Menopause and Mind

The current state of support for perimenopause in the UK is characterised by a growing recognition of the need for improved awareness, education, and support.[1] There is a rising emphasis on destigmatising conversations around menopause and enhancing workplace policies. Recent research showing the number of menopause linked absences and job losses has led to specific guidance that now aims to ensure reasonable adjustments in the workplace.[2]

While there has been an increase in menopause visibility, representations in the media have also deflected attention away from understanding menopause as a complex social and cultural issue as well as a medical and economic one.[3] There has been less interest in the impact on broader social, cultural life and relationships outside of the workplace or for those not in paid employment. Researchers are advising that we should be wary of conflating this increase in visibility of menopause with increased inclusivity, and are calling for more intersectionally-conscious accounts of menopause that reach beyond white, cis-gendered, middle-class affluence.[4]

The public sphere is seeing a disconnect between the broadly identified structural inequalities and the emphasis on individualised and privatised solutions.[5] For the majority that rely on the NHS and cannot access private care, our UK healthcare system still faces a shortage of high-quality menopausal care, with a specific lack of integrated mental health screening.[6] While GPs provide the majority of frontline care, most GP practices do not offer dedicated menopause services or additional training in menopause-care.[7]

While slow progress is happening, there is still a need for further research, public health initiatives, and tailored healthcare services to support individuals during the peri-menopausal phase effectively. Those already marginalised and discriminated against are likely to see existing challenges to accessing healthcare extended to accessing support around menopause.

There is also a need to understand different cultural approaches to menopause, including the complexity of displaced refugee and asylum seeker experiences and the way these identities impact and restrict access to healthcare.[8] It is a similar story with pre-existing health conditions, disabilities, and neurodiversity.[9] Recently, the unmasking of neurodivergence, such as Attention Deficit (Hyperactivity) Disorder and Autism Spectrum Disorders (ASDs) during the menopause transition, has been gaining more attention.[10] In general, there needs to be work to generate greater understanding and perceptions of how the experience of menopause links with lived experiences of religion, sexuality, menstruation, ageing, and ethnic identities.[11]

There is little research on LGBTQIA+, (particularly trans, gender non-confirming and non-binary research), although national groups such as the Menopause Inclusion Collective and previously Queer Menopause have been working to rectify this.[12] There also needs to be research into the socio-economic disparities of menopause care that looks beyond the working community. Also, while research indicates a clear connection between trauma and difficulties around the menopause transition, there is still work needed to embed this into practice and common knowledge among GPs.[13] There is also little research on the impact of hormone related conditions such as endometriosis and Premenstrual dysphoric disorder (PMDD) on the experience of the menopausal transition.[14]

Organisations and healthcare providers are at the start of a journey towards providing more comprehensive information, resources, and medical support to address the physical, emotional, and psychological aspects of perimenopause. Locally, Brighton and Hove Federation note that the health service is developing a range of specialist services such as Menopause Clinics, Coil Clinics, Long-term Condition Management and group consultations.[15] NHS Sussex has been working with voluntary and community sector partners to get feedback from women from underrepresented communities in Sussex about healthcare experiences.[16] They are now working to take on board feedback about people not being listened to or believed about their experiences, menopausal misdiagnosis, calls for better information about menstrual health and the menopause. This includes better support for neurodiverse women and girls; women experiencing homelessness; the travelling community; ethnically diverse women; and trans, non-binary and intersex people.[17]

We hope our research will help support the move to improve services locally by adding to the diverse voices calling for improved healthcare around the menopause transition.

You can read our research from last year here.

Our new research survey is now live, if you are in peri or post menopause please consider filling it in and adding to our knowledge and campaigning ability.

---

[1] ‘Menopause (Support and Services) Bill – Parliamentary Bills – UK Parliament’, accessed 16 August 2021, https://bills.parliament.uk/bills/2897; Shani Orgad and Catherine Rottenberg, ‘The Menopause Moment: The Rising Visibility of “the Change” in UK News Coverage’, European Journal of Cultural Studies, 15 April 2023, 13675494231159562, https://doi.org/10.1177/13675494231159562.

[2] ‘Menopause in the Workplace: Guidance for Employers | EHRC’, accessed 20 March 2024, https://www.equalityhumanrights.com/guidance/menopause-workplace-guidance-employers; ‘Guidance on Menopause and the Workplace’, accessed 9 August 2021, https://nipsa.org.uk/nipsa-in-action/equality/697-guidance-on-menopause-and-the-workplace; ‘An Invisible Cohort: Why Are Workplaces Failing Women Going through Menopause? – Committees – UK Parliament’, accessed 23 January 2022, https://committees.parliament.uk/committee/328/women-and-equalities-committee/news/156760/an-invisible-cohort-why-are-workplaces-failing-women-going-through-menopause/.

[3] Orgad and Rottenberg, ‘The Menopause Moment’.

[4] Deborah Jermyn, ‘“Everything You Need to Embrace the Change”: The “Menopausal Turn” in Contemporary UK Culture’, Journal of Aging Studies 64 (1 March 2023): 101114, https://doi.org/10.1016/j.jaging.2023.101114.

[5] Shani Orgad and Catherine Rottenberg, ‘Mediating Menopause: Feminism, Neoliberalism, and Biomedicalisation’, Feminist Theory, 13 July 2023, 14647001231182030, https://doi.org/10.1177/14647001231182030.

[6] Nayra A. Martin-Key et al., ‘Perceptions of Healthcare Provision throughout the Menopause in the UK: A Mixed-Methods Study’, Npj Women’s Health 1, no. 1 (7 December 2023): 1–10, https://doi.org/10.1038/s44294-023-00002-y.

[7] Kanyada Koysombat et al., ‘Patient and Healthcare Providers Experience of Access to Menopause-Related Information and Menopause-Care Provision across the UK: Results from a Nationwide Survey’, in Endocrine Abstracts, vol. 94 (SfE BES 2023, Bioscientifica, 2023), https://doi.org/10.1530/endoabs.94.P116.

[8] Jane M. Ussher, Alexandra J. Hawkey, and Janette Perz, ‘“Age of Despair”, or “When Life Starts”: Migrant and Refugee Women Negotiate Constructions of Menopause’, Culture, Health & Sexuality 21, no. 7 (July 2019): 741–56, https://doi.org/10.1080/13691058.2018.1514069.

[9] Yamnia I. Cortés and Valentina Marginean, ‘Key Factors in Menopause Health Disparities and Inequities: Beyond Race and Ethnicity’, Current Opinion in Endocrine and Metabolic Research 26 (1 October 2022): 100389, https://doi.org/10.1016/j.coemr.2022.100389; Rachel L. Moseley, Tanya Druce, and Julie M. Turner‐Cobb, ‘Autism Research Is “All about the Blokes and the Kids”: Autistic Women Breaking the Silence on Menopause’, British Journal of Health Psychology 26, no. 3 (September 2021): 709–26, https://doi.org/10.1111/bjhp.12477; Bettina Camara, Cintia Padoin, and Blanca Bolea, ‘Relationship between Sex Hormones, Reproductive Stages and ADHD: A Systematic Review’, Archives of Women’s Mental Health 25, no. 1 (1 February 2022): 1–8, https://doi.org/10.1007/s00737-021-01181-w.

[10] Camara, Padoin, and Bolea, ‘Relationship between Sex Hormones, Reproductive Stages and ADHD’; Moseley, Druce, and Turner‐Cobb, ‘Autism Research Is “All about the Blokes and the Kids”’; Rachel L Moseley, Tanya Druce, and Julie M Turner-Cobb, ‘“When My Autism Broke”: A Qualitative Study Spotlighting Autistic Voices on Menopause’, Autism 24, no. 6 (August 2020): 1423–37, https://doi.org/10.1177/1362361319901184.

[11] Mwenza T. Blell, ‘Menopausal Symptoms among British Pakistani Women: A Critique of the Standard Checklist Approach’, Menopause 22, no. 1 (January 2015): 79, https://doi.org/10.1097/GME.0000000000000256; Mwenza Blell, ‘The Timing and Experience of Menopause among British Pakistani Women in Bradford and Leeds, West Yorkshire, UK’ (Doctoral, Durham University, 2009), https://etheses.dur.ac.uk/291/.

[12] ‘Queer / LGBTQIA+ Menopause’, Queer / LGBTQIA+ Menopause, accessed 20 March 2024, https://www.queermenopause.com; ‘Menopause Inclusion Collective’, Menopause Inclusion Collective, accessed 20 March 2024, https://www.menopausecollective.org.

[13] Vasiliki Michopoulos et al., ‘Association between Perimenopausal Age and Greater Posttraumatic Stress Disorder and Depression Symptoms in Trauma-Exposed Women’, Menopause 30, no. 10 (October 2023): 1038, https://doi.org/10.1097/GME.0000000000002235; Joyce T. Bromberger et al., ‘Does Childhood Maltreatment or Current Stress Contribute to Increased Risk for Major Depression during the Menopause Transition?’, Psychological Medicine 52, no. 13 (October 2022): 2570–77, https://doi.org/10.1017/S0033291720004456; A. K. Shea et al., ‘Depression in Midlife Women Attending a Menopause Clinic Is Associated with a History of Childhood Maltreatment’, Climacteric 25, no. 2 (4 March 2022): 203–7, https://doi.org/10.1080/13697137.2021.1915270.

[14] Umit Inceboz, ‘Endometriosis after Menopause’, Women’s Health 11, no. 5 (1 September 2015): 711–15, https://doi.org/10.2217/whe.15.59; Cristina Secosan et al., ‘Endometriosis in Menopause—Renewed Attention on a Controversial Disease’, Diagnostics 10, no. 3 (March 2020): 134, https://doi.org/10.3390/diagnostics10030134; Fatma Tuygar- Okutucu et al., ‘Association of Menopausal Symptoms and Menopausal Quality of Life with Premenstrual Syndrome’, Malawi Medical Journal 35, no. 2 (2 August 2023): 95–100, https://doi.org/10.4314/mmj.v35i2.4.

[15] Designs, ‘Enhanced Access’, Brighton and Hove Federation, 2024, https://www.brightonandhovefed.co.uk/enhanced-access.

[16] Harriet Rayfield, ‘Women’s Voices Call for Improvements to Healthcare Services in Sussex’, Sussex Health & Care, 8 March 2024, https://www.sussex.ics.nhs.uk/womens-voices-call-for-improvements-to-healthcare-services-in-sussex/.

[17] Rayfield.