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The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)
I thank the hon. Member for Swansea East (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.
The hon. Member for Bradford South (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.
The hon. Member for Newport West (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 the hon. Member for Pontypridd (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.