Menopausal Symptoms: Support

Nusrat Ghani Excerpts

Wednesday 9th June 2021 Westminster Hall

[Ms Nusrat Ghani (in the Chair)]

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 [e-mail]. 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.

[Carolyn Harris (Swansea East) (Lab)]

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.

[Rosie Duffield (Canterbury) (Lab) [V]]

It is a pleasure to serve under your chairship for the first time, Ms Ghani. I thank my hon. Friend the Member for Swansea East (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, the hon. Member for Redditch (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.

[Ms Nusrat Ghani (in the Chair)]

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

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to be called to speak in this important debate and I thank my hon. Friend the Member for Swansea East (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.

[Ms Nusrat Ghani (in the Chair)]

I now call Alex Davies- Jones.