Women's Health Plan: Phase Two (2026 - 2029)

4 Optimising Future Health

“I think prevention would be a good thing to invest more in, catch people early.” Age Scotland Focus Group Participant [age 85-89, rural]

In Optimising Future Health, Phase Two of the Women’s Health Plan reaches beyond reproductive health with brain health, bone health and pelvic floor health as key considerations, adding to existing work on heart health supporting older women’s health concerns.

In focusing on prevention, and early intervention, we can support improvement in women’s healthy life expectancy, so they can enjoy longer healthier lives with better health in later years. We know many women and girls experience significant barriers to optimising their health.

The building blocks for good health begin in the earliest years, starting with preconception. Preconception care is a set of preventative actions and supports aimed at improving the health of all people of reproductive age before a pregnancy occurs, recognising that many pregnancies are not identified until early development is already underway. Preconception care addresses a wide range of health and lifestyle factors and acknowledges the importance of conditions that enable and encourage behaviour change. Its aim is to improve maternal and child outcomes, enhance long-term child health and reduce risks, with benefits that extend across the life course and into future generations.

Women of all ages have told us they want more education on women’s health, earlier, including how to stay healthy and prevent long-term conditions – to optimise their future health. Women with experience of poverty and homelessness said there is a lack of early education on women’s health which has an impact well into adulthood^[12].

Women make up 59% of those out of work because of ill health^[13]. We also know that women make up:

• 96% of the early learning and childcare workforce^[14]
• 89% of primary school teachers^[15]
• 79% of the adult social care workforce^[16]
• 79% of NHS Scotland employees^[17]

The Scottish Trade Unions Congress has highlighted women’s health as an area of priority. A significant number of women’s health related motions have passed at Women’s Conferences over recent years, highlighting the importance of women’s health, particularly in the workplace. We will build on the action commenced in phase one of the Women’s Health Plan relating to women’s health in the workplace.

We also know that physical activity is a powerful tool for the prevention of ill health.

There is strong evidence of its protective effect against conditions such as coronary heart disease, some cancers, hypertension, obesity, type 2 diabetes, and osteoporosis. It also plays a vital role in supporting pelvic floor health and maintaining strength and balance – these are key components of optimising future health that help sustain mobility, confidence and independence, particularly in later life.

These benefits are especially important during life stages such as menopause, when women may face increased health risks and often experience a decline in activity levels. We know women and girls face barriers to participation in sport and physical activity and are less likely to meet recommended physical activity levels. Research shows that women and girls participate less in sport and physical activity than men and boys^[18].

Bone health is important at every age and stage of life, particularly for women who have a higher risk of osteoporosis – a disorder in which bones become very fragile and more likely to break in later life.

• We know that half of women over 50 will break a bone due to osteoporosis.
• For women, bone loss starts to increase after the menopause because oestrogen levels decrease. Men lose bone more gradually than women^[19].

Bone density peaks around age 25-30 and then begins to decrease after age 50, meaning we lose more bone than we gain as we age. Therefore, it is important we all look after our bone health across our life course, taking preventative steps. This includes eating well, taking vitamin D and calcium supplements (if indicated) and being active and doing weight-bearing and strengthening training exercises to help keep our bones strong and healthy^[20].

Some women are at greater risk of osteoporosis due to genetics, lifestyle factors and specific medical conditions or treatments. For example, those experiencing early menopause or a hysterectomy before the age of 45, conditions like rheumatoid arthritis or eating disorders, or specific long-term medications such as steroids or chemotherapy can all impact bone density.

Taking a preventative approach to bone health will involve ensuring women and young people have access to reliable information and resources to raise awareness about good bone health. Improving the assessment of women’s future risk of osteoporosis and fractures by healthcare professionals through the promotion of existing clinical guidelines and tools in primary care is also important. Using opportunities to discuss bone health with patients is key, including those diagnosed with early menopause in whom hormone replacement therapy can be a preventative measure.

“A main priority within discussion was timely access to pelvic health physiotherapy, both for prevention and treatment of pelvic floor concerns. There were also calls for standardised referral to [pelvic floor] physiotherapy.” Lived Experience Development Day – ALLIANCE – March 2025

We know that symptoms of incontinence and prolapse impact significantly on the lives of women and girls.

• 60% of UK women have at least one symptom of poor pelvic floor health^[21].
• A 2024 study found 61% of women surveyed had recently experienced urinary incontinence, 22% faecal incontinence and 17% prolapse symptoms^[22].

Supporting women to understand how they can prevent, predict and treat problems with their pelvic floor is critical to helping women and girls to enjoy optimal health over the life course.

There are now accessible resources available on NHS Inform, including an animation designed to help women better understand their bodies by explaining how the pelvic floor muscles work and a film with a ‘how to’ on pelvic floor exercises.

Pelvic floor weakness often starts during pregnancy and following child birth, exacerbated by vaginal tears. Implementation of the OASI Care Bundle and perineal care has the potential to prevent third and fourth degree tears during child birth. NHS Boards are considering next steps for implementation in Scotland.

Work continues to support those harmed by transvaginal mesh, including a specialist mesh service in NHS Greater Glasgow and Clyde and funded independent provider options to allow women a choice of who performs surgery. We have also commissioned the Scottish Pelvic Floor Registry and Audit Programme, led by PHS, to collect and analyse data to improve pelvic floor services in Scotland.

Building on the work undertaken through the first phase of the Women’s Health Plan, women’s cardiovascular health remains a priority. We will continue to optimise opportunities for cardiovascular health, risk reduction and awareness raising across a woman’s life course.

Cardiovascular disease (CVD) is a leading cause of ill health and death for women in Scotland. More than 7,000 women died from CVD in 2024, and ischaemic heart disease kills more than 2.5 times as many women as breast cancer in Scotland, each year.

Our CVD Risk Factors Programme aims to reduce avoidable CVD death by 20% in 20 years by improving the identification and management of key CVD risk factors. These risk factors are high blood pressure, high cholesterol, raised blood sugars, obesity and smoking. The programme includes a particular focus on taking opportunities to identify women’s risk factors throughout the life course. Evidence suggests that risk factors like smoking, diabetes and high blood pressure can increase the risk of a heart attack more in women than in men^[23].

There are several points in a woman’s life course during which there are important opportunities to identify cardiovascular risk – for example, during and after pregnancy, menopause or for women with known reproductive health conditions, such as PCOS. We will continue to optimise opportunities for improving cardiovascular health, risk reduction and awareness raising across a woman’s life course.

“A focus on prevention, including education, would… ensure that women could advocate for themselves and access initiatives and services delivered through Phase Two… an example put forward by the Group was the use of existing touchpoints to share specific information or provide add-on care.” Lived Experience Development Day – ALLIANCE – August 2025

In this phase of the Plan we are focused on improving the pathways of care relevant to those key points in women’s life course. This includes work to test pathways to better inform women of lifetime CVD risk following hypertensive disorders of pregnancy and to build on the work taken forward in the first phase to support healthcare professionals with information and support about menopause management in women with CVD.

4.1 Optimising Future Health – Ambitions, Aims, Actions

Ambition

For all women and girls to experience the best possible health, from preconception and throughout the life course.

Aims

1. Healthcare services will support all women and girls to live long and healthy lives, focussing on prevention, early intervention and delivering personcentred care.

2. Women and girls will be informed and empowered to live long and healthy lives.

Actions

Health across the life course

7. The Scottish Government will continue work to support improvement in pre-conception and interconception health by:

• Further embedding the Scottish ‘OK’ Question into routine health care for women of reproductive age, to create more holistic, joined-up care aligned to individual need – including women who are not planning a pregnancy.
• Working with services that support women’s health, in the context of pregnancy desires, enabling informed choice through accessible and non-judgemental support.

8. The Scottish Government will review service pathways for pre-existing medical conditions to optimise women’s health before and between pregnancies to improve maternal and fetal health and future child health and development.

9. The Scottish Government will work with partners to review, update and promote the Women’s Health content on RSHP.scot to help girls and young women better understand their health, and know where and how to access help and support.

10. NHS Boards will maximise the use of women’s health ‘touchpoints’ to promote future health, staying well and preventative options by building on existing work to deliver holistic women’s health care. Resources will be developed to support healthcare professionals to confidently hold conversations on women’s health needs.

11. The Scottish Government and Public Health Scotland will collaborate to:

• Develop information for girls and women on the benefits of physical activity across the life course.
• Create learning and development opportunities for those working with girls and women on the importance of physical activity to health across the life course.
• Produce guidance on how to create sport and physical activity environments, services and opportunities that are conducive to the needs of girls and women.

Pelvic Floor Health

12. The Scottish Government will assess and map the provision of pelvic floor physiotherapy across NHS Scotland, including workforce capacity, to identify gaps and areas for improvement.

13. The Scottish Government will work with partners to establish a standardised referral pathway for pelvic floor physiotherapy, aiming to prioritise prevention and early rehabilitation.

14. NHS Education for Scotland will develop faecal incontinence management education for health care professionals working in Primary Care.

Bone Health

15. The Scottish Government will work with partners to develop and promote information and resources on bone health specifically for women and girls, including risk factors for osteoporosis.

16. The Scottish Government will work with partners to promote the use of existing guidelines and tools for the diagnosis and management of osteopenia and osteoporosis. This will focus on prevention and early intervention, particularly for women with risk factors.

Heart Health

17. The Scottish Government will support NHS Boards to test and implement new pathways of care to ensure women who experience hypertensive disorders of pregnancy are informed about their lifetime CVD risk and are provided with opportunities to reduce this risk.

18. The Scottish Government will work with third sector and academic partners to involve women with lived experience of cardiovascular risk factors in the development of the CVD Risk Factors programme, to ensure their insights shape priorities and delivery.

19. The Scottish Government will work with our partners through the CVD Risk Factors Programme, to deliver education for healthcare professionals in order to improve awareness of how cardiovascular risk factors and cardiac disease interact with women’s health, particularly during menopause and pregnancy.