I beg to move, That the Bill be now read a Second time.
The private Members’ Bills ballot at the start of each Session of Parliament gives each of us the opportunity to put in to champion a cause that we believe will make a real difference. When I was drawn at No. 3, I thought long and hard about what I should focus on. I wanted an issue that meant something to me and that would make a difference in the lives of people who really need it—not just in my constituency, but right across the UK. Being the only female Member drawn in the top seven, I particularly wanted to focus on something that would improve the lives of women up and down the country, and so the Menopause (Support and Services) Bill began to take shape in my head.
I have said all along that this Bill and the menopause more widely is not a political issue, and I maintain that. Women’s health should never be political. So I am not here today to win points; I am here because, right now, menopause support in this country, and indeed around the world, is falling short and failing women. GP training in medical schools, support in workplaces, public health messaging and curriculum content in our schools all need addressing, and I will come to each of those in turn in my speech.
However, I needed more: I needed something that only a change of legislation would put right, and it was a conversation with one of my colleagues in this place that gave me that something. I have always considered myself very fortunate to be a Welshwoman, and why wouldn’t I?—we are taking over the world, guys—but it had not occurred to me until that conversation that there was another reason why being Welsh was an advantage: NHS prescriptions are free in Wales. My colleague, on the other hand, was off to pick up her hormone replacement therapy prescription and was going to pay for it. She could afford to pay for it, but not everyone can. It was one of those eureka moments when I realised that this was the final piece in the jigsaw of my menopause Bill, which was always going to be about raising awareness and bringing a focus to the menopause as an issue we all need to consider.
Some 51% of the population are female, which means that 51% of us will personally experience the menopause at some point in our lives. Our experiences will all be unique. Some will sail through and barely notice. Others will suffer the most extreme symptoms: headaches, hot flushes, night sweats, brain fog, brittle nails, weight gain, insomnia, anxiety, low libido, vaginal dryness—and I could go on and on. Many women will present at their GP’s with one or more of those symptoms, and that can be the first hurdle. With 41% of medical schools offering no mandatory menopause training at all, thousands of GPs are qualifying and entering practice with no knowledge of how to diagnose menopause.
I congratulate the hon. Lady on again bringing a taboo subject out of the shadows. I am delighted, as one of the 49%, to be a sponsor of her Bill, not just because she would have beaten me up if I had not been, but because this is a genuinely needed and worthwhile Bill. Does she agree with me that it is not just the 51% or the 13 million who are peri or post-menopausal who are affected, but that it affects many of the 49% and younger women? Many of the conditions that she has described are a huge additional cost to the NHS that, if prescribed for properly—and diagnosed properly—would save a lot of money for the NHS and an awful lot of angst for many women going through that, and the people around them.
I agree with the hon. Gentleman and thank him for sponsoring the Bill. I would say that this is about not just the symptoms women feel, but the consequences in relationships; we have seen far too many marriages and relationships fall by the wayside because of menopause and its symptoms, and now is the time to change all that.
Women presenting to their doctor are often diagnosed with anxiety and depression. That happened to me and I have told my story previously: I presented to my GP believing I was having a nervous breakdown and ended up on antidepressants for 11 years. It was only when I spoke to friends and colleagues in this place and we shared conversations that people do not normally have—or did not have until now—that I realised that many other women were also experiencing what I was experiencing. That means we are seeing women being prescribed antidepressants when hormone replacement therapy may well have been more suitable, or presenting with insomnia and being given sleeping tablets when HRT may well have been more suitable, or being sent to consultants for tests for early onset dementia when visiting their GP about their brain fog and forgetfulness when, again, HRT may well have been more suitable. As hormone levels drop, women are at greater risk of developing a series of other conditions—cardiovascular disease, osteoporosis, type 2 diabetes, obesity, osteoarthritis, depression and dementia—and the cost of investigating and treating these as well as the other additional appointments is putting extra unnecessary pressure on our NHS.
I have heard countless stories of misdiagnosis. As I have said, I went on to suffer for 11 years with what I considered to be depression. Little did I know that over a decade later when I started HRT, I would see my life become transformed and I would have more energy. God, isn’t that scary: more energy? My husband is heading for the backdoor now. But we cannot blame GPs; we must make sure our medical schools reassess their curriculums so in future doctors are educated in the menopause and are able to offer all women the same high-quality care and support. Women are routinely called for cervical smears and breast screening; we need to see them being called for a menopause check-up around the time they turn 40. This would be a quick and an easy solution to helping women become more aware of the symptoms so that they are prepared and, importantly, educated in the available treatments.
I join the warm tributes to the hon. Lady’s genuine cross-party approach to this; it is a testament to her campaigning ability.
I was particularly struck by clause 2 of her Bill which talks about the wider strategy. Does she agree that while HRT is a wonderful prescription for many women there will be some for whom it is not suitable, and therefore wider issues about menopause awareness and training are going to be important if we are to reach as many women and their families as possible?
I do agree and my mantra has become that we can all become menopause warriors because that means we acknowledge the issues and problems and are prepared to work towards ameliorating them.
We can look at the good practice out there to see what can be done. I recently spoke to practice nurse Sharon Hartmann from Tudor Lodge surgery in Weston-super-Mare. The surgery supported Sharon to develop a special interest in menopause care. She is now certified by the British Menopause Society and delivers evidence-based practice to her patients. She is able to monitor progress, control treatment plans and prescribe suitable medication for each individual. I would love to see this kind of service in surgeries or clusters all over the country, with doctors being able to identify the symptoms quickly and ensuring women are then passed down to someone with a wealth of knowledge and experience in menopause care. But it is not just the education of the medical profession that needs attention. We need to address education in our schools, so that the next generation of girls and boys is far more prepared than any of us were. I certainly did not talk about the menopause when I was at school. We did not even talk about periods when I was at school. We want the next generation to talk openly about it, understand what is to come and what they can do to help. We need young men to understand that their mothers, wives, sisters and partners may struggle at some point in their life, and that it is not that they do not love them any more, it is just that the menopause is denying them emotion.
I, too, congratulate the hon. Lady on bringing forward this issue and pursuing it in such a constructive, positive and enthusiastic way not just in the House but outside it too, and on the points she raises about the stigma attached to the menopause and the idea that women of a certain age are maybe past their prime. Absolutely not. People need to know that women’s lives actually might begin at 50. Thank you for what you have done and, I understand, for your constructive work with the Government. What you are doing today is a most important step forward—
Order. I cannot let the right hon. Lady, who is a senior Member of the House, say “you” when she means “her”. Could she just say it again, just to please me?
I was carried away by the excitement of the moment, but you are quite right, Madam Deputy Speaker. The hon. Lady has done so much and will earn the gratitude of the whole country for what she is doing with this positive step forward today.
I agree with everything the right hon. Lady says.
It has been a pleasure to work with some fantastic women in this place who understand how important this issue is and, like me, want to ensure it is at the top of the agenda. The Minister, her predecessor, our shadow Minister, and all my cross-party colleagues and friends have been absolutely fantastic. We are so lucky to have strong male voices, too, who have not only signed the Bill but are here to support it. I want to thank—good grief, the hon. Member for Strangford (Jim Shannon) is not in his place! That is a first. I thank the hon. Members for Strangford and for Hazel Grove (Mr Wragg), my hon. Friends the Members for Bootle (Peter Dowd) and for Blaenau Gwent (Nick Smith), and the hon. Member for East Worthing and Shoreham (Tim Loughton) to name just a few, men who are not afraid to embrace the menopause revolution and have shown themselves to be dedicated menopause warriors.
I am sure we would have heard the voice of our dearly missed colleague, the former Member for Southend West, today if it were not for tragic events. I remember him coming to a menopause event I hosted a couple of years ago. When I asked him if he supported the cause, he told me, “With a wife and four daughters at home, I don’t have any option.” [Laughter.] So today, I would like to add my voice to those who have already spoken in the Chamber and around the country, and send my thoughts and prayers to his wife, his four daughters and his son. David was a very special man and we all miss him greatly. [Hon. Members: “Hear, hear.”]
We need to go further on education. We need to educate ourselves now. A public health campaign would help enormously, as so many women just do not join the dots between their own health issues and the menopause. As I mentioned earlier, 11 years ago I had no idea what was happening to me. If my inbox is anything to go by, I am not alone. I know from conversations I have had with friends and colleagues in this place that they, too, were not sure of the situation they found themselves in because it has been a taboo subject. It has been a dirty little secret that women were ashamed of. My earliest recollection of “the change” was a comedy sketch by Les Dawson dressed as a woman having a conversation over a fake wall with Roy Barraclough, lifting his left breast and referring to his neighbour as “being on the change”. We have to move on from those days. It is not a joke when you live with it and it is not a joke when you experience it. We can do so much more to make sure we do the right thing.
Well, I am not ashamed. That is maybe because I am Welsh and I say what I think. Fortunately, there are a lot of other people out there who are not ashamed. It is fantastic that celebrities such as Davina McCall, Lisa Snowdon, Mariella Frostrup, Penny Lancaster, Nadia Sawalha and Gabby Logan are all sharing their menopause experiences. As the right hon. Member for Tatton (Esther McVey) said, it is sometimes very difficult for someone to talk about their menopause when they are in a profession, because the assumption is made that they are over the hill.
There are some great tools to help us, too, such as the Balance app and the Henpicked website, which provide a wealth of unbiased and factual information about the menopause and aid women in taking control of their health. But it is our responsibility in this place to look at what we can do to ensure that the right message gets to everyone who needs it.
I congratulate my hon. Friend on introducing this Bill, on her passion and on raising it as an issue not just of medical training, but of realisation and understanding for everyone—men and women. Does she agree that one of the challenges in this area is the historical nervousness about taking HRT? The world has moved on since our mothers’ generation, when there were some real problems, and medical knowledge has improved. Does she agree that we need more education on the benefits of HRT, which she has so personally described?
I certainly agree. The information that would explain the situation with HRT is out there, but because we are not looking for it, we do not find it. There is really good information that debunks the myths on HRT, which has moved on a lot. It is a phenomenally different product from what it was in the day when too many people were prepared to criticise the use of it. Unfortunately, if someone does not look for that information, they will not find it and they do not prescribe HRT.
Someone understanding their own menopause is so important. Although we are, I hope, heading towards a time when women will discuss their experiences with family and friends, there is also a lot to be done in workplaces, where talking about symptoms can be a lot harder. Employers have a huge role to play in ensuring that support is available and understanding what their staff are experiencing. I have heard far too many accounts of women being given warnings, being sacked or even being made to feel that they have no choice other than to resign due to menopausal symptoms.
I congratulate my hon. Friend on this most excellent Bill and on the work of the all-party group on menopause. The work of the group also helped to inspire activity with employers across the country. I attended an event on the menopause with Shevaun Haviland, the new head of the British Chambers of Commerce, and the Dorset chamber. There was tremendous engagement from employers, who had never been able to have this kind of conversation. Does my hon. Friend agree that, alongside improving awareness in the medical profession and in society to help to encourage discussion in families, supporting employers to have this conversation is vital for their understanding and for women’s employment?
I certainly do. Very many businesses—really big players in their fields—have contacted me and asked for advice on how they can move forward. What I say to them all is, “Don’t have a policy that is left in a filing cabinet that reflects a tick box. Have a policy that reflects your workforce and what women need and is intended to help them.” I visited several big companies that are really good employers and I have seen the all-singing, all-dancing menopause policy that does all but make a cup of tea, but when I asked the staff, “How is the menopause policy working for you?”, their response was, “I didn’t know we had one.” It cannot be a tick box; it has to be relevant.
Other employers need to take heed of the likes of Timpson—I repeat that James Timpson walks on water, as I said in this Chamber last week—in prioritising the welfare of its staff who are experiencing symptoms of the perimenopause or menopause. There are other big companies, such as PricewaterhouseCoopers, Bristol Myers Squibb and Tesco, that do good work—I could go on, but I know that the right hon. Member for Romsey and Southampton North (Caroline Nokes), who chairs the Women and Equalities Committee, will talk about that.
I pay tribute to the amazing campaign that my hon. Friend is running. The Bill is making such an important contribution; I think we all sign up to being menopause warriors and menopause revolutionaries. To add to the point about employers, does she see a role for trade unions in promoting the excellent ideas that are in the Bill? Can she give some examples of how we as MPs and menopause warriors could do more in our constituencies to encourage employers and trade unions to take these ideas forward?
I have always thought of my hon. Friend as being Amazonian in his warrior status. I am sure that when he has his photograph taken later today with the lovely Penny Lancaster, he will prove to be Amazonian. In his constituency, the Community union is doing fantastic work with Tata Steel, which has welcomed in the union to hold menopause coffee mornings with the women in its workforce, who, let us not forget, are working in a very male-dominated arena. If they can do it, so many others can. My hon. Friend the Member for Newport East (Jessica Morden) has the Llanwern steelworks in her area, and it, too, is welcoming the Community union’s coffee mornings. I urge both my colleagues to attend one of those to share experience and listen.
Almost 80% of menopausal women are in work, with most planning to work for many more years. However, three quarters report that they are considering reducing their hours and one in four are giving up their jobs because they are finding it too difficult to balance their work life with their symptoms. Our careers should not stop when our periods stop. Whether our jobs are physically or mentally demanding, small adjustments could make all the difference. My hope is that employers listening to this debate will make those adjustments and take pride in the fact that they are menopause-friendly workplaces.
This is a great cause. The hon. Lady and I are working together on various other issues as well, and she is a doughty champion for cross-party working on so many important issues. Will she comment briefly on how small employers can help? As one myself, I have two superb women, Alison and Deborah, who work in my constituency office and they have made me very aware of the issue that is being raised in the House today.
Will the hon. Lady also comment on the “Better for women” report by the Royal College of Obstetricians and Gynaecologists, which has worked with me closely on the hymenoplasty and virginity testing changes that it is bringing forward? Will she say a bit more about those workplace policies, particularly to help small employers understand how they can better support women? The team is so important to small employers, and the individual members all contribute so much at different parts of their lives.
What I would say to the hon. Gentleman is that communication is key here; you cannot provide if you do not know what is needed. Do not be embarrassed and do not shy away from that conversation. If staff members do not feel comfortable talking to one person about it, find someone they will talk to. It is so important that you ask them what they need, not tell them what you are prepared to do. Communication and adaptation to suit the individual is key.
I, too, just want to pick up on the point that my hon. Friend made about women and the workplace. We know that, according to the Centre for Ageing Better, 800,000 people over 50 were wanting to work more and were under-employed—that was the case a year ago, at least. Does she agree—
Order. The hon. Lady has already had one intervention, which was very long. I allowed that, but her second intervention is heading towards being very long and I cannot construct this debate like that. About 30 people wish to speak this morning. I am sure that the promoter of the Bill wants to make sure that as many people as possible get to speak, but that she also will not want to talk out her Bill. I hope that those who support the Bill will not make long interventions and long speeches, because otherwise the Bill will be talked out and we will not achieve the result we are intending to achieve. So I ask for brevity, please, on all sides.
Thank you, Madam Deputy Speaker. May I suggest that my hon. Friend and I have a conversation outside the Chamber, where we can expand on what she is seeking to establish?
As women reach this stage in their lives, understanding their own bodies and having support in all areas of their lives is crucial, but it is clear that we have a long way to go. That is why the Bill calls on the Secretary of State to lay before Parliament a United Kingdom, cross-party, cross-Government strategy on menopause support and services that will incorporate all the areas I have spoken about.
I congratulate the hon. Lady on all her work on the Bill. My question is about the UK-wide aspect. Clause 1 applies only to England—prescriptions are free in Scotland—but clause 2 applies across the entirety of the United Kingdom. There is a duty to consult Scottish Ministers. If the policy area is devolved to the Scottish Parliament, how will those discussions work in practice? What would happen if Scottish Ministers did not agree with the strategy agreed by the UK Minister?
I am going to leave that to the Minister to worry about. I am sure that the Scottish Government do not want me telling them what to do. I would be happy to have a go. If only I was on the Government Benches, then I would get it sorted.
I am not just asking the Secretary of State to do this. I want to work with him, his Ministers and colleagues from across the House to build a taskforce that will take on these issues and find the solutions, because I truly believe that, working together, we can change this—even in Scotland, if necessary.
We also desperately need to look at prescription charges for HRT in England and at what we can do to ensure that the cost is not a barrier to women accessing it. The menopause does not discriminate, so the cost to treat it should not either. There are women struggling to find almost £20 a month, and that just is not right when it is a time in life that women will reach. There is no avoiding the menopause for half the population. Most women will spend at least a third of their lives perimenopausal, post-menopausal or—the joy—menopausal. We must ensure that those women who need it are not denied HRT because of financial restraints.
Like everyone else in the House, I thank the hon. Lady for her vociferous campaigning on this really important issue. Assuming that we get there and manage to abolish prescription charges for HRT in England, how does she perceive us running a good communication strategy so that women are still not put off because they do not know that prescription charges have been removed?
I am sure that the Minister will enlighten us on that issue. That is the issue: whatever we do today, it has to be communicated to the wider population so that they understand our commitment to their health.
The biggest complaint I have received over the past few months is from women who need both oestrogen and progesterone. Women who have had a hysterectomy can take oestrogen on its own, but everyone else needs both. Despite the two hormones being combined into one product, women are charged individually for the hormones, meaning that each prescription costs them £18.70, and with 86% of women getting only three months’ supply each time, the costs begin to add up.
The hon. Lady is being very good about giving way—I am very grateful to her. On the question of cost, I was struck by what she said earlier about her own really difficult experience of being prescribed antidepressants because she was not properly diagnosed with the menopause. I chair the all-party parliamentary group on prescribed drug dependence. She might be aware that last week Dr James Davies of Oxford University published research showing that the NHS currently spends half a billion pounds a year on unnecessary prescriptions of habit-forming drugs. Will she join me in raising serious concerns about that, and does she agree that we must press the Government to review properly the prescriptions of dependence-forming drugs?
I certainly do agree. We have all heard stories about chemists getting back a skip-full of drugs after people have passed away. It is wrong—I totally agree.
That leads me to the next issue: the National Institute for Health and Care Excellence guidelines, which recommend following a three-month trial period. Women are then prescribed HRT on an annual basis. I appreciate that that may not be possible for a small number of women, but from looking into this it is clear to me that that very rarely happens, so women continue to be charged each month, against the advice of the public body. It is clear that that has been overlooked for far too long, leaving far too many women in England either without the vital treatment they need or worrying each month about how they are going to find the money to pay for it. That is why the Bill calls on the Government to do something about it—to find a way to stop women in England being disadvantaged because of the cost of HRT prescriptions. Nothing will have a greater impact on such a huge proportion of society, especially those who are at a socioeconomic disadvantage.
Everyone has a part to play in this revolution—women themselves, educators, medical professionals, families, friends, employers—but it is to start here, in this place, today. For the 13 million women in the UK who are currently either perimenopausal or menopausal, and for all those women who follow, we need a commitment that things are going to change.
It was pointed out to me last week that, according to Hansard, since 1803 “menopause” has only been referenced in Parliament a mere 197 times. I think over the last two weeks I have probably been able to double that single-handedly. Changing the history of Hansard will be some achievement, but making history for menopause will be far more important to the women in this country.
I would like to thank everyone in this place, around the country and indeed across the globe who has been in touch to support this Bill. It has been quite overwhelming, and it is great to see everyone in the Chamber today with their “Menopause Warriors” badges, because this is a revolution for all those whose lives have been or will be impacted by the menopause. The dictionary definition of a revolution is the forcible overthrow of a Government in favour of a new system. Although I do not have time for that today—[Interruption]—not today; it has been a busy two weeks—there are women in Parliament Square today who are expecting us, as those they elected to this place, to do something for them and to do right by them.
Let us join the likes of Tudor Lodge surgery, Timpson and the Balance app as examples of best practice in tackling stigma and the symptoms of the menopause. I urge the Government to work with me to make HRT accessible to everyone, regardless of financial constraints; to ensure that women are diagnosed at their first appointment and get the treatment they need; and to educate everyone, so that those who are experiencing symptoms get the support and understanding they need in every aspect of their lives.
I associate myself with the comments of others and with their praise for the hon. Lady for raising awareness of this issue. Would she be willing to include in the Bill’s provisions those women who will experience a chemically-induced menopause? They will experience the menopause more than once, and sometimes even three times, in their lifetimes.
My revolution intends to help every woman who is experiencing the phenomenon, in whatever capacity, be they 13 years of age—I have heard about some women as young 13—or in their 80s. It does not discriminate, and I want to make sure we do our best for every woman. Our daughters and all those who come after them will have each one of us here today to thank for ensuring that we make progress and that the menopause revolution continues. We cannot let them down. Now is the time to do the right thing and to make sure that women across this country have all the support, guidance and reassurance they need to overcome their menopause.
I believe that the Government are listening. The Minister herself said in this Chamber just last week that the Government are putting the menopause at the top of the women’s health strategy. I believe that today will be the start of putting right the historical injustice that women have experienced, and that 2021 was the year that the menopause revolution was born.
It is a great pleasure to follow the hon. Member for Swansea East (Carolyn Harris), who has given a tour de force presentation of her Bill. She brings her characteristic charm and leadership with which she approaches all her campaigns. I am sure that when she was drawn at No. 3 in the private Members’ Bill ballot, the Government gave a collective intake of breath and thought, “Oh, my goodness! What is she going to bring in?” She has used that position to bring forward a Bill on a very important subject, which, as she says, affects 51% of the nation’s population. I am hugely grateful to her, not least because I have been banging on about exactly these subjects myself for a while. She is quite right when she says that there has been barely any reference to this debate or these issues in Hansard. Dare I say it, but that is because for a long time there just were not enough women in this place.
I thank the hon. Lady for giving way on that point, because this point was burning inside me while I listened to my hon. Friend the Member for Swansea East (Carolyn Harris) making her fantastic speech. Does the hon. Lady agree that this debate is one of the benefits of a truly diverse Parliament? Any time anybody asks us why it matters that there are more women in Parliament, here we have it—this debate would not have happened without more women being in Parliament, with all of our diverse experiences, alongside our male allies. Does she agree?
I could not possibly disagree with that. The really sad thing is that it has taken a century of women having the vote to get to a critical mass where we can now finally discuss these things. I hope that we will make up for lost time. This Bill is a very important one.
One of the most important things that this Bill will achieve is that society will start taking these subjects seriously. There is so much about women’s health that has been taboo for a very long time. I have spoken a lot previously about problem periods, and about the fact that endometriosis continues to go undiagnosed, causing massive problems for women and girls who suffer with it. It says everything. Again, one in three women suffer fibroids. We all think that it is normal. We all think that this is what a woman’s lot is, and we are encouraged to suffer in silence, and it really should not be that way. It is interesting to make that observation in the wake of the Cumberlege report, “First Do No Harm”, which, obviously, looked at these issues from the perspective of vaginal mesh.
Over and over again, we see the same issues raised. Women are not heard. The quality of conversations that women have with their medical practitioners is just not good enough. Too often, women feel fobbed off. That struck me when I was a Minister in the Department of Health and Social Care. A number of female colleagues would share with me their experiences. I just thought, “For goodness’ sake, we are pushy, opinionated women who are elected to this House! If we are not being heard, then God help the rest of the female population.” It is really important that we shine light on what can be expected. As the hon. Member for Swansea East so eloquently explained, presenting to a GP with symptoms, which ended up with her being sent away with a prescription for anti-depressants for something that all women will go through just is not good enough. I cannot believe that we are still having this conversation. The more that society in general understands what comes with menopause, the more that we will be able to have those sensible conversations and the more that we will be able to manage our conditions well. We must acknowledge this throughout society. We have to start in schools and make sure that everyone understands the life course around women’s health and what they will go through.
I thank my hon. Friend for giving way and the hon. Member for Swansea East (Carolyn Harris) for bringing this Bill forward. On educating people, one of the first times that I actually understood this issue was as a result of this Bill, so it is key for women and men to learn about the subject at a young age so that we can go forward.
My hon. Friend puts that extremely well. The fact of the matter is that, even as women who are well-informed and interested in this subject, we still do not necessarily know what to expect. It is also the case that boys and men need to understand these things too.
Hon. Members will know that I chair the all-party pharmacy group and I can advise the House that the National Pharmacy Association is fully in support of this Bill. It fully supports the exemption of HRT from prescription charges. It also expressed its willingness to play a much bigger role in terms of the education and support of women going through menopause. We know that, a lot of the time, the conversations that patients can have with their pharmacists are less intimidating and less formal than those they might have with their GP. Again, lots of things are available over the counter that can help alleviate the symptoms of menopause, but also a lot of advice can be given about generally looking after wellbeing. I say to the Minister that I know that pharmaceutical bodies will be very keen to play their role in making sure that there is a much wider understanding and in giving more support to women going through the menopause.
My hon. Friend the Member for Devizes (Danny Kruger) raised the important issue of the half a billion pounds of potential waste of prescriptions. We must make better use of pharmacists to review prescriptions, because they often tend to know more about the drugs that are being dispensed than thfe GPs who are writing the prescriptions. If we can play a better role in enabling pharmacists to review the prescriptions that their patients are presenting to them, we might go a long way to making those savings and getting more bang for our buck from the billions of pounds that we spend on our NHS. I encourage the Minister to look constructively at that suggestion, because the issue of misdiagnosis and the cost of drugs is significant.
The hon. Member for Swansea East has raised the issue of vaginal dryness. That leads me to make the observation that if we had applied as much attention to vaginal atrophy as we had to erectile dysfunction, we would be much better off—wouldn’t we? I cannot help but come to the conclusion that if this were happening to men, we might be in a better place. Look at what happened when Viagra was invented: within a year, it became available over the counter. That really begs the question of whether women are being treated fairly in this context. It does not feel like it to me. Again, I am sure that the Minister will be quite sympathetic to that point.
I ask the Government to look constructively at that issue, because we could liberate some of these drugs and make them more available over the counter. We have recently made the mini-pill available over the counter, which is really important given that one in three pregnancies is unplanned, and increasingly those unplanned pregnancies are women in their 30s, rather than teenagers. We have got to the right place when it comes to making contraception more available over the counter, but it took an awfully long time—much longer than making Viagra available over the counter. We must take these matters seriously.
On the subject of vaginal atrophy, I pay tribute to my constituent Sue Moxley. Sue used to be the beauty editor of The Sun. She is now better known for being the singing partner of her husband, David Van Day. She has spoken very publicly about her issues with vaginal atrophy. Again, she echoed the point that it happened to her completely unexpectedly. She was not prepared for it at all and it was incredibly difficult for her to find out information about what she was going through. In the end, having had a number of referrals, she experienced a direct laser-based treatment from Italy to improve the supply of collagen to the vagina, and it was transformational. I ask the Minister to look at that treatment. It is a direct physical treatment; it will not suit everybody, but neither does HRT. We have to ensure that we have a diverse range of treatments available, depending on people’s conditions, because, as the hon. Lady mentioned, everyone’s experience of menopause is very different.
One other issue that Sue raised with me was that it was suggested to her that women who have not experienced childbirth tend to suffer menopause worse. That raises another question, because if that is true, women should all know about it. There is lots about our life courses and experiences that will impact our health, but I would suggest that not enough research is being done into these things. For 51% of the population, I think we deserve better, so I encourage the Minister to look at that.
I have a few final points. The hon. Lady mentioned that HRT has had a bad press. A study in—I think—2001 suggested an increased risk of breast cancer as a consequence of HRT. In fact, that increase was very small, and the impact that study has had on women’s wellbeing has been far more damaging. Let us look at what goes on further through life. If more women were encouraged to take HRT, there would be massive savings for the Government. When we look at social care and why people go into residential care towards the end of their lives, we see that one of the biggest causes is falls and frailty. If we could encourage more women to take HRT—if it suits them—we would have fewer problems with osteoporosis and the injuries that lead to it. It makes perfect sense—we are spending to save.
I join my hon. Friend in her congratulations to the hon. Member for Swansea East (Carolyn Harris). It was Teresa Gorman who said:
“HRT keeps you out of hospital, out of an old folks’ home and out of the divorce courts.”
Does she agree that it is surprising that one third of women who visited a GP were not made aware of HRT, and that greater awareness of it will help improve women’s health?
My hon. Friend puts the point so well: it is incredible that so long after the former hon. Member for Billericay was making her campaign, we have not moved on—we have almost stalled. However, the hon. Member for Swansea East is turbocharging it so that we can make up for lost time. From a Government perspective, it is frankly a false economy not to make HRT more widely available.
The hon. Lady made the crucial point that there is not enough training of medical professionals about these issues, either. That must be addressed as a matter of urgency. I fully support the Bill and congratulate the hon. Lady and all the campaigners she has worked with to get us to this place. It is clear from the mood in the Chamber that the House is with her, and amen to that! Women are back in charge.
It is an honour to speak in the debate. I rise to support the Bill in the name of my hon. Friend the Member for Swansea East (Carolyn Harris), which I proudly put my name to. She has led the campaign on the Bill with her well-known enthusiasm, commitment and integrity. I am sure the whole House will join me in commending her on her approach.
I will speak on one aspect of HRT and menopause: the link with osteoporosis. I do so as the co-chair of the all-party parliamentary group on osteoporosis and bone health. As I have said before, menopause is an important time for bone health. According to the Royal Osteoporosis Society, the decrease in oestrogen levels causes 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 bone density more rapidly in the years following menopause. With that loss of bone density comes reduced bone strength and a greater risk of breaking bones. One of the many reasons that I support my hon. Friend’s Bill is that it is essential that women are properly supported around the time of menopause not just to assess their risk of osteoporosis and fractures but to be given appropriate advice and medication, including hormone replacement treatment, which reduces bone loss and the risk of fractures.
HRT is available only on prescription, and currently those accessing it are charged every time. That must change. The Bill’s provisions would be incredibly effective for the majority of women who take HRT. A recent survey of 1,000 women by Newson Health found: just one in five do not receive HRT as a repeat prescription; 86% receive a prescription for three months or less at a time; and 20% spend more than £150 on their NHS HRT prescriptions each year. The Bill’s provisions would create a useful cost saving for so many women accessing this important treatment.
Importantly, the Bill would also legislate for menopause for the first time and revolutionise how those who go through menopause are treated. Access to HRT must be widened to tackle misconceptions and ensure that those going through menopause can access the hormones to protect their bones and ease their experiences. Better education is needed in schools and for healthcare professionals to ensure that menopause symptoms are easily recognised and not misdiagnosed, as my hon. Friend and many others have said.
I am proud not just to help break the silence on the silent disease of osteoporosis but to break the taboo on talking about menopause, which is shrouded in mystery for many despite affecting over half the population at some point in their life. I support this Bill, which would undoubtedly help so many women to keep their bones safe and well.
It is always a privilege to be in this Chamber to support the work of the hon. Member for Swansea East (Carolyn Harris). It is just over a week since we last debated the menopause in the Chamber, and I always say that in Parliament we should pick not just our battles but our allies. It is a pleasure to campaign, to hold a revolution and to be a warrior alongside her.
The reality is that all women will go through the menopause, but not all women will suffer symptoms. Only about 80% suffer symptoms and HRT—a brilliant, wonderful solution to some of those symptoms—does not work for everyone, and the same type of HRT does not work for every woman. That is why it is often a case of trial and error, going through many prescriptions to find the form of HRT that works for each woman and resolves their symptoms. We have to address the costs because women will be bearing the burden of prescription after prescription until they find the solution for them.
We have heard a little this morning about education, but no one has yet paid tribute to the brilliant work of my right hon. Friend the Member for East Hampshire (Damian Hinds), who made sure that, as part of personal, social, health and economic education, girls are not just taught about periods, not getting pregnant and contraception but are taught about what might happen when those periods stop. Of course, it is not just a matter for girls. Their male classmates and colleagues, their fathers and brothers, also need to be part of this discussion.
As we have heard repeatedly, there is too little knowledge in schools and in the workplace. I regard this place as a workplace and, until very recently, it was heavily male- dominated, but we are clawing it back, sometimes just one seat at a time. I pay tribute to the work of one of the foremost menopause warriors, Anne Milton, the predecessor of my hon. Friend the Member for Guildford (Angela Richardson). As Deputy Chief Whip, Anne Milton played the crucial pastoral, human resources role of helping many of us with conversations on all sorts of weird and wonderful health issues. It helped that she was previously a nurse, but she was an evangelist for HRT. When I spoke to her about it yesterday, she said, “Just go and get yourself a prescription, because this will solve those hot flushes at night and the fact you wake up in a puddle of sweat.” I still tried to say, “No, I’m sure that’s just my insistence on sleeping under a 13.5 tog duvet.” Apparently not.
I vividly remember being brutally asked by GB News, “What are your menopause symptoms?” I recoiled a little from the question, which I thought was a bit rude. And then I thought, no, I have to talk about it. I regard it as my duty to talk about it so that younger women know, whether it is brain fog, anxiety, hot flushes or night sweats, this is all normal and it can be addressed.
I had that conversation with my predecessor, the right hon. Anne Milton, quite a few years ago, and she completely changed my mind about HRT. My mother and aunt had to go through this 30 years before me—I am now 47—and they had difficult reactions to HRT. My aunt died from cancer that, anecdotally, was blamed on HRT.
It was Anne Milton who said to me, in a frank conversation, “This is what women need to live good lives.” I pay tribute to her for having the courage to have that conversation with me, and I pay tribute to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for the courage she shows in talking about it, too.
My hon. Friend has made the point—lead good lives—and that is what we want to do, whether it is at home or at work.
Something in particular has struck me during Menopause Awareness Month. I have spoken to many employers about the menopause workplace pledge, and have talked to members of organisations in the City of London about what they can do to support women. According to a survey carried out by the Fawcett Society, 50% of women working in financial services were not taking on additional responsibilities because they were worried about their menopause symptoms, while 25% were considering leaving work. Women at the height of their careers are potentially losing them, and not providing those brilliant female role models to which we all need to aspire in order to progress in our careers.
I make no criticism of my right hon. Friend the Member for Pudsey (Stuart Andrew), the current Deputy Chief Whip, but I issue a plea to all those in the Whips Office: make sure you have good, strong women in there who can provide advice when it is needed. I pay tribute to Claire Hattrick, who lives in Hampshire and runs the clipboardclaire.com website, providing impartial, informed advice for women when they are going through the menopause. Many of us simply do not know what the symptoms are. We do not understand them, and we do not know where to turn. Claire and many like her across the country provide that advice, free of charge and independently, giving us all hope that the symptoms can be dealt with.
Bills such as this mean that we will debate the issue on the Floor of the House as well as in the wider country. It is about having the conversations, about making sure that we understand, and, most of all, about joining the hon. Member for Swansea East and ensuring that we are all warriors and allies, and that we are going to bring about change.
It is a privilege to speak in the debate, and to follow the right hon. Member for Romsey and Southampton North (Caroline Nokes) and the other Members who have spoken so far. I think that by speaking out about the menopause, Members on both sides of the House, women and men, will be giving a voice to 13 million menopausal and perimenopausal women in the country whose needs have been downplayed or ignored for too long.
I must begin by paying tribute to my hon. Friend the Member for Swansea East (Carolyn Harris), a phenomenal campaigner who is working across party lines, and with organisations up and down the country, to push this agenda, make a practical difference to women’s lives, and get the job done. I am very proud to stand alongside her today.
I feel that at this point I should make a personal declaration of interest in this topic, as many of my colleagues have already done today. To be honest, I am not really sure when the symptoms first started, but they have been building steadily over the last year—the truly terrifying sense of anxiety and panic that I had never experienced before; feeling completely exhausted, sore and aching all over, wondering in the evenings if I could make it up the stairs to go to bed, let alone do the exercise that has always been such an important part of my life; the itching, the hair loss, and just feeling downright low; and above all, what I can only describe as the catastrophically bad sleep, night after night. I would finally emerge in the morning drenched with sweat, thinking, “How on earth am I going to make it through the day?”
Like so many other women, I had absolutely no idea what was going on. I thought that there could be reasons for each of those symptoms individually, but together they felt overwhelming. 1t was only when a friend of mine recommended that I check out the MegsMenopause website that the penny finally dropped. This was something real, something really was happening, it had a name, and there was something that I could do about it that might start gradually getting the old me back.
I thank the hon. Lady for being so honest and open about this. She has just said that she did not know what was happening to her. Given that she is an intelligent, well-informed woman, does that not illustrate the importance of better education about this condition?
Absolutely. I must be honest: I was in a quandary about whether I was going to say anything today, but, like the hon. Lady, I thought, “If we in this place, with the power, influence and authority that we have, are too nervous to speak out, what does that say? “ We need to be leaders and champions, and I hope that we are all making a small contribution to that today.
I must say that I have had a very good experience with my GP. Two weeks ago, I did an online survey. A few days later, I had a phone consultation and I got my first HRT prescription last week—ironically, on the same day as the Backbench Business debate on World Menopause Awareness Month—but I know that millions of other women are nowhere near as lucky. Almost one in 10 women have to see their GP more than 10 times before they get proper help and advice. Two thirds of women suffering low mood or anxiety, like my hon. Friend the Member for Swansea East, are wrongly given antidepressants instead of HRT, often for many years. Around one in three women will end up having a hip fracture due to osteoporosis unless they take HRT, as was rightly mentioned by my hon. Friend the Member for Bradford South (Judith Cummins).
The objectives at the heart of this Bill—to raise awareness of the menopause, to make it easier for women to access HRT and to improve the education and training of health professionals—are absolutely essential. I hope when the Minister rises to speak, she will set out the steps her Government will take to make these goals a reality, because frankly, getting women the right diagnosis and the right treatment at the right time is a no-brainer. It is better for women and it is better for the taxpayer, because it will stop women having to have lots of unnecessary doctor’s appointments. It will stop them being put on the wrong medicines for years, leaving the real issue untreated and undiagnosed, and it will reduce the likelihood of women getting conditions such as osteoporosis when they do not need to, which can lead to much more serious and expensive NHS care, such as hip and other operations.
There is lots more I could say on that issue, but I want to use the remaining time I have to talk about the impact of menopause in the workplace, an issue rightly raised and championed by the right hon. Member for Romsey and Southampton North. There are currently more than 4.3 million working women aged 50 to 64. We are the fastest growing group in the UK workforce, often at the peak of our experience, with all the skills and talent that that brings, but 80% of women say that the menopause has affected their working lives.
Around 14 million days are lost at work every year due to menopause, and a quarter of menopausal women at work find the symptoms so debilitating that they are considering reducing their hours, changing their working patterns or leaving the workplace altogether. Women lose their income and careers, businesses lose their talent and the Treasury loses their taxes. Where on earth is the sense in that?
The fundamental problem is that the vast majority of women are too embarrassed, worried or frightened to speak out or discuss the issue with their bosses or line managers. I think the reason for that is the double whammy of sexism and ageism. If a quarter of men in their 50s were considering quitting work or reducing their hours, you can bet your bottom dollar that it would be at the top of the workplace agenda and a solution would pretty quickly be found. Women should not have to suffer in silence. We have to remove the ignorance and stigma about the menopause. It is not a women’s issue or a private matter, let alone a joking matter; it is a mainstream, no excuses, no ifs or buts workplace issue, and it must be addressed. Again, I hope when the Minister rises, she will set out the steps her Government intend to take on this vital issue.
In conclusion, Members will know that I have never been one for revolutions, but on this issue I make an exception.
I think every word that the hon. Lady has said will resonate with millions of people across the country for exactly the reasons she set out. It is powerful to hear from her about her personal experience, and I hope, especially after this day and going forward, that the whole House can co-operate and do much to help with this. I welcome her comments.
That is very kind of the right hon. Gentleman, and very much appreciated by me, my colleagues and women across the country. I am very proud to join my hon. Friend the Member for Swansea East, all the other women and men in the Chamber today, women outside this place and the organisations who are campaigning on the issue and calling for a menopause revolution. As she said on the radio this morning, let us make women wonderful again. Who on earth could disagree with that? Millions of women across the country deserve nothing less.
Is it me or is it warm in here? That is one of the issues we have to raise to get rid of the taboo of the menopause. How many of us have gone around saying that most days in the last few years?
I welcome the Bill of the hon. Member for Swansea East (Carolyn Harris). As a fellow Welsh woman, I know that no one should ever mess with a Welsh woman. I thank her for the support that she has given me since I arrived in this place. One of the first conversations we had was when I said to her, “I’m having a nightmare menopause. I don’t know what to do.” Since, she has been a great support to me and I have missed our menopausal women exercise classes on a Tuesday; we need to bring them back.
It is a serious and timely debate—the second on the menopause during Menopause Awareness Month, which is an achievement in itself. It is time for us—men and women—to talk about the menopause. As I have said before, my hon. Friends the Members for Totnes (Anthony Mangnall), for Eastleigh (Paul Holmes), and for Hazel Grove (Mr Wragg) have been supportive in talking about it to me personally, which makes a huge difference to us women. We have to do more of that. I also pay tribute to the Health Secretary who spoke earlier. I spoke to him last week and earlier today. He absolutely supports our wish to break down the taboos of the menopause and do more for women.
From my experience, GPs need better training on the menopause. I went to my GP several times before I could access HRT, and even then, it took six months to get access to an HRT clinic. In that time, I felt so alone, because HRT would work at some times in the month, but at other times it would not. I came off it after a year, but the symptoms became so bad again that I felt I had to go back on it. I have been fortunate that it has worked the second time, but the menopause can be a very lonely place, which is why there needs to be more education for GPs.
There also needs to be more education in the workplace. The hon. Member for Swansea East is right to say that we need to discuss the menopause in the workplace. As the Member for the City of London, I pledge to do all I can with the financial services industry to ensure that it takes it seriously.
I join all hon. Members in thanking the hon. Member for Swansea East (Carolyn Harris) for bringing the subject to our attention and for bringing the Bill to the House. I thank my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) for the workplace education that I am receiving today on this important issue. I hope that she agrees that we need to talk about it more openly, and today’s debate is a good place to start.
My hon. Friend makes several good points. This is a good workplace in which to bring the menopause to the forefront.
We have to start a public health campaign on the menopause. We have to ensure that it is not just women in their late 40s and early 50s who understand it but women who are younger who will reach it eventually and men. It is important that our partners, our sons and our daughters understand what we are going through. I pay tribute to my wonderful husband Alex who has been so supportive of me in the last three or four years. As we all know, it can be hell for us and for those around us.
Turning quickly to prescription charges, as I raised in the House last week—I have discussed this with the Secretary of State for Health and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield)—I think the NICE guidelines are very clear. However, we have to make sure that GPs are aware that, after the first three months of a woman being on HRT, they can put us on an annual prescription, which would be £18.70, or whatever, once a year. If we could really ensure that GPs understood that, it would be a saving of about £200. That would make a huge difference to women, and I declare an interest because I obviously pay for my own prescriptions.
Finally, I again thank the hon. Member for Swansea East for introducing this. I thank the celebrities—Davina, Penny and Meg—and all the other brilliant women, and also sites such as pausitivity.co.uk, with brilliant women who are really bringing Know Your Menopause to the front. People should get on that website and learn as much as they can about the menopause. I am part of the MenoRevolution, and I am absolutely proud to be a menopause warrior.
What a brilliant and important debate we have had today on women’s health. It has been fantastic, has it not? I want to pay tribute to my butty, my hon. Friend the Member for Swansea East (Carolyn Harris). She has done some fantastic campaigning on this issue.
I would like to look at the issue of menopause and employment. About 14 million workdays are lost each year in the UK due to the menopause. A TUC survey found that nearly nine in 10 women say it has affected their working life. How a woman experiences the menopause in work can be dramatically shaped by what her employer does. Here is one story from a woman called Barbara, who spoke to the Wellbeing of Women charity. She said:
“My memory was shot to pieces… I felt hot and sweaty all the time… I didn’t want to speak up in meetings for fear of”
embarrassment about how she looked. She also said:
“Overnight, I felt I’d lost all my confidence in my ability to do my job.”
When Barbara went to her employer, she thought it said the right things, but did not understand what support was needed. There are too many stories like this. About 900,000 women have left their jobs because of the menopause. Something has to be done.
Some women have more severe symptoms than others, which is why employers must be proactive and flexible. As my hon. Friend said, a tick-box exercise will not work. This is why organisations such as the Wales TUC have produced fantastic resources for union reps to give advice on what they can do. There are already some companies doing good stuff. Santander has started training managers to better understand the menopause, and places such as Sainsbury’s have brought together colleagues to tackle this topic, while HSBC has introduced menopause champions to encourage more conversations at work.
It is fantastic that more and more women are speaking about the menopause. When Andrea McLean shared her experiences on “Loose Women”, she said that
“within 24 hours, 10,000 women got in touch”.
Workplace wellbeing for women needs a helping hand today. We must send a message to employers that they need to put menopause policies and support in place, and to do it now. We all need to play our part so that women like Barbara are given the respect and the dignity they deserve. Parliament needs to support this important Bill today.
It is a privilege to be speaking in this debate. I too pay tribute to and thank the hon. Member for Swansea East (Carolyn Harris) for her work in this area and for allowing all of us to speak. I also echo the thoughts of my hon. Friend the Member for Thurrock (Jackie Doyle-Price) about how it has actually taken having this number of women in the House to enable us to have such conversations. When I first went into politics, I was advised not to talk about women’s issues, but if we do not talk about women’s issues, who else is going to?
This very much highlights the message, which I have referenced before, that we are far more united and have far more in common than that which divides us—the words of the fallen Jo Cox. This is also for friends of mine, such as my schoolfriend Fiona, who has given up work after 24 years as a civil engineer because she cannot manage her perimenopausal symptoms. What is the point in encouraging these fabulous women to go into science, technology, engineering and maths professions if we lose them 15 years before the time they should be retiring? It is vital that we talk about and emphasise this, and that we learn about it. I am fortunate in having feisty friends who have told their doctors during lockdown that they have the menopause and will be having HRT, but not every woman is prepared to take on their GP in that way, so I also want to highlight concerns around those women who have self-diagnosed and need their GPs to open their doors. I recognise that GPs have been under huge duress and done fantastic work during the pandemic, but women would like to see them again. We would like to have our blood pressure taken by our doctor in the surgery rather than get a friend to do it over dinner because they happen to be a nurse; I would love to say I am making that up but I am aware of women who have been on HRT for several years now and who have not seen their GP at all or had their blood pressure checked. It is important that we get back in touch with our doctors, have these conversations, and ensure we are on the right treatment to tackle the symptoms, because we quietly hide so many of them and are, perhaps, not aware. The shadow Minister the hon. Member for Leicester West (Liz Kendall) gave a moving description and I hope many women are listening today and say, “Ah, I wonder if that’s what’s going on” rather than just brushing it under the carpet as so many of us do so that we can get on with our busy lives.
I hope today’s debate also serves as an opportunity to tackle the issue of our having busy lives because, as well as the cost of having a prescription every three months, for those of us with busy lives there is also the hassle of having to contact the doctor’s surgery. Those surgeries are also very busy and would probably rather not hear from us every three months to get that repeat prescription, which then has to go back to the pharmacist, who also has a busy life. It would be fantastic if we could agree on the treatment and move forward.
I know that many Members want to speak so I have kept my comments brief. I am grateful for the opportunity to contribute and I hope the Minister will build on this menopausal momentum and prioritise changes in this area.
These are some of the words of my hon. Friend the Member for Swansea East (Carolyn Harris) when she launched the all-party group on menopause:
“I’m determined to change the woeful support offered to women…This menopause revolution will bring an end to women’s suffering.”
She also said:
“I know that we can deliver legislation that will make a real difference to women’s lives.”
I commend my hon. Friend on those words and, more importantly, her determination to put them into action by introducing this Bill. I hope to be just one of the many hon. Members who help her achieve her aim to
“bring an end to women’s suffering.”
My hon. Friend is well aware that this Bill is just the start of the process. It is a foundation for much of the rest of the work that has to follow. It is the beginning of a process that will take a great deal of time, effort, endeavour and resource. This House can help in that challenging process by supporting the Bill, and the Government can also help by supporting it.
We are not short of experience, evidence and real-life stories of the impact and effect perimenopause and the menopause can have on women. They are not statistics on a spreadsheet. Those women are our wives, mothers, daughters, aunties, sisters, nieces, friends, colleagues, and constituents.
Millions of women will need the support of everyone in this House to ensure that they get what they are entitled to: not indulgence, but that which is their right. They have a right to live a life that is not bedevilled by the vicissitudes of the menopause or exacerbated through ignorance, lack of support, the unspoken—“let’s not talk about it” approach—that we have seen on this issue for so long. They have a right to a life free from the impacts of the menopause such as anxiety, depression, tiredness and the myriad other challenges women face, many outlined by hon. Members today.
Last week my hon. Friend the Member for Bradford South (Judith Cummins) rightly raised the issue of osteoporosis in the debate on menopause and she rightly did so again today. She highlighted the link between the menopause and osteoporosis.
I want to touch on three areas to reinforce what Members have said today. In the first instance, the primary aim of the Bill relates to prescription charges. This is a major anomaly that my hon. Friend the Member for Swansea East has raised time and again. It cannot be right that this crucial health support is out of synch on prescription charges when compared to other forms of non-charging for prescriptions. For example, the hon. Member for Thurrock (Jackie Doyle-Price) referred to erectile dysfunction and issues around contraception. This is all the more important when the impact menopause has on women for years, and the deleterious knock-on effect it has on family life and work life for so many women and their families, is clear.
Secondly, as I alluded to earlier, this is just the start of a process, not the end or the fulfilment of a process. There needs to be a reappraisal of the training given to clinicians both pre-qualification and post-qualification to ensure that this significant health issue, which affects millions of women to one degree or another, is given the priority it deserves. It is not an attempt to point the finger at hard-working and in many cases overworked clinicians, as others have said; it is an attempt to recognise that women have been ignored, not understood and passed over, and that other issues around their perceived health have not been linked to the menopause when they should have been.
Thirdly, I want to make a suggestion. Given that it is patently obvious that women go through the menopause with varying degrees of intensity and impact on their health, what about a menopause health check for women starting at the perimenopausal stage and into the menopausal phase? From the evidence of the all-party parliamentary group on menopause we know that many women themselves were unaware of the symptoms linked to menopause. NICE guidance setting out an holistic approach to support for woman during both phases would be welcome, as the current guidance is not necessarily as comprehensive as it could be. The last guidance was updated in 2019, as far as I can tell. Perhaps a more substantive refresh would be appropriate.
In conclusion, the impact of the menopause on so many women—an impact often hidden, misunderstood, neglected, ignored and misunderstood—really does need a thorough reappraisal, not just in a narrow or focused medical way but with a cultural sea change in attitudes to the menopause and its impacts. Some of them are life changing and they need to be dealt with right across society in schools, health services and workplaces.
I believe the Bill goes some way to address some of the issues we are debating today, but as my hon. Friend the Member for Swansea East said, nothing short of a menopause revolution will suffice to address this challenge, which is not going away. As a vice-chair of the all-party parliamentary group on menopause and a co-sponsor of the Bill, and as someone who has been conscripted into it, not necessarily as a warrior—[Laughter.]—I exhort Members to support it. The Government and Members right across the House can play their part by supporting my hon. Friend’s endeavours. I support the Bill and I really do implore everybody to do so.
I join Members from across the House in paying tribute to the hon. Member for Swansea East (Carolyn Harris) for bringing forward this very important debate and for the campaign she has been running.
I have a different experience of the issue. Obviously, I have not been through the menopause, but as a doctor working in mental health I have looked after several women who have come to me where their depression has been misdiagnosed as the menopause. So I have seen the issue the other way around. I completely get the point that has been made across the House by several Members that understanding and recognition in this area by clinicians is something that people have many concerns about and needs to be improved. One thing that I have really taken notice of is the strength of feeling around that and the medical profession needs to think about that. I should make some declarations. I am still a member of the medical profession. I am a member of the Royal College of Physicians and the Royal College of Psychiatrists, but, as I would say if I was a member of the Scientific Advisory Group for Emergencies, I am here speaking in a personal capacity today.
I want to talk about one of the statistics that has been put out, which is that 41% of medical schools do not have formal training on the menopause. I found that astounding—I had formal training on the menopause when I went to medical school—so it is worth unpicking that a little bit. I had a look in the briefing to see where that came from. My reading of it is that it is not that student doctors and GPs are not getting training; they are getting training. They are getting vocational training on placements with senior doctors who are teaching them, but some schools do not have formal modules in terms of didactic sit-down teaching on it. I think we need to be a little careful when we say there is no training on the menopause and to dig in a little bit. The reason that is important—as I say, I totally get the sentiment and agree on the need for improvement and better recognition —is that we need to be careful about issuing diktats for how the profession approaches its training programmes. If we carve off something for one disorder, the question then is, “Well, what about other things?” Eventually, the strength of the argument will start to diminish, because we will have all different campaign groups saying, “This needs to be separately cut out, and this, and this.”
Can I just say, 51% of the population is a huge amount of people who are not getting appropriate care.
I thank the hon. Member for her intervention and for pointing that out, but I would argue that it is maybe not 51% of the population who are in that situation of needing that care and support. Although 51% will go through the menopause, that is different from saying that 51% of the population will therefore need medical intervention and medical discussions around this.
But like I say, I do not particularly want to get into a deep debate on this; I just wonder whether we could ask the profession what it thinks it can do better, rather than us telling it, top-down. Of course, I would say that, I am a doctor—yadda, yadda, yadda; declarations, etc.—but I just wonder what the profession would say in response to the hon. Member’s campaign about how it can improve things and whether we can hear a bit more about that.
My final point is that, in a sense, I find the fact that we are having to have today’s debate deeply depressing. It is a wider indictment of the problems we have in society with the role and position of women. We have got the Equality Act 2010 and lots of legislation and statute, but as we have heard, when it comes to cultures and attitudes, it is just not there. There really needs to be a step change, given the events of the past year and what we have seen with sexual harassment. I have loads of constituents who come to me and tell me about the disrespect experienced by women. I hear the points made by my hon. Friend the Member for Thurrock (Jackie Doyle-Price). It is frankly appalling that women’s health has been left behind. We need to think carefully about what we can do as leaders of our communities and society to change things and increase respect for girls and women and the position of women in society. On that note, I absolutely pay tribute to the hon. Member for Swansea East for bringing this debate forward and the campaign she is running.
This debate, which my hon. Friend the Member for Swansea East (Carolyn Harris) has brought forward, is so important, and leadership starts here, so I declare an interest as a perimenopausal woman.
I just remembered to say that, though, because the brain fog was good this morning when I woke up. We have talked about how many times we want the word “menopause” to be mentioned in this Chamber. I will try to say it a number of times to help my hon. Friend to up the count, but I also want to say the word “spatula”, because I could not remember what it was called, and that is when I first started to google “memory loss” and “dementia”. When I started forgetting words for things—I knew what they were, but I could not remember—I thought there was something wrong and I might be getting early onset dementia. We sort of chuckle, but when I started mentioning it to other female friends, they just said, “Oh, that’s just brain fog. You know it’s linked to the menopause?”
I wanted to raise a number of points that have already been raised about misdiagnosis—we have heard that 41% of medical schools offer no mandatory menopause training. I also wanted to talk about workplaces, which have no legal requirement to have menopause policies or to protect employees experiencing menopausal symptoms. However, when I mentioned this debate in my WhatsApp group on my 40-minute train journey into Parliament this morning, I got more lived experience in those 40 minutes. So I am going to put down my speech and read out some of the responses I received:
“Please talk about the fear of dementia. I am so struggling with brain fog now and know now that I need to go on HRT but so many women struggle with postcode lottery with HRT.”
“Great to see such an important topic being discussed with such importance. Ironically I’ve got my call with the doctor today about HRT.”
“One symptom I didn’t think I mentioned—paranoia. I convinced myself that my husband was having an affair for about seven months.”
“Feeling inadequate at work when I have been doing this for decades. I have days where I can’t seem to find clarity or lift my mood.”
“If my GP tried to put me on antidepressants, I would list all the life experiences I have had without them and insist on a second opinion. I feel strongly that we need to treat the cause, not the symptoms.”
“I have had three years of worrying myself sick that I have cancer. Numerous unpleasant, stressful and invasive tests, and only now, when I ask, ‘Could all these symptoms be menopause’ do they think. Numerous GPs, a urologist and a gynaecologist. FFS.”
“I might mention how I’ve knackered my Achilles tendon. That’s a likely consequence of the menopause because tendons are affected due to lack of oestrogen.”
And we have heard about osteoporosis.
In one of her final comments, a friend says:
“My long-term strategy is education for the medical professionals and society. We are literally provided with sex ed, but it stops at that. Too many women feel lucky if their doctor knows their stuff on this. The amount of women who leave employment because they aren’t coping with symptoms. We are financially, physically and emotionally demonised because of a hormone deficit. I am seriously considering leaving work.”
Another friend says:
“I know at times of stress I often think about leaving work, but so many women are taking early retirement or reducing their hours, not because they want to but because they think they’ve lost it. Menopause needs a myriad of support beyond HRT.”
The final comment:
“My workplace is more likely to put a cabbage wrestling on our meeting schedule rather than some open, frank discussions surrounding this.”
I just want to say, for Trish, Sarah, Caz, Liz and Helena, and for women around our country: viva the menopause revolution.
May I also add my thanks to the hon. Member for Swansea East (Carolyn Harris) for this amazing debate and Bill?
When I was first in Parliament, I encountered the exact experiences in all the comments read out by the hon. Member for Luton South (Rachel Hopkins). I was incredibly worried about it. I am delighted that so many people are now speaking out about it in public, because none of that was happening when I was first in Parliament and going through the menopause myself. Other than knowing that hot flushes were part of the process, I had no idea about any of the other symptoms until I listened to “Woman’s Hour” in, I think, 2017 and literally everything became clear: the brain fog, the insomnia, which I am afraid has not gone away—it was in the middle of the night that I heard the programme—and the anxiety and weepiness and feeling that you couldn’t cope with what was happening to you. That was very much part of it. Weight gain is common in Westminster anyway, and a lot of men also gain the Westminster stone, so I cannot blame the menopause for that, but it is certainly something that we need to work on.
That is why this conversation is so important. There are 5.1 million women aged between 45 and 55, and it is estimated that 1.5 million will be going through the menopause at any one time, yet we are so embarrassed to talk about it. Husbands and partners are at a loss as to why their wives and partners are struggling, because the symptoms have been hidden from public knowledge. If I had known some of the symptoms before, I could have dealt with them better, and I am sure my husband could have as well. That “Woman’s Hour” programme was a saviour for me, because suddenly I understood what was happening, and if you understand what is happening, you are better able to face it.
Turning to HRT, I never take medication, apart from the odd pain killer, so taking something to control a natural process was something that I did not consider—probably mostly from ignorance, I should add—but I completely understand that others need medical help. The House of Commons Library briefing states that
“16,000 women were admitted to hospital in England in 2019/20 with conditions associated with the menopause.”
I had absolutely no idea, and I am sure that most of the public do not either.
The case on HRT has been well made, so I will not say more on that, but I do hope that we can consider how it can be made affordable, because, otherwise, it will become a postcode lottery. I am very grateful that a Member who represents a constituency in Wales is interested in looking after all of us who live in England.
I wish to comment on the second part of the Bill, because it is very important. I am really pleased that everything has been raised so publicly, but it is extraordinary that it is only in the past four years that people have been bold enough to speak out, when this has been happening to millions of women for centuries. The big change is that more women are in the workplace now than at any time over the past 100 years, and nearly half of all women are over 50. I am really pleased that we have the menopause workplace pledge, with so many employers leading the way. I hope that Parliament has signed up to it, too. Flexible working hours are essential, especially as lack of sleep is a big issue. Another thought is allowing women to come later into work if they travel on public transport, so that they do not have to crowd themselves in when they are feeling incredibly hot. I have come off the tube so many times absolutely drenched in sweat and incredibly embarrassed that I do not have a change of clothes when I get to my office.
The point about training GPs is crucial, too. I listened to what my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) had to say. I spoke to a doctor about this and found that the issue is barely covered in their initial medical training. For GPs, the clue is in the name—the name is general practice, which means that GPs have to cover a huge area in their curriculum, and it is not mandatory to have additional training for a condition such as the menopause in their professional development. I would very much like to see such training being seen as part of their professional development and it should be taken perhaps every year or every few years, so that they can keep up to date with every aspect, whether it be HRT or anything else on the menopause.
Does my hon. Friend hope that the chair of the Royal College of General Practitioners is listening to this debate today and responds to the hon. Member for Swansea East (Carolyn Harris) on what we are talking about on GP training?
Absolutely, because it is incredibly important that people understand what we are going through—whether we are talking about men or women or people of any age. As someone who does not see the same doctor twice in their practice, although I have not been there very often, I do not have that relationship with a GP, so I would feel embarrassed about going to ask for something that I did not know much about.
On the peer-to-peer point, when I returned to Parliament in 2019, I looked around at the new intake and started approaching women of a certain age—I call them my WOCA group—to form a support group to help those going through the menopause. This has been a lifeline to us, and I hope that everyone else considers that as well. [Interruption.] I can see Madam Deputy Speaker indicating to me.
Finally, may I thank the hon. Member for Swansea East. She truly is a force of nature and I congratulate her on all the things that she is achieving in Parliament, and it is such a joy to work with someone on the Opposition Benches to make a real difference to people’s lives.
I start by reflecting on the importance of these sitting Fridays. They are full of noble pursuits, with hon. Members trying their utmost to leave their small stamp on the world.
To my hon. Friend the Member for Swansea East (Carolyn Harris), whether it is this Bill today, or measures on gambling machines, school holiday hunger and child funeral costs, she always champions the right and just causes, using her voice in this place to elevate the voices of those who feel that they have been long forgotten. I congratulate her and thank her for the support that she has always given me.
Madam Deputy Speaker, perhaps this will come as a surprise to you, as it will, I hope, to everyone in this place today, that I, too, am a woman of a certain age. The challenges that women face in this place are great. Many women may be starting families or raising young families and I can only imagine how difficult that must be.
I was first elected in December 2019, not long ago, and my two sons were of high school age. I had avoided such challenges, but new ones presented themselves. I want to briefly share a little of my personal experience. A number of years ago, I had a blood test and went to get my results. I was told by the GP quite incredulously, “You are in your 40s and peri-menopausal.” A few weeks ago, I contacted the GP to ask for a referral to the women’s hospital in Liverpool to go to the menopause clinic. He asked me why. I said that I wanted to discuss HRT. He said, “We can prescribe HRT.” I replied, “I was told I had to discuss that with the nurse, and last time I discussed my symptoms with her, she prescribed anti-depressants to me when I wasn’t depressed. I also asked her how long I needed to take the medication for. She told me, ‘Forever’.”
That story is not unique; it is the story of so many women. Whether it is brain fog or migraines, whether it is hot flashes—which I have suffered incredibly from all morning—weight gain or overwhelming tiredness, as a perimenopausal women, I know all these signs and symptoms to be true and real, and I appreciate the toll that it can take on physical and mental health.
Despite my challenges, I know how lucky we in this place are. The challenges that perimenopausal and menopausal women must negotiate in the workplace are many and sometimes complex. Many co-workers simply do not understand bosses and shift managers concerned at the drop in productivity, the changes in mood and the need for time off, given the irregular periods, bladder problems and much else besides. There are no warning signs, and no timeframe is set out by our bodies, which are all unique and respond very differently.
As my hon. Friend the Member for Swansea East set out so eloquently with her Bill, we should abolish prescription charges for HRT right away, and what is so evidently lacking is a national conversation on the menopause. That is why clause 2 is so important.
I congratulate my hon. Friend the Member for Swansea East (Carolyn Harris) on her campaign, which she has delivered in her inimitable and passionate style, which we know and love. As well as awareness in medical school and in the workplace, does my hon. Friend the Member for Liverpool, Wavertree (Paula Barker) agree that it is hugely important that we have awareness across society? Until this campaign, my awareness of menopause was shockingly bad and awareness in society, particularly among men, is really important.
I thank my hon. Friend for his intervention. I was going to say that education and awareness for those of school age right through to GP practices should form the backbone of a new dawn for women, who so often feel alone and frustrated that men around them just do not get it.
Finally, I say to my hon. Friend the Member for Swansea East: “From one sister to another, I stand with you today and with every woman out there who needs to know that someone, somewhere has got their back.”
Time is very much against us, but I particularly welcome this debate and especially the decision by the International Menopause Society to adopt bone health as its theme for this year. I pay particular tribute to Councillor Janet Gardner of the London Borough of Hillingdon, who has been very public in talking about the impact of osteoporosis. Having people in public life who are willing to talk about that, to demonstrate how they can continue to serve the public, is incredibly important when we discuss these issues.
The Bill’s scope is extensive and, in the short time open to me, I will focus particularly on the lessons that we can learn from public health campaigns, as well as on the points raised by the hon. Member for Swansea East (Carolyn Harris) about how we turn the aspirations that we all share into transformational change in the way in which women are supported with the symptoms that they may experience and other members of society can engage in providing the help that is needed to access that range of support.
There is an opportunity through the devolution of public health responsibilities to local authorities, which took place in 2013, to ask our local health and wellbeing boards, which play a key role in educating the public about a huge range of different health issues, to take on some of the issues that the hon. Lady raised. In particular, I was struck by the point about a menopause check. Public health bodies are very active in encouraging, for example, parents to take two-year-old children for their health check and adults to access the health check for 40-year-olds. That would be an excellent way of building into public health work an opportunity to raise this discussion and highlight the issues, because it has been striking that so many voices today have said that the key challenge, as with so many different aspects of public health, is ignorance. Not knowing what is happening or how to access treatment and ask good questions remain the biggest barriers to success.
Finally, I encourage the hon. Member for Swansea East and Ministers in responding to think about how we can devise a process that is useful in addressing all the issues that she highlighted, including mental and physical health aspects and the relationship with GPs. We must ensure that local authorities who lead on the work can share best practice so that all women in our society can access excellent services such as those highlighted by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) and no one is forced to suffer in silence.
Once again, I thank the hon. Member for Swansea East (Carolyn Harris) for all her work in raising awareness on the menopause both in the House and publicly. The menopause, for once, has taken centre stage in the press, in Parliament, among the public and, most importantly, among women. The menopause revolution is here.
The menopause is being debated for the second week running, as last week the hon. Lady and my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) secured a general debate to mark World Menopause Month. I believe that this is the first time that the menopause has been debated twice in two weeks. I pay tribute to everyone who has spoken in the debate—both this week and last—including the hon. Members for Pontypridd (Alex Davies-Jones), for Luton South (Rachel Hopkins), for Leicester West (Liz Kendall) and for Liverpool, Wavertree (Paula Barker) as well as my hon. Friends the Members for Stourbridge (Suzanne Webb) for Meon Valley (Mrs Drummond), for Thurrock (Jackie Doyle-Price), for Cities of London and Westminster (Nickie Aiken) and for North Devon (Selaine Saxby). I could go on. Every one of them raised experiences from either their own lives or those of their constituents.
We have heard how important this issue is: it directly impacts 51% of the population, and the effects are wide-ranging and often debilitating. Let us be clear, however, that it also indirectly impacts the remaining 49% of the population. The menopause is everyone’s business. Let me therefore update the House on the work that the Government are doing to break down the taboos and improve menopause care for women. It covers three main areas: healthcare; the workplace; and the women’s health strategy.
On healthcare, we know and have heard many times that people often think the menopause is just a woman’s period stopping and hot flushes starting, but it is so much more than that. There are the night sweats, the fatigue, the unexplained anxiety, the brain fog, the headaches and the insomnia. It is important to break down the taboos surrounding menopause so that women can discuss those symptoms with their healthcare professionals and access high-quality healthcare support.
The NICE guidelines are clear that an individualised approach should be adopted at diagnosis and investigation and in managing the menopause. However, the work carried out earlier this year by the menopause improvement programme found that those guidelines are not being consistently followed, and HRT is often not prescribed despite being a safe and appropriate treatment for most menopausal women. We must ensure that those guidelines are followed.
We have recently made a huge amount of improvement in the workplace. With one in four women in the workplace being menopausal or post-menopausal, it is important that employers create a supportive environment. The Chartered Institute of Personnel and Development, the British Menopause Society and the Faculty of Occupational Medicine among others have provided workplace guidelines, which I encourage all employers to explore. As we heard in the House last week, many employers are starting to lead the way, and I pay tribute to all the businesses that have shown such leadership in the area.
The Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Mid Sussex (Mims Davies), is hosting a roundtable with organisations including the British Chambers of Commerce and the Federation of Small Businesses to improve support for and understanding of the menopause, which will make recommendations to Parliament in November. Flexible working options, whether part-time working or job sharing, go a long way to help women in the workplace. The Government’s consultation on making flexible working the default is currently open, and I urge everyone to respond ahead of the 1 December closing date. The Women and Equalities Committee, chaired by my right hon. Friend the Member for Romsey and Southampton North, is about to hold an inquiry on menopause and the workplace. I look forward to its recommendations.
The NHS is leading the way; with a 77% female workforce, it has many measures in place already. I am pleased to say that the civil service will shortly have a menopause policy in work, to follow the guidelines and support the women in our civil service. I wish briefly to touch on the women’s health strategy, because I mentioned it in the debate last week. It will be published towards the end of the year.[Official Report, 15 November 2021, Vol. 703, c. 1MC.] We had more than 110,000 responses to the consultation earlier in the year, and we found that for those between the ages of 40 to 49 and 50 to 59 the menopause was the key issue, and it will be a priority in the health strategy, when it is published.
This Bill is why we are all here today, and I pay tribute to the hon. Member for Swansea East, because there is no doubt that she has made a difference to women’s lives across the country, with the support of other hon. Members, in all parts of this House. Clause 1 seeks to exempt HRT from NHS prescription charges, which are set out in the National Health Service (Charges for Drugs and Appliances) Regulations 2015. Those regulations apply to England only and are amended annually. They set out the prescription charges payable per drug that is dispensed. The charges apply unless someone is exempt because of age, income or other medical exemption, such as epilepsy. It is common for HRT to be prescribed at relatively short intervals, three-monthly or even monthly, in a minority of cases, and a prescription charge applies each time. As we have heard today, a course of HRT treatment often requires more than two medicines, oestrogen and progesterone, or different preparations—patches, tablets, creams and so on. Sometimes that means that women have to pay two charges, even if these products are supplied in a combination pack or included on the same prescription.
I am pleased to announce that although the Government cannot exempt HRT from prescription charges entirely, we have listened carefully to the argument and, as a result, we will amend the regulations to reduce the costs and improve access to HRT. We will do that by reducing the costs of repeatable prescriptions for HRT for women experiencing menopausal symptoms, so that instead of paying for a repeat prescription every month or every three months, the prescriber can issue a batch of prescriptions for up to 12 months with one signature and one prescription charge. The prescriber will set the interval between the issues of the medicine and the number of times the prescription can be repeated, and of course this will be done on clinical grounds. Repeatable prescriptions can be issued either electronically or on paper.
What that will mean in real terms for women is that where it is clinically appropriate, one prescription charge can be paid per year. For example, where a woman currently takes two hormone treatments, oestrogen and progesterone, and receives a repeatable prescription every month, she pays £18.70 each time, which makes a total of £224 every year. Under the changed system, she would pay just £18.70 each year. That is a saving of £205. [Hon. Members: “Hear, hear!”] I feel like the Chancellor, Madam Deputy Speaker. For a woman currently prescribed HRT on a three-monthly interval, moving to a 12-monthly repeatable prescription will make a saving of £66 a year.[Official Report, 15 November 2021, Vol. 703, c. 2MC.] However, we are going further, as we are also committing to reviewing the double hormone issue. The hon. Lady has made a compelling case for our taking this further, to reduce the cost of living, because it is important that we look at this clearly. I am happy to take that away to look at it further, working with her and other colleagues, and NHS colleagues, to see what progress we can make on that specific issue.
As has been described so eloquently today, the cost of HRT is not the only issue, which takes us on to clause 2. A UK-wide menopause strategy is tough, because health is a devolved matter, and we heard last week about the Scottish Government’s plans for a women’s health plan to address many of these issues. In England, we have our own women’s health strategy, in which the menopause will be at the top of the priority list. However, I recognise that there is work to be done on medical school training, workforce support, access to HRT and other therapies—and just recognising that the menopause actually exists. So today I commit to establishing a new menopause taskforce, with the hon. Member for Swansea East as a co-chair. The taskforce will encourage faster action and join up the dots across the system to take a coherent approach to improving support for those experiencing the menopause. The hon. Member set out in her speech, and we have heard today, that menopause should not be a partisan issue. I hope that she will accept my invitation to co-chair the new taskforce.
I hope that I have reassured hon. Members across the House of the Government’s commitment to this issue. It was telling that the Secretary of State was here earlier to hear these very issues. The Government are committed to reducing the cost of prescriptions, to introducing a menopause taskforce and to making the menopause a priority in the women’s health strategy. I heard the hon. Member on Radio 4 this morning, saying that the aim is to keep women wonderful. As a Conservative and as Government Minister, I probably should not say this, but: up the revolution!
With the leave of the House, I thank the Minister and the Clerks. Wonderful women—thank you! What has happened today is only the beginning, but we can do such great things together. It is all about looking after women. I have just been told that the Welsh Government have also announced that they will be putting mandatory lessons for young people on the national curriculum, and will be delivering a pathway for menopausal women. The revolution has made a big difference. We are keeping women wonderful. Thank you all for your speeches and your time.
I beg to ask leave to withdraw the motion.
The hon. Lady appears to have achieved her objective.
Motion and Bill, by leave, withdrawn.