Personnel and Development, and the Royal College of Obstetricians and Gynaecologists—for example, considering workplace temperatures, designing uniforms to limit the impact of hot flushes, and being flexible with working hours so that people experiencing these symptoms are not required to travel during rush hours. Those should all be common-sense considerations without being intrusive. They will be of benefit to individual women workers and will help us unlock productivity gains as our workplaces become safer and more equal, with the talent and experience of women able to be realised much more fully. Will the Minister commit to such measures?

I would like to end by asking the Minister what is being done to hear the voice of perimenopausal and menopausal women in the women’s health strategy, which closes next week. Can she guarantee that the strategy will address the discomfort faced by perimenopausal women at work?

Photo of Nadine Dorries Nadine Dorries Minister of State (Department of Health and Social Care) 5:31 pm, 9th June 2021

I thank Carolyn Harris for securing this really important debate. It is our second session today, and I think she knows that there is nothing she has brought forward in the House that has not had my full support. I mentioned in our previous meeting that, when it comes to women’s health, and particularly in relation to the menopause, there is no place for politics. Women’s health is above that.

I congratulate and thank the hon. Lady, and I hope she will not mind if I use her debate, once again, to talk about the women’s health strategy. The reason is that we have had more than 100,000 responses to the call for evidence, which is just amazing. Many of the responses were from perimenopausal women, women experiencing the menopause and post-menopausal women, like me—I will not go into my own experiences but, like most women’s, they were not pleasant. As the menopause is a feature of the women’s health strategy, I urge people here today, and those listening who have networks, to send the link out, because it closes on the 13th, which is Sunday, so we have five days to go. We need as many women as possible to respond, because that will give us a mandate of more than 100,000 voices, and give us the evidence and data that we need to proceed with the development of policy.

I would also like to put on the record my sympathy for all women who have felt that they have not been listened to when discussing, or even attempting to discuss, the menopause with their healthcare providers or employers. The hon. Lady said it is referred to as “women’s troubles”—there is this taboo. There has actually been a taboo about women’s health issues since Aristotle—or since the beginning of time. It has been ingrained in the system and into us as women that it is something that we do not raise or talk about, yet we all suffer from it at some stage or another.

Judith Cummins raised osteoporosis. I will come on to some of the health conditions that women can experience as a result of the menopause, but I thank her for raising osteoporosis. Sadly, women are more susceptible to osteoporosis, because bone loss becomes more rapid after the menopause as a result of the reduction in oestrogen levels. So many of our problems in the menopause are a result of the reduction of oestrogen levels. Additionally, women tend to have smaller bones than men and a slightly longer life expectancy. But although women live longer than men, we live a longer period of time in poorer health. Declining oestrogen levels when we are perimenopausal, and a lack of oestrogen when we are menopausal and beyond, contribute to that poorer health.

Ruth Jones raised the issue of mental health. Again, having talked to leading doctors in the field of menopausal treatment, we know that women will be given half a dozen prescriptions for anti-depressants before getting a prescription for oestrogen, even though what they actually needed was the oestrogen replacement.

I heard the point made by Alex Davies-Jones about employer-led facilitation of the menopause, but one of the things that I hear a lot from women is, “I don’t want a fan on my desk. I don’t want special treatment at work. I want the HRT. I want the oestrogen, because when I have the oestrogen, I am the same as everybody else. I want to laugh again. I want to live again. I want to feel normal again. I want to have the same energy levels again, and the only way I can do that is if my GP will listen to me and give me the HRT that I want—the oestrogen.”

Today I spoke to ex-servicewomen who were talking about the menopause and wearing heavy clothing. If they were on HRT, the thick jumpers and uniforms would not be an issue for them, because they would not be going through the hot flushes. There are many women’s voices and experience of the menopause to be heard, and I am afraid it is not just as simple as saying that we want employers to give leave or to put fans on desks. One woman said to me, “I’ve been told that I can have my desk moved to be near the window, which is a prime position. I don’t want that; I just want my doctor to give me HRT.” That is actually the nub of the issue with HRT and the menopause for many women, particularly when it comes to osteoporosis. We are hearing evidence, and we will hear more, that HRT delays the onset of dementia and so many other things. Some of the research that doctors are now using to set guidelines for HRT is from 2004 and earlier.

The hon. Member for Swansea East chose a really opportune time to have this debate. I hope that she continues to take this campaign further, because we need someone with her—I hope she will not mind my saying this—flamboyancy, tenacity and ability to get gender issues to the top of the agenda. I really hope that she will continue and take this issue forward, because that is what we need. We need women like us—women on the Back Benches, women in my position and women such as the hon. Member for Swansea East—to raise this issue, because the only way we can break down taboos is by making them no longer taboos. We need to talk about this issue, and it needs to stop being something that no one wants to discuss. Women have to do it.

We are consulting on the women’s health strategy over the summer—it closes on 13 June—and the menopause is playing a huge part. We will sift through the information over the summer period, and we will come back with our findings in October/November, when officials have the time to sift through it, take up the themes and get the evidence out. That will be an amazing collection of women’s experiences and what they have gone through—not being listened to, being closed down, and not being given the treatment they want—with most of it within the healthcare arena. We know that women are not listened to in the healthcare arena. As a result of the Cumberlege report, the Paterson report and so many other reports, we know that this is the case.

To help ensure that women receive the best possible care, NICE published guidelines on the diagnosis and treatment of the menopause in 2015. It states that clinicians should adopt an individual approach or stages of diagnosis in the investigation and management of the menopause. I was accused of possibly patient-shaming when I said that women should feel empowered to be able to stand up for themselves and to challenge decisions that are made about their healthcare. I know myself, I know other women and I have heard from many women as part of the women’s health strategy who say that they know they are menopausal or perimenopausal, but their doctor insists on giving them a prescription for anti-depressants. One woman was told by a doctor to take a walking holiday before going back to him. Women know they are perimenopausal and should feel empowered to speak up about their situation.

NICE guidelines are not mandatory, although health and care clinicians are expected to take them fully into account. That is something that we need to continue to raise. Women may view various risks differently, according to their medical history, and the impact of the menopause symptoms on their daily lives.

In 2019, the Medicines and Healthcare Products Regulatory Agency published updated safety information to enable women to make informed choices about whether, and for how long, to use HRT. Despite that, as I said, I have heard that many menopausal women seeking treatment are not receiving either the appropriate advice or the medication that they need to manage their symptoms.

I am committed to looking into that further. One of the reasons why I said that I hope the hon. Member for Swansea East, with her profile and her ability to take on difficult issues, will continue to champion this is that it will help everything we do in this place—all that women do in this place will help.

We are committed to supporting women at all stages of their lives to enable them to reach their potential. Half the population will go through the menopause, obviously, but one in four women in the workplace are menopausal or have completed the menopause, and 53% of women state that menopausal symptoms impact on their work. That is why I raised the issue of those women who were not given the treatment that they seek. What they say is that they just want treatment so that there is no impact on their work. We have to do more to combat that, for the sake of women and of our economy.

A number of organisations are working to change the approach to menopause in the workplace, such as the Chartered Institute of Personnel and Development, the Faculty of Occupational Medicine and the NHS Staff Council’s health, safety and wellbeing partnership group, which has produced guidance on the menopause for employers. I encourage employers to refer to that guidance. I would be interested to know how many employers do refer to it, do develop policies in their work- place on the back of it, or even know that it is there.

Hon. Members asked about education in schools. In order to break down the taboos about menopause, there must be access to high-quality information to produce productive conversations. Health education is compulsory in all state-funded schools. From September 2020, relationship education became compulsory in all primary schools, and relationship and sex education became compulsory in secondary schools. Pupils are taught about intimate and sexual relationships, including facts about reproductive health and sexually transmitted infections, as well as facts about menstrual health, fertility and the menopause. That is a landmark step to ensure that all the population are educated about women’s health issues from an early age.

That was a challenge. When I was growing up, I had never even heard of the menopause. I do not think that even my daughters, now in their young adult life, had heard about it when they were growing up. It was just not discussed. Now, it is being taught in schools, which is a huge step forward.

Hon. Members know how brilliant our NHS staff are. This year, they have provided amazing care in the most difficult and testing circumstances. However, training is important at undergraduate, medical school and all levels. Individual medical schools set their own medical curriculum, which must meet the standards set by the General Medical Council. The GMC monitors medical schools to ensure that those standards are maintained. Importantly, all new qualified doctors must be able to recognise how normal human structures and physiology apply or change at significant age milestones and at the menopause. From 2024, the GMC will introduce the medical licensing assessment, which all UK medical students will need to pass to join the medical register. I am pleased that assessment includes knowledge of the menopause.

Things are moving and things are changing, but it is too slow. I think I said to the hon. Member for Swansea East that it is like turning the direction of a tanker on the ocean—it takes not just a Government, a Minister or a person; it takes all of us as women to start talking about the menopause and to start campaigning here. From my perspective, the women’s health strategy is my start.

I am excited to tell the House about a new menopause pathway improvement programme led by NHS England and NHS Improvement . The programme brings together key stakeholders and partners representing clinical colleges, menopause specialists, the workforce and women to develop evidence-based care pathways for women, aligned to NICE guidance and accounting for all demographics, to increase access to and delivery of optimal perimenopause and menopause care for women. It includes plans to increase access to education packages for clinicians who provide menopause care and a workforce support model that will be pioneered in the NHS and shared with all other industries and sectors. This programme of work feeds into the all-staff retention programme board, supporting the retention work specifically for those at risk of leaving the workforce—namely, female nurses aged 50-plus.

I again thank the hon. Member for Swansea East for securing the debate, and I am grateful to hon. Members for their invaluable contributions on this really important topic. While there is some good work under way, I am determined to make rapid progress to improve the support available to women experiencing the menopause and end the stigma that still surrounds many areas of women’s health. Following analysis of the call for evidence for the women’s health strategy, we will draw the work together and take an end-to-end look at women’s health from adolescence to menopause. That approach will ensure that women have better, more open conversations about their health and receive important treatments, including during the menopause.

Photo of Carolyn Harris Carolyn Harris Labour, Swansea East 5:46 pm, 9th June 2021

Thanks from me and from every woman out there who is suffering. I totally agree with the Minister that there is no room for politics in women’s health. Together, those of us in this room and in Parliament can make a change. We can, and we will, create a menopause mandate, and we will transform menopause support and services going forward. Of that, I am confident.

Question put and agreed to.

Resolved,

That this House
has considered support for people experiencing menopausal symptoms.

Sitting adjourned.