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House of Commons Hansard
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NHS Menopause Services
13 February 2019
Volume 654

Motion made, and Question proposed, That this House do now adjourn.—(Jo Churchill.)

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I thank the Members who have stayed behind for this important debate.

Every woman will experience the menopause at some stage in her life. When she does, she will embark on a journey that will throw up some of the most pernicious taboos that still exist in our society. The toxic combination of ageism and sexism that exist around the menopause, piled on top of the often debilitating symptoms, can cause mental health problems, relationship difficulties, problems at work, anxiety and depression, and much more. While menopause is a natural stage of life and ought to herald new freedoms and opportunities, for too many, it turns out to be the opposite. I know this from the menopause work that I have been doing in my constituency, including a Menopause Café, where we get together to drink tea and coffee, eat cake and talk about the menopause.

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To speak from my own perspective, I organised a Menopause Café in my constituency in the Stan Ball Centre, and I was delighted to see a number of women from right across the constituency. Quite a broad range of age groups came to that event, so I will be arranging more in future.

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I thank my hon. Friend so much, both for his work locally and for supporting me in this work in the Chamber and the House. He is an absolutely fantastic campaigner for the menopause and for women.

Psychologically, none of us likes to be reminded that we are growing old. For women, however, the menopause provides irrefutable evidence that our biological clock has ticked. While men can, and do, continue to reproduce into their old age, we cannot. With that loss, we face a grieving process. Our species has evolved to reproduce itself, and women’s bodies have evolved to carry out childbirth and child-rearing. Aeons of our cultural norms have been built upon that basic and irrefutable fact. Despite advances in all areas of medicine, I do not see men being able to conceive children or breastfeed any time soon, so the loss of those capabilities comes weighted with deep-seated and unexpected emotions. At the same time that we are attempting to grapple with those emotions, we find ourselves beset with a huge laundry list of symptoms and facing at best, indifference and ignorance, and at worst, downright hostility, mockery and discrimination while we attempt to help ourselves.

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I congratulate the hon. Lady on securing the debate. Like the hon. Member for Walsall North (Eddie Hughes), I have much interest in this, not only because it involves health issues that I am responsible for, but because sometimes things are pretty close to home. Does the hon. Lady not agree that the support that is needed for women who are going through tremendous changes in their bodies is not readily and sustainably available at GP surgeries, and that funding needs to be allocated to support groups, like the ones that the hon. Lady and the hon. Gentleman referred to, to ensure that the mental and physical health of ladies going through the menopause is readily available? That is very important.

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I thank the hon. Gentleman very much for making that valid point. I will talk about some of those issues, and he makes the really good point that these issues also affects men who are living with women as they go through the menopause.

I became a campaigner for the menopause by accident. For me, the start of the menopause came as I took my seat in this place. I attributed the almost constant migraines, the exhaustion, stress, insomnia, and the more than usual irritation with my ever-stoic husband, down to the new job, and the fact that my parliamentary accommodation was just over the bridge from Big Ben. I was probably the only Member to rejoice when Big Ben ceased to chime all through the night, because believe me, I heard every single bong.

It was only when I started to seek treatment for the unbearable migraines that I discovered the link with the menopause, and I started on a process that led me to understand that, very sadly, I was far from alone. I hesitated before speaking out about this personal issue, because I feared that in this place I would be regarded negatively by some colleagues or gain an unwarranted stigma attached to me as a menopause campaigner. However, when I realised how many women are affected by this issue and how many fail to get the help they need, I realised that it fell to me to speak out—to speak for people who cannot be here. And if I did not do it, who would?

I am pleased to say that this campaign, as we have just seen, has been universally welcomed by Members from across this House, including in particular, my hon. Friend the Member for Walsall North (Eddie Hughes), my hon. Friend the Member for Banbury (Victoria Prentis), who has just left the Chamber, my hon. Friends the Members for North West Cambridgeshire (Mr Vara) and for Selby and Ainsty (Nigel Adams), and the hon. Member for East Lothian (Martin Whitfield).

Outside our four walls, this debate is being followed with a keen interest, and I thank everybody—I know that they are watching and that they are heartened to see that this issue is receiving the attention that it deserves, although there is much more to be done. There are too many people for me to mention them all personally, but I particularly thank Dr Louise Newson—the menopause doctor—for her advice and knowledge on this matter. She operates a specialist menopause clinic in Stratford-upon-Avon and is an expert in this field. Her help has been invaluable.

Almost all women will be affected by the menopause at some point in their life. Most will experience symptoms between the ages of 45 and 55, but early menopause can also occur. For one in 100 women, this natural ageing process can begin before the age of 40, and early onset menopause occurs in one in 1,000 women under 30. In other words, it is very common, yet many are told they are too young to be menopausal, which is clearly wrong.

The duration and severity of symptoms vary from woman to woman. Generally, symptoms start a few months or years before periods stop—this is known as the perimenopause—and can persist for some time afterwards. On average, symptoms last for four years after the last period, but about one in 10 women experience them for up to 12 years. About eight in 10 women will have additional symptoms for some time before and after their periods stop, including hot flushes, night sweats, difficulty sleeping, palpitations, poor concentration, memory problems, low mood, anxiety and depression.

The common symptoms are numerous and varied. Every woman’s experience is unique. For example, I never experienced hot flushes or night sweats, but I certainly did experience other symptoms, and that was a problem for me, because I did not realise I was menopausal. That is the case for many other women. I remember considering whether I could even continue my job, and I know from correspondence I have received that countless other women struggle to manage the menopause however it affect their lives. A survey from West Midlands police showed that 21% of policewomen had given up work due to their menopausal symptoms.

Of course, the menopause does not affect just women. Every man in the country either lives with, works with or is related to a woman, and employers are affected and will continue to be affected.

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It is vital that men understand the symptoms and the challenges women face during this time of their lives and that they offer support, not just at home but in the workplace.

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I thank my hon. Friend again for that really good point. In fact, menopausal women are the fastest-growing demographic in the workforce. It is vital, therefore, that employers step up and produce menopause policies to help women going through this process.

There are many ways in which society can better support menopausal women, but we must look also for ways in which menopausal women can better help themselves. Of course, education can help. We can raise awareness of these issues in numerous ways—for example, through sex and relationships education in schools. We teach young girls about reproduction and periods, about contraception and relationships, and we ought at that stage to educate them about what happens in the menopause.

Employers also have an important part to play and can introduce supportive policies in the workplace, and I am pleased that many large employers are starting to lead the way in this respect. The best known local employer I have worked with is the West Midlands police, who are introducing creative and groundbreaking policies. Having spoken to women who have worked with them to introduce those policies, I know they faced considerable barriers when they first started to bring these conversations into the workplace—this very traditional, male-dominated environment—and yet they persisted, and now they find that their events and support groups are oversubscribed and that men really want to help and get involved to support their female colleagues.

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I mentioned in my earlier intervention the importance of access to GP surgeries. Every lady who has this problem goes to her doctor. That is a fact. At that stage, there is an opportunity to address the issue. I hope that the Minister will respond to this point—she always does respond very positively—because there needs to be some extra assistance in GP surgeries to help the ladies whenever they present with these problems.

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I completely agree with the hon. Gentleman. I have heard that point from so many women who have written to me, and I know that many of the women watching right now will have had the experience going to their GP and not getting the necessary support.

I will now talk about what I think the Government, the NHS and GPs can do to better support women experiencing, and sometimes struggling to cope with, the menopause. Central to the treatment available is hormone replacement therapy—or HRT, as it is commonly known. In essence, by addressing the hormonal imbalance resulting from the ageing process, HRT can address a wide variety of different symptoms experienced by menopausal women, and this is explicitly confirmed in NICE guidelines on the menopause. It is recommended to treat vasomotor, psychological and urogenital symptoms, as well as altered sexual function resulting from ageing.

Despite these guidelines having been published in November 2015—three years ago—only 10% of women are actually taking HRT. Time and again, I hear about women who have been turned away from their GPs—as the hon. Member for Strangford (Jim Shannon) mentioned a moment ago—and not given this effective medicine, on spurious grounds. They are told, for example, that because their periods have not stopped they are not menopausal. However, it is suitable to prescribe the medicine at that point. It is not expensive, it is safe, and it has a transformative effect.

Back in 2015, when these guidelines were introduced, they were heralded as a great step forward, but that, sadly, has not materialised. Many attribute the problem to a 2002 study which found some causation between HRT and breast cancer, but the 2015 NICE guidelines are crystal clear: for the vast majority of women, the benefits of HRT greatly outweigh any risks. The guidelines state explicitly that it does not increase the risk of developing cardiovascular disease, that there is no association between developing type 2 diabetes and taking HRT, and that there is no evidence to suggest an increased risk of developing dementia. In fact, evidence suggests the contrary.

Even in individual cases in which cardiovascular concerns may discourage the prescription of HRT, oestrogen in the form of a skin patch or gel is available, and carries no risk of clots. That is the form of HRT that I am taking, and, combined with migraine treatment, it is helping me enormously. In fact, evidence shows that HRT lowers the risk of heart attacks by 50% and the risk of osteoporosis by 50%, and that the risk of depression is also reduced. Moreover, women on HRT are less likely to put on weight, because weight increases during the menopause. It is therefore clear that HRT brings public health benefits.

HRT with oestrogen alone is associated with no change in the risk of developing breast cancer. Body-identical progesterone does not carry a risk of breast cancer for the first five years, and even after that point the risk is very low. The risk of developing breast cancer is much higher in women who drink just a couple of glasses of wine every day, or who are overweight.

Sadly, despite all that evidence, the media have misreported and whipped up fear about HRT for a number of years, and many people, including women and healthcare professionals, are still misinformed as a result. The issue is further augmented by the fact that very few GPs and nurses receive enough training, undergraduate or postgraduate education about the menopause. That has led to a general lack of awareness and misinformation in the medical community. It is clear that many GPs are not following the NICE guidelines.

That negligence is a problem, because many women are being sent away with no support, or are being mistakenly treated for misdiagnosed conditions such as depression and anxiety. Research that Dr Louise Newson has undertaken and shared with me shows that it is common for GPs to prescribe, for example, risperidone or diazepam rather than HRT. Of the thousands of menopausal women whom she surveyed, some 66%—a truly staggering figure—had been given antidepressants rather than HRT. Those expensive and addictive medicines are, of course, effective in treating certain conditions, but in menopause cases there is no evidence that they improve low mood or anxiety. Both types of HRT, oestrogen and progesterone, cost the NHS about £4 a month, so they are low-cost in comparison with antidepressants. They are highly effective, and pose a very low risk.

The benefits of HRT are clear, the size of the issue is unavoidable, and the action that needs to be taken is simple. The health service must give better training to GPs and other health workers, and must increase their awareness of the benefits of HRT in treating the menopause. The myths must be dispelled, and I hope that many millions more women will then see the benefit. Society, including men and employers, will also see the benefit, and the health service should benefit as well. Women who take HRT are less likely to attend GP surgeries, and effective HRT treatment removes the need for unnecessary referrals to specialists such as cardiologists or psychologists. That would undoubtedly relieve pressure on those already burdened specialisms. Medicine and diagnostic costs would be also reduced.

A few weeks ago, I held a productive roundtable discussion about this issue with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price). I am pleased that the Department will be considering what more it can do to support menopausal women. I was encouraged by my hon. Friend’s commitment and her pledge to engage in further work with us. However, I implore the Department to prioritise that work, because it affects every woman.

I am keen to hear the Minister’s remarks, and I look forward to working closely with her. Women across the UK, including in my constituency, are struggling and being denied help. That is so wrong when there is a cheap, effective and low-risk treatment already available. I am glad we have started to break the stigma in this place and I thank all who have supported me in this campaign.

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I congratulate my hon. Friend the Member for Redditch (Rachel Maclean) on securing this debate on health services and the menopause, and I want to start by celebrating the fact that we are discussing this subject. For too long the things that only affect women have been taboo; they have been brushed under the carpet—they have not been discussed in this place. One of the most magnificent of the many great side-effects of having a more gender-equal place is that we begin to discuss these subjects and those last taboos get addressed properly. It is wonderful to hear and see the men present in this Chamber who also care passionately about this subject; that must be celebrated too.

My hon. Friend has been a passionate and highly effective campaigner for improved awareness of the menopause and better support for women who are dealing with some of the difficult symptoms. I am very grateful and supportive of her work on this issue; in my eyes she is an absolute hero. I believe it is vital that we provide effective support and treatment for women with menopausal symptoms. It is of the utmost importance that we continue to work to improve that and to tackle the misconceptions attached to the menopause.

My hon. Friend raised the issue of HRT and expressed her concern that some GPs are not prescribing or recommending it to women who need it. No two menopauses are exactly alike and GPs play an important role in ensuring patients are given treatment that is appropriate to them. It is worth bearing in mind that the menopause is a natural stage in a woman’s life, and that many women will experience the menopause without troublesome symptoms or the need for treatment. Where symptoms do arise, HRT can be very effective in relieving them, and GPs should give menopausal women information about HRT as a treatment option, highlighting its risks, if they see that there are any, and its benefits. However, every patient is different and HRT might not be suitable for everyone. It is not the only treatment for menopausal symptoms, and GPs should also, where appropriate, talk women through all the non-hormonal and non-pharmaceutical treatments that are available.

My hon. Friend is right to say that there has been real confusion in the past about the safety of HRT. Concerns were raised in the early 2000s, as she mentioned, when a study said it was associated with an increased risk of breast cancer and heart disease. As a result, many women were advised by their doctors to come off HRT and the number of HRT users in the UK fell significantly. I cannot stress strongly enough that, as my hon. Friend has noted, the evidence base has since become clearer and the NICE guidance on the menopause is clear that HRT is a perfectly safe treatment in the majority of cases, and in most cases there is a far lower health risk in taking HRT than in drinking a couple of glasses of wine every day or in obesity, as my hon. Friend said.

The NICE guidance on the menopause also provides GPs with advice on how to recognise symptoms of the menopause. This guidance has helped prevent misdiagnosis, and my hon. Friend spoke very powerfully about how sometimes menopause can be mistaken for depression, which is incredibly worrying. Improving treatment of the symptoms of the menopause is also important.

We are also taking a range of other actions to improve support for women experiencing menopausal symptoms. This includes the work of the royal colleges, which of course play an important role in the education, training and professional development of healthcare professionals who treat women with menopausal symptoms. The Royal College of General Practitioners has produced a toolkit that includes learning resources for GPs on diagnosis and management of symptoms of the menopause. In addition, the Royal College of Nursing, in collaboration with the British Menopause Society, has produced a guide providing information for nurses who wish to become specialists in the menopause. That is very important, too. The Royal College is also aiming to develop a GP specialty that focuses on women’s health, which will be warmly welcomed.

Correct diagnosis and treatment of symptoms of the menopause are important, but we also have to focus on improving wider awareness of the menopause. An important part of this will be to have more open conversations around the menopause, so that we can start tackling the taboos that are attached to it. Taking this wider, bigger-picture approach is vital, given the huge impact that the menopause can have on all parts of a woman’s life.

In raising awareness and tackling taboos, we need to ensure that we reach out to all demographics, including boys and men. I cannot help thinking that if a similar hormonal transition affected men for an average of four years in the second half of their life, we would never hear the end of it—[Interruption.] Present company excepted, of course. As it is, the menopause has become something of a taboo, and we have to get over that. That is why it is so incredibly faith-restoring to see these incredibly liberated and forward-thinking gentlemen in the Chamber tonight, including my hon. Friend the Member for Walsall North (Eddie Hughes), who has talked about the menopause cafe that he runs. He should be championed for that. I was also pleased to see that the debate that was held on world menopause day last October was called by a male MP. These men are champions, in my eyes, and they deserve to be celebrated.

As my hon. Friend the Member for Redditch mentioned, education is absolutely key to promoting awareness and understanding of the menopause. The Government are making relationships education compulsory in primary schools and relationships and sex education compulsory in secondary schools. The underpinning focus in these subjects is to equip young people to develop positive attitudes to health, relationships and wellbeing. Schools will then have a really good opportunity to improve pupils’ understanding and awareness of the menopause.

Hon. Members will be aware that women represent 51% of the UK population and 44% of our workforce. They play a vital role in the nation’s health, but they do not always receive the most timely or appropriate healthcare. My hon. Friend mentioned the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who is the Minister with responsibility for mental health, inequalities, and suicide prevention. She is doing sterling work on this issue, and she has set up a women’s health taskforce. This taskforce will work to ensure that women receive timely and appropriate care in relation to a whole range of issues, and as part of its upcoming early work, it will consider the menopause.

This work will be informed by a collaborative discussion that will be led by the brilliant chief medical officer and include the Royal College of Obstetricians and Gynaecologists, a number of academics who work in menopause research and GPs who specialise in the menopause. These discussions will feed into the taskforce’s wider objectives: to empower women to speak more confidently; to raise awareness and break taboos around women’s health problems; and to improve the access, quality and experience of care for women. I hope that that will help to address some of the important issues that my hon. Friend has raised today, and I am sure that my ministerial colleagues in the Department of Health and Social Care will be absolutely delighted to work closely with her on the taskforce’s developing work around the menopause, because she has done such sterling work in this area so far.

We need to ensure that workplaces provide the necessary and appropriate support for women. A recent study found that 41% of women aged 50 to 60 said that the menopause had affected their job, but that 70% did not tell their employer about their symptoms. This demonstrates the work that needs to be done to move beyond shame and silence to an open conversation about the menopause, because half the population will go through it. Giving better support to those women in work is not only right but fundamentally good for the economy. Women over 50 are now one of the fastest growing groups of employees. They have invaluable skills and experience, which means that they are incredibly difficult to replace. We should be looking to support them to stay in work whenever we can.

I am particularly proud to be responding to this debate tonight not only because I am hurtling very fast towards the menopause myself but because, when I was Minister for Women and Equalities, I chaired the very first parliamentary roundtable on awareness and taboos around the menopause in the workplace. This was the first ever meeting in Parliament that brought together important stakeholders and interested parties to discuss this important issue. We heard some incredible evidence. I remember one lady telling us that she had had to leave her workplace because all she wanted was a desktop fan to help her deal with the hot flushes, but the company would not let her have one and so lost an employee with incredible experience and huge amounts of skill, which just makes no sense at all.

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I thank the Minister for her positive response. There is an old proverb that a problem shared is a problem halved, and the Minister has clearly indicated a method of doing that. I encourage her to get that message out across GP surgeries, education and all the relevant bodies.

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The hon. Gentleman is an enlightened man. The work that we did at the very first roundtable led to an evidence review that was published in 2017, which talked about raising awareness and about the effects on women’s economic participation. The review led to the Women’s Business Council developing a toolkit to enable employers to support their employees more effectively, and I think we can all agree that that can be nothing but a good thing.

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I thank the Minister both for the measures she is outlining and for the work that she did originally. Is she aware that the menopause used to be called the silent passage? The work that she and the others in the Chamber tonight are doing is helping to bring some sound to this passage, which can only be a benefit for every member of society.

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My hon. Friend is right. I had not heard that description before, but it sums up what we are talking about.

The toolkit that the Women’s Business Council produced when I was in the Government Equalities Office sets out positive action that employers can take around flexible working and improving awareness and understanding around the menopause. It also provides practical and often simple adjustments that employers can make. We also support actions taken by individual organisations to raise awareness. My hon. Friend mentioned some wonderful examples of such work, including at West Midlands police and the Bank of England. I pay tribute to them and encourage more employers to think about what more they can do to support women through the menopause.

I thank my hon. Friend for raising this important issue. The menopause is about valuing people, equality and rights. We have shown we can make progress on such issues elsewhere, and we must and will do the same here.

Question put and agreed to.

House adjourned.