NHS Menopause Services — House of Commons, 2019-02-13
Topic: Health
Rachel Helen Maclean (Conservative, Centre-right): I completely agree with the hon. Gentleman. I have heard that point from so many women who have written to me, and I know that many of the women watching right now will have had the experience going to their GP and not getting the necessary support I will now talk about what I think the Government, the NHS and GPs can do to better support women experiencing, and sometimes struggling to cope with, the menopause. Central to the treatment available is hormone replacement therapy—or HRT, as it is commonly known. In essence, by addressing the hormonal imbalance resulting from the ageing process, HRT can address a wide variety of different symptoms experienced by menopausal women, and this is explicitly confirmed in National Institute for Health and Care Excellence guidelines on the menopause. It is recommended to treat vasomotor, psychological and urogenital symptoms, as well as altered sexual function resulting from ageing Despite these guidelines having been published in November 2015—three years ago—only 10% of women are actually taking HRT. Time and again, I hear about women who have been turned away from their GPs—as the hon. Member for Strangford (Jim Shannon) mentioned a moment ago—and not given this effective medicine, on spurious grounds. They are told, for example, that because their periods have not stopped they are not menopausal. However, it is suitable to prescribe the medicine at that point. It is not expensive, it is safe, and it has a transformative effect Back in 2015, when these guidelines were introduced, they were heralded as a great step forward, but that, sadly, has not materialised. Many attribute the problem to a 2002 study which found some causation between HRT and breast cancer, but the 2015 NICE guidelines are crystal clear: for the vast majority of women, the benefits of HRT greatly outweigh any risks. The guidelines state explicitly that it does not increase the risk of developing cardiovascular disease, that there is no association between developing type 2 diabetes and taking HRT, and that there is no evidence to suggest an increased risk of developing dementia. In fact, evidence suggests the contrary Even in individual cases in which cardiovascular concerns may discourage the prescription of HRT, oestrogen in the form of a skin patch or gel is available, and carries no risk of clots. That is the form of HRT that I am taking, and, combined with migraine treatment, it is helping me enormously. In fact, evidence shows that HRT lowers the risk of heart attacks by 50% and the risk of osteoporosis by 50%, and that the risk of depression is also reduced. Moreover, women on HRT are less likely to put on weight, because weight increases during the menopause. It is therefore clear that HRT brings public health benefits HRT with oestrogen alone is associated with no change in the risk of developing breast cancer. Body-identical progesterone does not carry a risk of breast cancer for the first five years, and even after that point the risk is very low. The risk of developing breast cancer is much higher in women who drink just a couple of glasses of wine every day, or who are overweight Sadly, despite all that evidence, the media have misreported and whipped up fear about HRT for a number of years, and many people, including women and healthcare professionals, are still misinformed as a result. The issue is further augmented by the fact that very few GPs and nurses receive enough training, undergraduate or postgraduate education about the menopause. That has led to a general lack of awareness and misinformation in the medical community. It is clear that many GPs are not following the NICE guidelines That negligence is a problem, because many women are being sent away with no support, or are being mistakenly treated for misdiagnosed conditions such as depression and anxiety. Research that Dr Louise Newson has undertaken and shared with me shows that it is common for GPs to prescribe, for example, risperidone or diazepam rather than HRT. Of the thousands of menopausal women whom she surveyed, some 66%—a truly staggering figure—had been given antidepressants rather than HRT. Those expensive and addictive medicines are, of course, effective in treating certain conditions, but in menopause cases there is no evidence that they improve low mood or anxiety. Both types of HRT, oestrogen and progesterone, cost the NHS about £4 a month, so they are low-cost in comparison with antidepressants. They are highly effective, and pose a very low risk The benefits of HRT are clear, the size of the issue is unavoidable, and the action that needs to be taken is simple. The health service must give better training to GPs and other health workers, and must increase their awareness of the benefits of HRT in treating the menopause. The myths must be dispelled, and I hope that many millions more women will then see the benefit. Society, including men and employers, will also see the benefit, and the health service should benefit as well. Women who take HRT are less likely to attend GP surgeries, and effective HRT treatment removes the need for unnecessary referrals to specialists such as cardiologists or psychologists. That would undoubtedly relieve pressure on those already burdened specialisms. Medicine and diagnostic costs would be also reduced A few weeks ago, I held a productive roundtable discussion about this issue with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price). I am pleased that the Department will be considering what more it can do to support menopausal women. I was encouraged by my hon. Friend’s commitment and her pledge to engage in further work with us. However, I implore the Department to prioritise that work, because it affects every woman I am keen to hear the Minister’s remarks, and I look forward to working closely with her. Women across the UK, including in my constituency, are struggling and being denied help. That is so wrong when there is a cheap, effective and low-risk treatment already available. I am glad we have started to break the stigma in this place and I thank all who have supported me in this campaign.