Pushing the menopause conversation up the national agenda

Our submission

We – My Menopause Centre and BritainThinks – welcome the Department for Health and Social Care’s call for evidence to collect views on women’s health and are presenting a joint, evidence-based submission. We have recently completed a piece of qualitative and quantitative research with men and women across the UK to develop a holistic understanding of perceptions and experiences of the menopause. This work, alongside other published data, forms the basis of our submission.

Our submission references the themes outlined in the submission guidance and provides an overview of our expertise in women’s health, specifically the menopause.

Who we are

My Menopause Centre was founded by Dr Clare Spencer (registered menopause specialist and GP) and Helen Normoyle, former Chief Marketing Officer of Boots UK and Ireland.

Dr Spencer qualified from Cambridge University and holds Membership of the Royal College of Obstetricians and Gynaecologists and Membership of the Royal College of General Practitioners. She initially trained in obstetrics and gynaecology where she gained a Doctor of Medicine for research in fetomaternal medicine. As well as her role of clinical director at My Menopause Centre, she currently runs an NHS menopause service and is a GP partner of a practice in Leeds. She is also a British Menopause Society menopause trainer and is involved in educating GPs about the menopause transition through talks, lectures and seminars. She wrote the menopause training module for doctors.net and has written for the Primary Care Women’s Health forum publication, Her Life Her Health, on a variety of menopause-related topics.

My Menopause Centre is an online website that provides free, evidence-based information and advice on all stages of the menopause transition, 38 symptoms of the menopause, and an algorithmically driven questionnaire that provides a personalised menopause assessment. Led by Dr Spencer, My Menopause Centre also provides an online (private) menopause clinic, run by doctors who specialise in the treatment of the menopause.

BritainThinks is a global insight and strategy consultancy dedicated to putting the people that matter most to its clients at the heart of their thinking. BritainThinks works across a range of issues and sectors but has particular expertise in the healthcare space, where its clients include DHSC, NHS England, the Richmond Group of Charities, and the Cabinet Office.

Summary overview

The menopause is a natural part of a woman’s life, and all women will experience it.

Around 8 in 10 women will experience symptoms of the menopause, experiencing an average of 7 symptoms ^[1]; symptoms usually last 4 years, but can last for up to 12 years^[2] and change over time.

Overall, the symptoms of the menopause can have a negative impact on all aspects of a woman’s quality of life – home, work, social and sex life.

Women’s Voices

Research indicates that women do not feel they are listened to within the healthcare system. It also suggests that the pervasive menopause taboo deters women from seeking help and, when they do access healthcare, can negatively impact their interactions with HCPs.

Information and education on women’s health

The menopause taboo feeds directly into low awareness of the menopause as a women’s health issue and low knowledge and understanding of this phase in women’s lives, including amongst women themselves: only one in four of the menopausal or post-menopausal women surveyed by My Menopause Centre and BritainThinks feel – or felt – prepared for the menopause, and over half underestimated the physical and mental/emotional symptoms^[3].

However, our research also highlights the importance of education and information in enabling women to feel empowered to talk about their health and shows that women who feel prepared for menopause have better outcomes.

Women’s health in the workplace

Multiple studies show the negative impact that the symptoms of the menopause can have on women’s workforce participation, including engagement, retention and performance:

• On average, women missed 3.27 days^[4] of work each year due to their symptoms, with a potential productivity loss of c14m working days. Almost half the employed women who took time off because of the menopause (47%) would not tell their employer the real reason.
• Various research studies also suggest that, amongst those experiencing symptoms, for some women, their symptoms are leading them to consider reducing their hours, leaving their jobs altogether or are the reason they have left their jobs^[5].

Women also do not feel supported at work (a survey by Nuffield Health found 72% of female workers suffering symptoms said they felt unsupported at work, even though 1 in 5 said their symptoms have a detrimental impact on their work^[6]) and there is an appetite for menopause policies and access to advice and support^[7].

Impact of Covid-19 on women’s health

While it’s too soon to properly understand and assess the full implications of COVID-19 on women’s experience of the menopause, there is nonetheless evidence that Covid-19 has had an impact, albeit in complex and mixed ways.

Driving change

Drawing on our recent research with men and women across the UK, BritainThinks and My Menopause Centre have identified 5 actions that we believe are needed to improve the experiences of the millions of women who are going through the menopause transition:

1. Reframe the menopause – by reframing what it means to be middle-aged, tackling ageist stereotypes and by helping women to be prepared for the menopause, it can be a time of positive change in life. Preparation requires building knowledge and understanding of the stages and symptoms of the menopause, and the range of evidence-based treatment options available.
2.  Encourage women to seek help for their menopause symptoms. To do this we need to raise awareness of the symptoms of the menopause, tackle the stoicism and embarrassment around them and, importantly, get the facts around the pros and cons of HRT out there.
3. Ensure all healthcare professionals are educated about the menopause, so that when women do ask for help, they are fully informed and able to address all aspects of their treatment.
4. Make all workplaces menopause-friendly by developing and implementing a menopause policy, championing this from the most senior levels of the organisation to become embedded in the organisation’s culture.
5. Make the menopause everyone’s business by tackling the taboos around it and showing that it affects not ‘just’ the 50% of the population who experience it, but everyone around them… their families, friends, and employers. Educate, inform and engage everyone, men and younger women in particular, to drive real and sustainable change.

Women’s Voices

The available research indicates that many women do not feel they are listened to within the healthcare system, are not satisfied with the support they are getting from their GP and/or are not getting the support they need. It also suggests that the pervasive menopause taboo affects women’s interactions with the healthcare system: making women less likely to seek help and meaning that some HCPs are not comfortable when they do.

• Research conducted by ComRes on behalf of the BBC^[8] indicated that, of women with symptoms of the menopause, 59% consulted their GP and 41% did not. Of those that consulted their GP, almost 4 in 10 (39%) did not find their GP useful in helping them with the symptoms of the menopause (very useful 23%, fairly useful 38%).
• Research carried out by not-for-profit healthcare provider, Nuffield Health^[9] showed that:
  • 38% of women sought help from a GP
    • however, a quarter of those who visited a GP said the possibility of the symptoms being menopause-related failed to come up.
  • “Despite recent evidence that hormone replacement therapy (HRT) can significantly improve quality of life for many women, as well as protecting younger women from long term diseases including osteoporosis”:
    • a third of women who visited a GP were not made aware of hormone replacement therapy
    • just 20% who visited a GP were prescribed HRT
    • a third were told HRT was unsuitable for them
    • one in seven women (14%) said they turned it down due to the belief that it is dangerous.
• This quantitative data is backed up by Dr Clare Spencer’s experience with hundreds of patients in her specialist menopause clinic. Women tell Dr Spencer that they do not feel listened to, that they feel their symptoms are not taken seriously or are misdiagnosed as depression and/or anxiety. This misdiagnosis means that women are frequently offered antidepressants instead of HRT, despite evidence that this is less effective for managing menopause symptoms^[10]_.
• It is further supported by the qualitative element of the research delivered by My Menopause Centre and BritainThinks, which provides evidence of the impact of the menopause taboo on interactions with HCPs.
  • Women interviewed in the research described embarrassment when discussing their symptoms as a barrier to seeking help, especially when talking to a younger or male GP.
  • When they overcome this embarrassment at attending their GP practice, women described feeling dismissed or that their GP did not understand – or was uncomfortable discussing – the full range of symptoms they were experiencing.

“I thought, if something’s not right, I need to go to the doctors and the first thing they wanted to do was to give me some form of antidepressants – I knew that I wasn’t depressed.”

“Some 30-year-old male doctor joyfully printed me off some info on how to prepare yourself for sleep: dark room, no blue light. Gosh, I could do this on my own. When I mentioned vaginal dryness to him, he went into a spin. And I was like ‘No, I don’t need this’.”

This data highlights the need to ensure all healthcare professionals are educated about and comfortable discussing the menopause, so that when women do ask for help they are fully informed and able to address all aspects of their treatment.

Information and education on women’s health

The increase we are seeing at the moment in public and national conversations about the menopause is much needed and very welcome. However, our research shows the long-standing menopause taboo is still very much in place: 47% of the public agree it is a taboo topic in UK society – rising to 72% of perimenopausal and menopausal women^[11].

This taboo feeds directly into low awareness of the menopause as a women’s health issue, and low knowledge and understanding of this phase in women’s lives, including amongst women themselves: only one in four of the menopausal women we interviewed feel – or felt – prepared for the menopause, and over half underestimated the physical and mental/emotional symptoms. As one of our participants explained:

“I don’t think we speak about it. Menopause is almost like a bad word. I don’t remember my mum or aunties talking about it. So no one ever knows enough.”

In wider society, knowledge and understanding is even lower: 2 in 5 (43%) of the public agree they don’t know much about the menopause and just a third (33%) say that they would know how to support a woman who is going through the menopause. This lack of knowledge, coupled with difficulties talking about menopause, has real-world impacts.

However, our research also highlights the importance of education and information in enabling women to feel empowered to talk about their health and shows that women who feel prepared for menopause have better outcomes.

• While only 1 in 4 women say they feel/felt prepared for the menopause, those who say they feel prepared are far more likely than other women to say that menopause can be a positive change in women’s lives (54% vs 26%) and less likely to say they feel/felt under pressure just to cope with the symptoms (24% vs 71%) and less likely to say they feel/felt more isolated from others as a result of the menopause (12% vs 44%).

This finding highlights the importance of building knowledge of the menopause amongst younger women so that they’re prepared for what’s to come. In our survey, over half (53%) of women aged 18 – 44 interviewed agree they ‘don’t really know much about the menopause’, compared to 20% of women aged 45 – 64.

This data also highlights the need to make the menopause everyone’s business by tackling the taboos around it and showing that it affects not just the 50% of the population who experience it, but everyone around them… their families, friends, and employers. Educate, inform and engage everyone, men and younger women in particular, to drive real and sustainable change.

Women’s health in the workplace

Multiple studies show the negative impact that the symptoms of the menopause can have on women’s workforce participation, i.e. engagement, retention and performance:

• On average, women miss 3.27 days of work^[12] each year due to their symptoms, with a potential productivity loss of c14m working days. Almost half the employed women who took time off because of the menopause (47%) would not tell their employer the real reason.
• In our survey, three quarters (77%) of the menopausal women interviewed agreed that a woman’s experience of the menopause can negatively impact her performance at work, 67% her career.
• Various research studies also suggest that, amongst those experiencing symptoms, for some women their symptoms are leading them to consider reducing their hours, leaving their jobs altogether or are the reason they have left their jobs^[13].
• Women also do not feel supported at work (a survey by Nuffield Health found 72% of female workers suffering symptoms said they felt unsupported at work, even though 1 in 5 said their symptoms have a detrimental impact on their work^[14]).
• In My Menopause Centre’s work with BritainThinks, women interviewed were largely unaware of policies to support women through the menopause at work and were often uncomfortable discussing the issue with their line manager (especially if they were younger and/or a man) – meaning that they were left feeling that they “just have to cope”.
• Nevertheless, there is a desire for support: in an Ipsos MORI survey, among the women interviewed whose employer did not offer any support, almost 4 in 10 (37%) would like their employers to offer access to specialist menopause advice from a third-party expert and 31% would like their employer to offer a menopause policy^[15].

Our research indicates that to be effective, policies and support needs to be championed from the very top of the workplace, with one workplace manager interviewed described the transformational effect the CEO talking about her experience had.

“They do drop-in sessions and the CEO was really good and open about her situation and that encouraged other people to be open, and that opened up a lot of doors.”

This data clearly highlights the need to make all workplaces menopause-friendly by not only developing and implementing a menopause policy but also championing this from the most senior levels of the organisation so that it becomes embedded in the organisation’s culture:

• Raising awareness
• Training managers
• Sharing information
• Normalising the conversation
• Making workplace arrangements
• Creating an inclusive culture

This is, of course, in addition to the general awareness-raising and education that needs to happen (see above).

Research, evidence and data

We echo the DHSC’s view that while we have a world-class R&D system in the UK, women have been historically underrepresented in research. More research, data and evidence is needed to tackle this gender data gap, and to enable analysis of women of different ages and from different socioeconomic and ethnic groups.

As it relates to the menopause, more data is needed on the impact of the symptoms of the menopause on women’s health and quality of life, as well as the range of effective treatment options.

This is particularly important as life expectancy increases and women live ever more of their lives postmenopausal. It’s not hard to imagine that the day will come when a woman will live a majority of her life postmenopausal, so understanding the implications of hormonal changes on her physical and mental health and wellbeing is critical to ensuring that we extend healthy life expectancy for women.

Impact of COVID-19 on women’s health

While too soon to properly understand and assess the full impact of COVID-19 on women’s experience of the menopause, and the implications, there is nonetheless evidence that Covid-19 has had an impact, albeit it in complex and mixed ways.

Our quantitative research – conducted in April -May 2021 – found that 47% of the menopausal women interviewed said that the COVID-19 pandemic has made the emotional symptoms of the menopause worse, and 43% that it has reduced the amount of support available to help them with their symptoms.

• Encouraging women to prioritise their health and wellbeing and to see a HCP to help with their menopause symptoms is key, as is ensuring that the support is being provided by the health care community

However, in our qualitative research, some women discussed how working from home, and reduced pressure to socialise had made it easier to cope with some of the physical symptoms, for example removing the fear of embarrassment as a result of having a hot flush in public.

“Had I been at work [in school] I would have asked my colleagues ‘How did you do it’?”

This reinforces the very individual way that the symptoms of the menopause are experienced,  that a ‘one-size-fits-all approach’ to menopause care is not appropriate, and the benefits of a flexible working policy for women in employment.