Menopause

Caroline Nokes Excerpts

Thursday 9th June 2022 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to serve under your chairmanship, Mr Robertson, and, dare I say—I do not wish to be rude—an even greater pleasure to follow the hon. Member for Swansea East (Carolyn Harris), who has been such a champion on this issue.

As I said at an event earlier this week, having got to the grand old age of nearly 50, I am now a woman in a hurry. I do not feel as if I have an awful lot of time left to effect real change and I have got to the point with the menopause where I am determined that we see change, and we see change quickly. I think it is an age thing, but I have turned into a woman in a hurry. I want there to be change, support and help for women.

Over the last 12 years in this place, one thing I have learned—apologies, Mr Robertson—is that women do things differently in Parliament. We have become very pragmatic. We look at the solutions and the answers, not at the problems and the ideologies. There is no political ideology around the menopause; we just want it sorted, and as quickly as possible. That is why it has always been a huge privilege to work in tandem with the hon. Member for Swansea East. She and I come from different parts of the country and different political persuasions, but we have both recognised a problem that just needs solving.

Women across the country do things pragmatically. We heard from the hon. Member for Swansea East about different support groups, and it really struck me that women, usually of a certain age, come together to provide each other with support, advice, hints and tips about how to get through the menopause. We have all done it in this place, and turned to someone who may be a little bit older or wiser than us to ask them for advice. Last October, I gave up a weekend away. Fridays tend to be precious to Members of Parliament, and none of us likes being in here for private Members’ Bills on a Friday, but occasionally a private Member’s Bill comes along and one thinks, “That is worth it. That is where I will be this Friday. Instead of going away for a nice weekend, I will be in Parliament to make sure that we effect real change.”

On that day, I sat and I listened to a speaker from the other side of the House who cannot be here today because, absolutely fabulously, she is on maternity leave; that speaker was the hon. Member for Leicester West (Liz Kendall), who spoke about her own menopause symptoms. It took real bravery and courage for her to stand up in a packed Chamber of the House of Commons and start listing off all the weird and wonderful symptoms she was suffering. She identified anxiety, sleeplessness and night sweats, and I sat there thinking, “I get that. Yes, I get that. Yes, I get that too.”

I then trotted downstairs and found Dr Louise Newson sitting in Portcullis House and said, “The speech by the hon. Member for Leicester West was absolutely fascinating and it made me think that I am suffering from some of those things.” Dr Louise Newson turned to me and said, “Will you please go and get yourself a prescription for HRT?” For me, it was a lightbulb moment that showed that in this place, and indeed outside, people can learn so much from their peers.

I take my hat off to my constituent Jo Ibbott, who runs the naughtily entitled What the Fog? group, which is specifically designed for menopausal women in the Romsey area. Jo is a menopause guru and a fount of advice. She wanted to come and talk to me about the debate initiated by the hon. Member for Leicester West and about the menopause, and instead she found herself sat in Costa Coffee in Romsey giving me advice about what I needed, the importance of body identical HRT and not allowing myself to be fobbed off with anything that was a lesser product. She managed to persuade the Chamber of Commerce in Romsey to bring together a group of employers, and she has held a number of seminars, in the evening, talking to employers in the town about what they can do to support menopausal women.

That brings me to the whole raison d’être of the Women and Equalities Committee over the course of the last year. It feels as if we have been talking about the menopause forever, and I am not going to stand here and trail the recommendations of our report, because it is not yet public but is coming very soon indeed. We have taken evidence from some brilliant and interesting men and women about what we can do to help menopausal women in the workplace. It is not good enough to have policies that sit in filing cabinets gathering dust. They have to be real, living documents that both employers and employees can talk about, so that people can highlight the challenges of their symptoms and be open about them and the flexibilities and changes that might help.

I have spent the last two years trying to find some positives from the pandemic. One of the positives we have learned is that, while flexible working can be a benefit to everyone, it can particularly work for women. I get terribly cross when male employers say that it has been great for women in the workforce. It has been great for everyone—men as well—and particularly for people suffering from hot flushes, anxiety or sleeplessness. We all know how debilitating insomnia can be. Flexible working could be something that helps menopausal women stay in the workplace.

Standard Chartered and the Fawcett Society have done research on this. They learned that 50% of women do not take on additional responsibilities at work if they are going through menopausal symptoms. I scratched my head and thought, “What does that mean?” It means that they do not take promotions, which means they have less income, which means that they make smaller pension contributions. The menopause does not just affect women physically; it affects them financially, because those promotions are gone.

We know that 25% of women consider leaving work altogether. That is not just an additional income forgone. It is their whole income and whole pension contribution forgone. Is it any wonder that we suffer from a gender pensions gap when over a million women have left the workplace because of the menopause and many more have been forced to take career breaks? That brings me on to some of the wider governmental issues.

I am not going to copy the speech of the hon. Member for Swansea East. Members will have noticed me tearing up pages of my speech, because she covered the issues I wanted to speak about. There is a whole Government challenge around the menopause. I desperately want to see the Department for Work and Pensions and the Department for Business, Energy and Industrial Strategy working hand in hand. It is crucial that if somebody is lost from the workplace, there are routes back into it. It is important that work coaches are given support and training so that they understand what the challenges may be for women in their late 40s and early 50s returning to work.

The menopause can give people anxiety, so it is about restoring confidence and giving people the belief in themselves to be able to take on new challenges. Perhaps we need to be looking at retraining programmes that are gendered. I get terribly cross from time to time with the employment Minister, my hon. Friend the Member for Mid Sussex (Mims Davies), who tells me that she must look at employment policies in the round. We have lost a million women going through the menopause from the jobs market. How can we get them back? What additional training and programmes might be put in place in order to achieve that?

We heard yesterday from the Minister for Children and Families, my hon. Friend the Member for Colchester (Will Quince), about the work being done in schools and the statutory nature of what I refer to as PSHE and what he refers to as RSHE. It is crucial that we focus not just on building resilient young people and teaching them how not to get pregnant, how to respect each other and about their own bodies; we do have to have to those conversations, but there will come a time in every girl’s life when they will not be able to get pregnant any more. How will it impact them?

I got to the age of 49 without knowing the slightest thing about the menopause. I have managed to turn myself over the course of the last year into something of an expert. We do not educate children and young women enough about the changes that the menopause will bring to their body and how important it is that they have knowledge and the ability and confidence to talk about it, whether it be with their employer, family or friends.

We heard moving evidence during the course of the Select Committee’s inquiry. It would be unfair to stand here and reel off a great long list; Members would get bored by me, but I do want to highlight some particular challenges. No two women will experience the menopause in the same way. Yes, of course, there will be many similarities, but it is different for each woman. I would particularly like to highlight these challenges for the sake of younger women, for those who might be going through a surgical menopause and for those who go through very early menopause. It can suddenly be very debilitating and feel completely out of kilter with their age and the experience of their peer group. We have to realise that those women need particular assistance.

There are other groups. We heard evidence from a fantastic woman called Karen Arthur, who set up the organisation Menopause Whilst Black. I was being very bad that day and did not take part in a Division that was happening in the House. Instead, I snuck out into the corridor to talk to her about her personal experience. My goodness—she was the most incredibly inspirational and motivating woman. It is true not only that different ethnicities experience the menopause differently but that there are different cultural expectations. It may well be harder for those people to talk to their friends and family about it, and we have to keep breaking down those stigmas.

We heard from representatives from the police service and the ambulance service. I personally picked up the phone to one of the Justice Ministers and begged them to allow the Davina documentary into a prison to talk about the work that was being done not only with inmates but with staff going through the menopause. Every organisation, large or small, has menopausal women in its workforce.

I have been bowled over by the constituents who email or phone me to thank me for doing this, including Simon Parkes, who runs a tiny company in Romsey. Sometimes people say to me, “Will you please stop banging on about the menopause?”, but he rang me up to say, “Will you please keep talking about the menopause?” He has very few female employees, but he said that suddenly the penny dropped about what was going on with his wife and what the challenge was with staff members. We have to be able to talk about this and give women in the workforce the support they need.

There were some shocking, sad, awful stories too. I was stunned by how many people wanted their evidence kept confidential. I was struck by an email from the female human resources director of a major blue chip company, who emailed me with her personal story of the menopause and finished by saying, “Please keep this confidential, because I would never want my employers to know what I am going through.” That is the HR director of an organisation who did not want her employers to know what she was going through, so we have a long way to go in beating down the taboo.

I am conscious that I have probably spoken for far too long, but I want to make a final plea to the Minister. These are my asks for the Government. The hon. Member for Swansea East rightly focused on prescriptions and the shortages of some HRT products. The DHSC is working hard to resolve that matter, and I very much welcome the establishment of the taskforce and the appointment of Maddy McTernan. I think we are beginning to see progress on that front, and that gives me hope. It would be wrong of me not to reiterate that we were promised last October that there would be the £18.70 charge for 12 months-worth of prescriptions. I know there are IT challenges and that it is difficult, but please can that be expedited?

I implore BEIS and the DWP to work hand in hand. Why do we still not have an employment Bill that promises flexible working from day one? Why do we not have programmes targeted at retraining women over 45? Why are work coaches not easily able to identify the additional challenges of menopausal women who want to get back into the workforce? I have pointed out the challenges with personal, social, health and economic education and the importance of the Department for Education in ensuring girls are educated about the challenges they will face later in life.

It is really important that we have a women’s health ambassador to champion these issues. I raised that with the Minister just yesterday, and it would be remiss of me not to remind her of it. We need to see that appointment. I want to see somebody in place who is experienced, dedicated and committed, and will be a real champion for women up and down the country on a wide range of issues, but please can menopause be front and centre in that?

--- Later in debate ---

[Nickie Aiken (Cities of London and Westminster) (Con)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I want to start by congratulating my dear friend, the hon. Member for Swansea East (Carolyn Harris), on securing this debate and on all her brilliant work highlighting the importance of speaking about the menopause. I am very proud to be a vice chair of the APPG on menopause, which she chairs. We have done some brilliant work together and will continue to do so. We have finally lifted the lid off the menopause jar—the genie is out of the bottle. I could refer to other sayings, but it is important that finally we are ensuring this is no longer a taboo subject where we whisper, “the change”.

The issue crosses over every demographic—from royalty, including the Countess of Wessex, all the way through. I was fascinated to hear the hon. Member for Swansea East refer to it as a “posh” issue. That is so depressing, but she is absolutely right that some women feel that HRT products and help and support are available only if they are posh and can demand them. She is right that in the cost of living challenge we are now living through, too many women will be putting food on the table for their children rather than spending £18 on the vital HRT products that they need.

I welcomed the Minister and the Secretary of State for Health’s support for the private Member’s Bill promoted by the hon. Member for Swansea East. They agreed to her proposals, but it is disappointing that we have to wait until April 2023, given that there are women in England who are desperately waiting for an annual prescription.

It was interesting to listen to the hon. Member for Belfast South (Claire Hanna). The issue applies to all four nations, and it is a shame that England is still the poor relation of the four. She reminded me of a close friend of mine who lives in Northern Ireland and is a constituent of the hon. Member for Strangford (Jim Shannon). She was telling me a few weeks ago of all the symptoms she had. She had been to her GP in Northern Ireland and he was suggesting antidepressants. I begged her and said, “Please, you are 51. You are going through the menopause. Go back to that GP and demand.” She did, and now she is on HRT. She is an educated woman who has been to university and has a high-profile job, but she still has to beg her GP to take her seriously. That is unacceptable. There is more to do to ensure that GPs across the four nations have the right advice and training.

I want to highlight Pausitivity, an organisation I know very well and whose posters I have previously mentioned in the Chamber. I wrote to the Minister recently and I hope she will respond positively. We need to support Pausitivity’s Know Your Menopause campaign. Its leaflets are a signpost for women and highlight symptoms, so that they can go back to their GPs and demand support and help.

[Caroline Nokes]

My hon. Friend makes an important point about Pausitivity. Claire Hattrick from Hampshire has published a whole book about self-help. There is a brilliant case for the Department of Health and Social Care to consider making small funding streams available to ensure that the work of all those smaller, regional self-help and campaign groups can be disseminated much more widely. All of us have friends, like my hon. Friend’s friend in Northern Ireland, who have not had the confidence, knowledge or expertise to go to their GP and say, “This is what I have got. Please can I have?” We need to spread the information. Perhaps DHSC should look at how it can fund that.

[Nickie Aiken]

My right hon. Friend is absolutely right. I wrote in my letter to the Minister that we need to support organisations such as Pausitivity so that women can use them as a signpost. Its posters are brilliant. They are in Urdu, Punjabi, French, Dutch, German, English and also, as the hon. Member for Swansea East will be delighted to know, Cymraeg. Let us support women from all walks of life, and let us also support families.

This morning I went to talk to a group of year 10 pupils at Pimlico Academy. They asked me what I was doing this afternoon and I said that I would be speaking in the menopause debate. I said, “It is really important that you guys, aged 15—boys and girls—are aware.” I said to the girls, “PMT and periods are tough enough, but you wait: the menopause is something to really know about. You have to know for your mums who are going through it, or are about to go through it, and for your grandmothers and your aunties. It is really important that you know about the menopause so that you can support them and so that you know that when they are screaming at you, there is probably a reason for it. It is not because of you, but because they are probably having a really tough time because they haven’t slept for five days, they feel like they are having an out-of-body experience, they do not feel themselves and then they take that out on their families.” It is really important that husbands, partners, brothers and fathers also understand what women are going through.

We have come a long way. The Government have been listening. I know that the Minister takes a lead on this issue and I absolutely welcome the Government’s real emphasis on it, but we still have issues with a shortage of HRT products. When I went to get my prescription a few months ago, I was told that I could not have my Oestrogel because it is not in supply at the moment. I was really worried. I have one bottle left and am squeezing every single ounce of it. I hope to God that it will be back in when I go back to the GP next week. I urge the Minister to do all she can to make sure that the products get back on the shelves. I fear for my Chief Whip and my Whip if I do not get my HRT product. I am just putting that out there to the Minister—you have been warned.

More seriously, there is so much more that we have to do on education and for businesses. I am extremely proud that this week the Cabinet Office—the Minister was also at this event—became the largest organisation to sign the menopause workplace pledge. More than 1,000 organisations have now done so. That is a start, and it is amazing. The Government are actually taking the lead, but as many have said here today, including my right hon. Friend the Member for Romsey and Southampton North, there is much more that each Government Department can do—like not working in silos. We know that when Governments work in silos, nothing gets done. There has to be a holistic approach. Let us get this done.

It is very important to ensure that women are aware of the symptoms of menopause, but also that they can be symptoms of other conditions. I have recently been diagnosed with hypothyroidism and Hashimoto’s, and the symptoms are very much related to the menopause. Although I may have been going through the menopause, I wonder whether the vast majority of my issues over the past two or three years were because of my thyroid problem. I am now on thyroxine, and it is changing my life, but women need to understand that their symptoms might not just be from the menopause. GPs have to understand that, too. Again, I would like there to be more information and for GPs to have a better understanding of those issues.

To conclude, being in politics can be very difficult. We have so many arguments, and there is so much that can divide us, but women’s health—particularly issues such as the menopause—unites us. We can see Northern Irish, Scottish, Welsh and English MPs here today in support of getting more help for the menopause. That is what makes it great to be a Member of Parliament—we can come together and join forces to ensure that we support women and men in all walks of life. The menopause revolution has only just begun. It is only the start, but I am sure that, working together, we will ensure that women have the products and support they need to carry on with their lives. The menopause is a change. It is the midpoint in our lives. It should never be the end of women’s lives. I feel that I am just beginning my life.

[Jim Shannon (Strangford) (DUP)]

As always, I am thankful to be able to speak on behalf of my constituents. I want to start by congratulating the hon. Member for Swansea East (Carolyn Harris). I have been fortunate in my life to have always been surrounded by powerful women. It was my mother to start with, then my wife, and in the political sphere the hon. Member for Swansea East, who is a really powerful lady. Whenever she asks me to be involved with debates, she is pushing on an open door. She knows I will be more than happy to support her—I always have been.

When the hon. Member for Swansea East started this campaign some time ago, she and I talked about it, and she was very keen to have a man on board. I am very happy to give my support, for a number of reasons. I do it because the request is right: it is about raising awareness. As a man, I do not find these subject matters particularly easy to discuss—it is probably my old-fashioned, traditional nature—but I know that these things happen. It happened to my wife, Sandra. We have been married 35 years. She is an extremely powerful lady. She is very understanding and has stuck with me for 35 years, so I think that tells you all about that lady.

I remember that when we married she had period problems. The doctor she went to see was very good and he said, “Sandra, when you have children, everything will change.” Well, it did not. We had three children fairly quickly in a period of five to six years. We both wanted children. I was very fortunate to get three boys. I think Sandra would have liked a wee girl, but it did not work out that way. Throughout her life, she always had problems with her periods—they were always very heavy—but then she came to the menopause.

I am pleased to speak in this debate and give a man’s point of view. I am giving a husband’s point of view, too, because I understood from the very beginning what the problems were for my wife. It was all the things that the hon. Members for Belfast South (Claire Hanna) and for Guildford (Angela Richardson) referred to: the night sweats, the brain fog, the pain, the agony. She just could not get settled and was always restless. I understood why that change was coming in Sandra’s life. I was not there all the time—perhaps that was better for her, actually—but whenever I was, on those three and a half days a week, I understood that she was having terrible difficulties. We are lucky that the boys have left the house, but the two cats and the dog absolutely dote on her. They do not understand what is happening, but they trot alongside her.

I tell that story because I want the ladies here—the right hon. and hon. Members—to know that I do understand, although I have not experienced it personally. The hon. Member for Belfast South asked what would happen if men could live through this. I tell you what—we would have a different attitude. I have lived through it with my wife, and I think I understand it—I hopefully understand it well.

I have been very pleased to see more businesses and people seeing the benefit of bringing menopause into the light. The civil service has launched a menopause strategy, citing that females account for 50% of the 24,000 Northern Ireland civil service workforce, and that more than 55% of the female employees are over the age of 45, so a significant number of employees are likely to be affected by the menopause. The aim of the policy is to raise awareness and understanding of menopause and outline the support available.

The hon. Member for Belfast South and I, as Northern Ireland MPs, understand this debate from a Northern Ireland perspective, but also because we are active constituency MPs. We understand the importance of having a good workforce who are able to do the work and understand when things are not right.

The hon. Member for Cities of London and Westminster (Nickie Aiken) referred to GPs. I have seen a change—I just whispered this to the hon. Member for Belfast South—in GPs and doctors in my constituency. The hon. Member for Cities of London and Westminster inadvertently, or maybe purposely, referred to her friend from Killinchy. Men have retired and ladies have taken their place, so I hope that means that there will be better understanding. Giving depression and anxiety mediation is the wrong thing to do; HRT should be given. I hope to see those changes. I see them in my doctor’s surgery and in the surgeries and clinics in Newtownards. That seems to be replicated across the whole of the constituency, and I suspect it is happening in other parts of Northern Ireland. The hon. Member for Belfast South, in conversations we have had, has said that women GPs and doctors have to take time out to look after their families. That happens at times, but I see a change coming, with a better understanding, so that in the future we will hopefully not have the problems that we once had in the past.

I referred to the strategy for the 24,000 members of the Northern Ireland civil service workforce, and that comes on the back of the first meeting of the UK-wide menopause taskforce, which has been established to strengthen co-ordination across Government and raise awareness of the impact of menopause, improving care and support for women and ending the taboos and stigmas what still surround a natural part of ageing.

I echo the request that every other Member has made. I am very pleased to see the Minister in her place. I have seen more of her this week than I have seen of my wife—she has been in this Chamber on three or four occasions to respond to debates. She said to me, “You’re back again,” to which I said, “Well, I never leave here.” I am so pleased to see her in her place. I know that she has understanding of the issue and compassion. When the hon. Member for Swansea East was introducing the debate, the Minister was cheering as much the hon. Lady was—that’s the Minister. I look forward to her response.

I am pleased that the taskforce is attempting to lead the way. While I am thankful to all the big businesses that are stepping in to acknowledge this medical issue, my mind turns to those smaller businesses that do not have a human resources department to guide them. I ask the Minister—I do not know whether this is under her control; responsibility might lie with another Minister —what support are the Government offering smaller businesses to help them understand the issues that their workforce are facing, and to support their workforce throughout their journey?

I am very fortunate to have always had powerful women in my life. I have six ladies in my office—apart from me, it is a purely female staff. That sometimes gives me an understanding of what happens in the office among ladies. One of the lovely ladies in my office had a hysterectomy and went through her menopause in her mid-50s. The hon. Member for Cities of London and Westminster referred to the age of 51 in relation to the menopause. I do not miss too much in the office; I usually have a fairly good idea of what is cooking. One of the other girls in the office did a small thing that I think made a big difference. She bought her a wee pink fan—I use the word “wee” all the time; it is a Northern Ireland thing—that sat on her desk and made a psychological difference for her. The girls were telling her, “We know what you are going through.”

[Caroline Nokes]

The hon. Gentleman makes a brilliant point about the small pink fan. Some of the interventions, changes and support measures that employers can put in place are small, cheap, unobtrusive and not difficult.

[Jim Shannon]

The right hon. Lady is absolutely right. As with constituents, the small things that we do are big things in their lives.

At the same time that my staff member had her hysterectomy, one of the younger girls in the office—I have two girls in their early 20s in my office—was going through endometriosis treatment, and her medication pushed her into menopause. It was drastic for a such a young girl, and one who is keen to have children someday— I very often feel for her.

The issue of menopause and perimenopause affects a large amount of the working population. It is great that work has begun to recognise that, but that support should be in every avenue of work, not simply the big companies. Can the Minister therefore give us some indication of what is happening for smaller companies in that regard?

The hon. Members for Cities of London and Westminster and for Belfast South asked about HRT. We would really appreciate an update on the supply of HRT medication. When ladies present themselves to GPs, there needs to be a better understanding of how to respond. In this House we need to ask ourselves how we can come alongside the small business owner to ensure that they are aware of how the small things—as the right hon. Member for Romsey and Southampton North (Caroline Nokes) said—can make a huge difference to the quality of life of their employees, as well as to the environment and productivity in the workplace. It has been said for many years that a contented workforce is a productive workforce, and which of us does not want to understand how to get the best work out of our employees and allow them a decent quality of life?

The hon. Member for Cities of London and Westminster and I must have been speaking to the same script writer. I remember the days when people muttered under their breath, in hushed tones, that someone “must be going through the change.” People almost whispered it—“don’t say it too loudly.” Today’s debate is about saying it loudly, because it is important. That is what the hon. Member for Swansea East has done, right down the line. I admire her courage and determination to make things happen, which is infectious—I come to all her debates and support her in everything she does. I do it because I want to, but also because it is right. This is a debate that is right.

It is time for us not to be ashamed of the menopause or to try to hide it; we should accept that it is a part of life with medical implications. We need appropriate responses in the workplace and appropriate responses from the general public—from men and all those out there who do not understand it. That may be because they do not want to, or because they have a wee bit of trepidation about it. We should give those businesses the opportunity to learn more, and put in place effective policies. That is up to the Departments for Work and Pensions and for Health and Social Care, working in partnership and, respectfully, what I believe we must see.

Again, I am thankful for the opportunity to represent my constituents, and to represent my wife, obviously, since I have first-hand knowledge of how this has affected her. I have always tried very hard to be supportive and understanding. I hope that this will not be another lost opportunity, where words are spoken but no action is taken. To be fair, today’s debate is about actions, and there are people here who drive actions.

I said this in the last debate, and I will say it again:

“Eighty per cent. of women suffer from menopausal symptoms; 100% of women deserve support.”—[Official Report, 21 October 2021; Vol. 701, c. 1023.]

For me, this debate is about every one of those 80% of the ladies, and giving them my 100% support, as everyone else here today does. I look forward to hearing the Minister’s response shortly, and to the participation of my male colleague, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar).