The last few years have seen a sea-change in public discussion of the menopause, Dr Edward Morris, President of the RCOG, writes.
It was less than a year ago I wrote about the huge awareness boost given to menopause by major broadcast documentaries supported by celebrity voices, and even since then women’s experiences of the menopause have become ever more common on our screens and in our newspapers. I have spent my career supporting women through their menopause for whom stigma and shame made their already challenging symptoms even more difficult to manage, and the veil of stigma that is fast disappearing around menopause is a real cause for celebration.
With this increase in awareness and reduction in stigma comes a generation of women and people who are empowered to come forward and ask the health service for the care and treatment they need. Our colleagues in primary care tell us often how many more women they see who are experiencing menopausal symptoms, and we know prescriptions of Hormone Replacement Therapy (HRT) have increased 50% over five years up to the end of 2021.
How the healthcare service can support women experiencing menopause
With the numbers of women seeking out support for their menopausal symptoms increasing, it is essential that we as a health service are there to fully meet their needs. This means healthcare professionals in the NHS having the right knowledge and skills to provide women with the right treatment and support, and that treatment being available and accessible to all who need it.
With the increase in information around menopause, comes the shadow of a corresponding increase in misinformation, making it more challenging for both women and healthcare professionals to know what advice they should follow, and make informed and individualised choices about treatment options.
RCOG and our fellow professional bodies have a role to play in ensuring the evidence-based information is always in the hands of those who need it.
For healthcare professionals, best practice around menopause care was set out brilliantly in the NICE guidelines, first published in 2015. These guidelines were updated in 2019, and are currently undergoing a further major update which should be published next year. We know that the evidence that informs best practice in menopause care is growing, and are pleased that the NICE guidelines will soon reflect this (the next iteration will look at management of urogenital atrophy, long-term benefits of HRT and Cognitive Behavioural Therapy for managing menopausal symptoms).
Joining with other organisations to improve care
Whilst we await the updated guidance, we have worked alongside our colleagues who deliver menopause care to set out best practice for professionals. We have supported the Royal College of GPs (RCGP) new position statement on menopause which aims to support their members and those working across primary care to feel confident in meeting women’s needs. We have also just published a statement alongside the British Society for Endocrinology (BSE) and the BMS to outline expert consensus on best practice for menopause care and treatment.
We must also make sure that women always have access to the right information to make informed decisions about their menopause care, including knowing everything they can to ensure they manage symptoms as effectively as possible (including knowing about the role that diet, exercise and other lifestyle choices can have).
The soon to be published Women’s Health Strategy must set out actions to ensure women always have access to this information, as part of wider action to improving education and information across all areas of women’s health. We also encourage women and people to access information through the RCOG’s menopause hub, the BMS Women’s Health Concern website, and the Rock My Menopause resources. It’s also essential that when women want to access treatment, it is always available to them.
HRT shortages
We know that for many women and people who use HRT, shortages in the supply of some forms of HRT have hampered access, leaving many women once again facing difficult symptoms unnecessarily. Government action to improve this situation is positive, and we have high hopes that the newly appointed ‘HRT tsar’ will be able to address these shortages both in the short and long term. Alongside our colleagues at the RCGP, the BMS and the Faculty of Sexual and Reproductive Healthcare (FSRH), we recently produced a position statement on supply shortages. In our statement, we highlight the importance of utilising the evidence-based guidance the BMS has produced around HRT equivalents, and also encourage a greater role for pharmacists in advising on and prescribing substitutions where products are unavailable.
In the coming years, we need to build a health service that is equipped with everything it needs to deliver great menopause care to women who need it, and I look forward hopefully to a future where no woman lives with challenging symptoms unnecessarily.
To visit the RCOG menopause hub, click here.