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World Menopause Day is led by the International Menopause Society and held annually on 18 October. It is intended to raise awareness of the menopause and to support options to improve health and well-being for older women.

What is the menopause?

The menopause is a natural stage in life for women, trans men and non-binary people who menstruate, when their periods stop, and they are no longer able to get pregnant naturally. It happens when there is a change in the sex hormones as women and other people who menstruate get older. The ovaries stop producing the hormone oestrogen and no longer produce an egg each month. The menopause usually occurs between the ages of 45-55; the NHS says the average age for women in the UK to reach menopause is 51.

The process of menopause is usually gradual. Although symptoms may go on for a number of years, menopause is said to have taken place when a woman has not had a period for 12 months. The transition phase before menopause – when periods become irregular – is often referred to as ‘perimenopause’. The menopause thus affects women and other people whose oestrogen levels are declining, which could include trans people and non-binary people. Menopause can also be triggered by some treatments for cancer, and in some exceptional cases, younger women may become menopausal (known as premature menopause).

An estimated 1.5 million women – around 80% of those going through menopause – experience common symptoms such as hot flushes and night sweats. These are caused by a change in the balance of hormones. Symptoms can have a significant impact on daily life and well-being and experiences vary widely.

Hormone replacement therapy (HRT)

HRT helps to relieve symptoms by replacing oestrogen levels that naturally fall during the menopause and offers protection against bone loss and fractures.

The National Institute for Health and Care Excellence (NICE) guidance on Menopause: diagnosis and management recommends a range of treatment options for menopausal symptoms. HRT is included in the range of treatment options recommended by NICE and is the most commonly prescribed treatment.  NICE reports that the use of HRT “varies with socioeconomic and cultural factors”. Advice and support for HRT as a treatment is also variable.

The current NICE guidance, Menopause: diagnosis and management, advises clinicians to explain to women that, although combined hormone (oestrogen and progestogen) HRT “can be associated with an increase in the risk of breast cancer”, oestrogen-only HRT “is associated with little or no change” in risk. The guidance also says the increased risk is related to the duration of treatment and reduces after stopping HRT.

HRT shortages

Concerns have been raised about UK-wide shortages of some HRT products (see for example, BBC News, Menopause: HRT rationed amid continuing shortage in UK, 29 April 2022).

On 29 April 2022 the Government announced measures to improve supply. This included issuing serious shortage protocols (SSPs) in which community pharmacists are allowed to substitute a specified product in accordance with the protocol in place of a prescribed product without needing to return to the prescriber. The Government also imposed a maximum dispensing quantity of 3 months for medicines subject to the protocol, and appointed Madelaine McTernan as Head of the HRT Supply Taskforce.

The UK Menopause Taskforce

The first meeting of UK Menopause Taskforce took place on 3 February 2022

The Taskforce was to be co-chaired by Maria Caulfield, the then Minister for Patient Safety and Primary Care and Carolyn Harris MP, and its membership includes Ministers from the Government Equalities Office, DWP, Department for Business, Energy and Industrial Strategy, clinical experts from across the UK and Health Ministers from the Devolved Administrations.

The Taskforce will look at several areas of work, including recommendations made to government, ensuring that clinical evidence underpins all aspects of menopause work and increasing awareness amongst the general public.

The Women’s Health Strategy

In July 2022, the government published its Women’s Health Strategy for England. In it, the government made several commitments with respect to menopause, including:

  • Providing women with high quality, personalised menopause care within primary care, and where needed, specialist care, in a timely manner
  • Enabling women to access the full range of treatment options for menopause symptoms, and at a reduced cost
  • Healthcare professionals in primary care are well-informed about the menopause and able to offer women evidence-based advice and treatment options including HRT and alternatives
  • Women are supported to remain in the workplace during the menopause, and employers are well-equipped to support their workforce during the menopause
  • Including menopause in the relationships, sex and health education (RSHE) curriculum in schools
  • The launch of the NHS Menopause Pathway Improvement Programme in 2021, which brings together NHS England, the DHSC, menopause specialists and other stakeholders. This programme will develop optimal care pathways for women experiencing the menopause, in line with recommendations set out in NICE’s guideline on menopause, diagnosis and management.
  • NHS England working with Wellbeing of Women to develop an awareness raising package among health professionals, to ensure more women are advised to seek support earlier in their menopause
  • The launch of a new HRT pre-payment certificate which will enable people to access as many NHS prescriptions for HRT medicines licensed for treatment of the menopause as they need for an annual cost of just 2 single item prescription charges

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