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

5 Gynaecology and Reproductive Health

While gynaecology was not identified as an area in need of specific and additional focus during the development of the first phase of the Women’s Health Plan in 2020-21, priorities including menopause, menstrual health and endometriosis all fall under the specialty of gynaecology. In this next phase we are expanding our focus. In addition to the priority programme to ensure all women and girls in Scotland have access to timely and sustainable gynaecology services, we will undertake specific actions relating to menstrual health, fibroids, endometriosis, adenomyosis, PCOS and menopause.

It is estimated that, by the age of 50 years, 80% of Black women and nearly 70% of white women will have had fibroids^[24]. Between two and four in 100 women get pre-menstrual syndrome (PMS) that is severe enough to prevent them from getting on with their daily lives^[25]. It is estimated around 1 in 10 women in the UK are affected by endometriosis^[26].

“Securing a diagnosis is a crucial first step which enables those with endometriosis to make informed choices about the management and treatment of their condition.” Endometriosis UK – Our strategy for 2025-2030

It is important to ensure that women who can be effectively supported within primary care are able to access that care promptly, while those with more complex needs can reach specialist services without delay. We want women to be able to access the support and treatment they need regardless of what their diagnosis may ultimately be. The first step on any diagnosis journey is to recognise that the symptoms being experienced are affecting a person’s day-to-day life, and that they know where to go for help. There can be two stages to diagnosis, a ‘working diagnosis’ at primary care level and a confirmed diagnosis in secondary care. For example, not everyone with endometriosis will choose a diagnosis in secondary care, which can mean an invasive procedure, if they are happy their symptoms can be well managed without this.

Through the first phase of the Women’s Health Plan we have taken action to raise awareness of endometriosis and other menstrual health conditions and to improve access to reliable information on symptoms. Actions in this next phase continue to build on that momentum with a particular focus on building knowledge and understanding of menstrual health symptoms and conditions, including endometriosis and adenomyosis, at an earlier age.

There are currently around 400,000 women in Scotland of menopausal age, between 45 to 54 years – although we know some women will experience menopause at a younger age.

Every woman will, at some point, experience menopause. Whilst not all women will experience menopausal symptoms when they go through the menopause, up to 80-90% will have some symptoms, with 25% describing them as severe and debilitating^[27]. Variation in menopause support and care persists across Scotland, which is why menopause remains a focus.

Building on the work from the first phase of the Women’s Health Plan, we will take a more targeted approach to address the inequity of menopause care across Scotland. Research will allow us to explore the reasons why hormonal replacement therapy (HRT) is less likely to be prescribed to women in deprived communities and how improvements can be made for more equitable care in Scotland. We will use this evidence to design and implement targeted improvements, with a specific focus on reducing inequalities to ensure women in the most deprived communities receive timely, high-quality support.

For women experiencing more complex menopause symptoms – whether due to induced menopause following surgery or cancer treatment, spontaneous premature menopause, or living with a pre-existing physical or mental health condition – more targeted attention will be given to ensure better access to holistic and timely menopause support, and we will consider how we optimise the future health of women during this life transition.

5.1 Gynaecology and Reproductive Health – Ambition, Aims, Actions

Ambition

Our ambition is for all women and girls to enjoy the best possible reproductive and gynaecological health throughout their lives.

Aims

1. For women and girls in Scotland to feel informed, confident and supported in their menstrual health.

2. For women to feel prepared and informed on what to expect during perimenopause/ menopause, know how to seek support for managing symptoms and have access to timely treatment and care.

3. Diagnosis times for all menstrual health conditions, including endometriosis, are reduced.

Actions

Menstrual Health

20. The Centre for Sustainable Delivery will:

• Review the current Endometriosis Care Pathway to align with updated NICE guidance, identifying gaps and opportunities for improvement.
• Develop and support implementation of a suite of clinical pathways, and associated patient friendly versions, to support better diagnosis and treatment of gynaecological conditions.

21. The Scottish Government will work with partners to explore how to provide additional education and support for school-aged girls and young women on periods and menstrual health, with the aim of developing new resources.

22. The Scottish Government will work with partners to support healthcare professionals in community, primary and secondary care to ensure that a full blood count and ferritin measurement is considered when seeing women or girls with symptoms of heavy, frequent or prolonged menstrual bleeding (to identify/exclude iron deficiency and implement appropriate treatment).

This will include updating the Heavy Menstrual Bleeding Pathway.

23. NHS Education for Scotland (NES) will develop and roll out educational materials for healthcare professionals in order to improve understanding, diagnosis and management of mood changes/ disorders across the menstrual cycle (including Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Syndrome (PMS)).

24. The Scottish Government will work with partners to promote the use of existing guidelines, education and other tools on pelvic pain, irregular periods and heavy menstrual bleeding in primary care, to support the timely diagnosis and management of menstrual health conditions including fibroids, endometriosis, adenomyosis and PCOS.

25. NHS Boards, with the support of the Scottish Government, will pilot drop-in sessions which enable primary care staff to hold regular case discussions with specialists with a focus on menstrual health conditions, including fibroids, endometriosis, adenomyosis and PCOS.

Menopause

26. The Scottish Government will work with partners to undertake research which explores the reasons HRT is prescribed less often to women in deprived communities.

27. The Scottish Government will develop and promote a toolkit which will support healthcare professionals in both primary and secondary care to deliver Group Consultations on Women’s Health, with an initial focus on Menopause Care.

28. The Scottish Government will work with the Menopause Clinical Reference Group to improve support for women experiencing:

• Treatment induced or spontaneous premature menopause;
• Menopause with pre-existing gynaecology conditions such as fibroids, endometriosis, adenomyosis; and
• pre-existing mental illness through the promotion of a holistic, interdisciplinary approach which will include the development of guidance and resources for women, and for healthcare professionals.

29. NHS Education for Scotland will offer education sessions for Healthcare Professionals on emerging issues or ‘hot topics’ for menopause clinical management.