Women's health plan: progress report

Menopause and menstrual health, including endometriosis: progress against the short-term actions

Menstrual health

Most women and girls experience periods and menstrual cycles – but many are unprepared for the impact they can have. From pain, to heavy bleeding and Pre-Menstrual Syndrome (PMS), many are not aware of what's normal and what's not normal when it comes to this aspect of their lives. Improving information, education and awareness is vital to help women and girls know when and how to seek help.

NHS Inform Menstrual Health Resource

In May 2022, a new menstrual health resource was launched on the NHS Inform Women's Health Platform. The resource includes information from choosing period products, to period pain and menstrual health conditions including fibroids, Polycystic Ovary Syndrome (PCOS) and endometriosis. There are three brand new short films which provide information and support from experts on; What's Normal? ; Irregular Periods and Premenstrual Syndrome (PMS). The resource includes a film focussed on living with endometriosis, as well as an animation on endometriosis created by Endo Warriors West Lothian with the Excellence in Pelvic Pain and Endometriosis Care and Treatment centre in Edinburgh (EXPPECT).

The content is available in Arabic, Chinese (Simplified), Polish, Punjabi and Urdu, BSL and Easy Read versions.

Action 27: Promote the use of positive language around menstrual health.

• A new menstrual health resource on the NHS Inform Women's Health Platform has been launched. Menstrual health content, including endometriosis and polycystic ovary syndrome, has been reviewed, refreshed and published.
• Short films on menstrual health provide affirmative information for women and people who menstruate on i) what's normal ii) PMS and iii) irregular periods.
• Parent Club information on girls' and women's health now includes up-to-date information on menstrual health, including endometriosis, and menopause.
• The Period Products (Free Provision) (Scotland) Act 2021 commenced in August 2022.

This action continues beyond the short term and promoting positive language will be an ongoing piece of work throughout the lifetime of the Plan.

Free period products

The Period Products (Free Provision) (Scotland) Act 2021 commenced on 15 August 2022 and places duties on local authorities and education providers to ensure that everyone in Scotland who menstruates can have reasonably convenient access to period products, free of charge, as and when they are required.

We are proud to have taken world-leading (and award-winning) action by investing over £33 million since 2017 to fund access to fre priod products across a range of settings including schools, colleges and universities, wider public spaces, and targeted access through community groups for those on low incomes.

Being able to access period products is fundamental to equality and dignity. In a society as rich as Scotland, no-one should have to suffer the indignity of not having the means to meet their basic needs.

Period dignity goes beyond the provision of free period products which is why we have also provided funding for a Period Dignity website for employers, run a successful anti-stigma campaign, and enhanced the menstrual health resources available for teachers, on RSHP.scot

We awarded funding to Hey Girls to update content on their website, www.myperiod.org.uk and to support the development of the PickupMyPeriod mobile app

This has resulted in workplace resources being created and made available on the website, including in-house training and online courses which cover period stigma, menstrual health, reusable period products, and ways that employers can support staff that have periods. The development of the app is supporting people to identify locations where period products can be accessed for free in Scotland.

Action 28: Where appropriate, offer women who are eligible for combined hormonal contraception, the option of a continuous or extended regimen and raise awareness of the option of no bleeding, even if contraception is not required.

• Information on the option of no bleeding included on the NHS Inform menstrual health resource and contraception content.

This action continues beyond the short term and will be an ongoing piece of work throughout the lifetime of the Plan.

Endometriosis

Endometriosis is a long-term condition where tissue, similar to the lining of the womb, is found elsewhere in the body. It affects around 1 in 10 of those who menstruate. Improving access to appropriate support, speedy diagnosis and best treatment is one of the key priorities of the Women's Health Plan. Progress this year has included the following.

• NHS Inform pages on endometriosis have been updated to ensure that people across Scotland are able to find accurate and accessible information on Endometriosis and the support available. This includes a lived experience video as well as an animation on endometriosis created by Endo Warriors West Lothian and the Excellence in Pelvic Pain and Endometriosis Care and Treatment centre in Edinburgh (EXPPECT).
• The Relationships, Sexual Health and Parenthood (RSHP) curriculum resource for senior year pupils has been updated with an endometriosis animation created by Endo Warriors West Lothian, and the EXPPECT centre in Edinburgh. The animation provides young people with appropriate and accurate information about endometriosis, the symptoms and treatment options.
• We awarded £15,000 to Endometriosis UK to develop a project to better understand the support needs of those who are newly diagnosed and those awaiting diagnosis. Responding to the need for more information, a set of informative webinars for those 'newly diagnosed in Scotland' have been delivered and are available online.

Newly Diagnosed in Scotland: What is Endometriosis, The Diagnosis Journey & Pain Management with Professor Andrew Horne, Dr Lucy Whitaker and Priscilla Fernandez – EXPPECT Edinburgh.

Newly Diagnosed in Scotland series: Endometriosis & Fertility with Dr Lucky Saraswat – Consultant Gynaecologist and Minimal Access Surgeon at Aberdeen Royal Infirmary.

Action 31: Implement and raise awareness of current national guidelines on endometriosis and develop and implement further pathways for care where these don't currently exist – for example endometriosis outside the pelvis.

• The Modernising Patient Pathways Programme (MPPP) Integrated Endometriosis Referral Care Pathway for NHS Scotland has now been approved and will be distributed to all NHS Boards for implementation.
• An endometriosis advisory group of endometriosis specialists, secondary care health professionals and service managers has been established to increase collaborative working, inform policy actions and drive improvement. The first meeting of the group was held in April 2022.
• An endometriosis lived experience forum has been established, supporting the sharing of knowledge and expertise, and current processes and pressures in the support, diagnosis and treatment of endometriosis.

Action 32: Commission endometriosis research to find the cause of the condition, leading to the development of better treatment and management options, and a cure.

• Scottish Government have jointly funded a £250,000 research call with Wellbeing of Women, which was awarded in December 2022. The research aims to develop improvements into treatment and management options for endometriosis.

Menopause

Menopause is a key life transition yet is something that many women know little about. The 10 actions set out in the WHP aim to ensure that women have timely access to menopause support and services; healthcare professionals are aware of the impact of medical or surgical treatments to induce menopause and all women have access to a healthcare professional with an interest in menopause through primary care.

Action 34: Develop, maintain and promote a support network for menopause specialists throughout Scotland. Each HCP with special interest in menopause should have access to at least one menopause specialist for advice, support, onward referral and leadership of multidisciplinary education.

"The Menopause Specialists' Network has been formalised, developed and expanded from an existing informal group and now has over 50 members. Meetings are held through Teams approximately every three months to update on current issues and share ideas and practice. In addition, clinical experience and support is provided through regular email communications between meetings. This network provides excellent peer support and encourages consistency of menopause advice provided across Scotland by Menopause Specialists which is then shared with primary care teams." Dr Heather Currie, Consultant Gynaecologist and Network Chair.

• The National Menopause Specialists Network, chaired by Dr Heather Currie, meets on a quarterly basis and includes representatives from all mainland NHS Boards.

Action 35: Provide a holistic approach to care by promoting greater joint working between healthcare professionals on menopause diagnosis and treatment across primary and secondary care and specialist clinical, including through joint education sessions starting with pre- and post-qualification training on gynaecology.

• Three education sessions have been held, to date, with Scottish obstetrics and gynaecology trainees on menopause, with the latest session supporting 63 attendees. This session, held in September 2022, has been recorded so that the resource can be accessed by other trainees so they too can 'think menopause'.

This action continues beyond the timescales of the action and increasing holistic care in menopause will be an ongoing piece of work throughout the lifetime of the Plan.

Graphic text below:

Menopause

• Mood swings
• Aches and pains
• Tiredness
• Recurrent UTI Symptoms
• Vaginal dryness
• Palpitations
• Anxiety
• Hot flushes
• Brain fog
• Loss of sex drive
• Night sweats
• Insomnia
• Lack of energy
• Memory loss
• Painful sex
• Weight gain

Beyond the short term:

Action 38: Provide a specialist menopause service in every NHS Board, and where sub specialisation is impractical (e.g. Island Health Boards) develop a buddy system.

• There is a specialist menopause service in every mainland NHS Board, with a buddy system in place for the Island Boards.

Action 39: Develop a menopause and menstrual health workplace policy, as an example of best practice, starting with NHS Scotland, and promote across the public, private and third sector.

An expert advisory group is leading the development of a menopause and menstrual health workplace policy for NHS Scotland. Membership includes expertise from NHS Scotland Human Resources, union representatives, specialist clinical services and academia.

• A survey of NHS Scotland staff launched on World Menopause Day.

The survey seeks the lived experience of those working in NHS Scotland in relation to their personal experiences of menopause and menstrual health in the workplace. This large survey will be a ground-breaking world first to consider menstrual health at work. The results of the survey will provide a firm evidence base for the policy as well as vital intelligence on experience of menopause, menstrual health and the workplace.

Spotlight on: menopause education across the life-course

Around 400,000 women in Scotland are of menopausal age. Improving the information available to them, at all stages of their lives, can help them feel more confident about what to expect, what's 'normal', the options available to them and, importantly, to know that they are not alone.

Menopause education in schools

• We have strengthened inclusion of menopause in an activity at the senior phase of relationships, sexual health and parenthood education in the Scottish curriculum to ensure meaningful learning is delivered about this important topic. Human Fertility and Reproduction (Senior Phase Activity Plan) Feb 2022 (rshp.scot)

NHS Inform Menopause Resource

We want all women and people who experience symptoms of menopause, to have access to high quality and comprehensive information and support.

In October 2021 we launched the NHS Inform menopause information resource through which we are busting menopause myths, and highlighting menopause symptoms, options for care, treatment and support, mental health and much more.

• Eight short films are busting menopause myths
• Dr Sigi Joseph is 'talking menopause with your GP'
• Women talk about their personal experiences of menopause

The content is available in Arabic, Chinese (Simplified), Polish, Punjabi and Urdu, BSL and Easy Read versions.

• In the year since the launch of the resource in October 2021, there was a fivefold increase in access to menopause information on NHS Inform.

The ALLIANCE Menopause Webinars

To further increase the information available to women on menopause the ALLIANCE have, in partnership with the Scottish Government, hosted a series of webinars with each one focusing on a different aspect of menopause.

1. Menopause mythbusting

• In December 2021 The ALLIANCE held a menopause mythbusting session for all those who wanted to know more about how we can bust the myths that persistently and negatively affect women's experience of menopause.

Chaired by the ALLIANCE's Irene Oldfather, a panel of experts busted myths and answered questions from the audience.

2. Menopause and the workplace

Attendees of the mythbusting webinar particularly highlighted menopause and the workplace as a topic they'd like to hear more about.

• A second webinar on menopause and the workplace was held in August 2022.

Providing information on 'what is menopause', the evidence around menopause and the workplace, effective support and putting policy into practice, this event provided practical information on how we can all positively improve support for menopause in the workplace

"I have been reflecting on the message that as a (peri)menopausal woman in the workplace, I am an asset to be supported, rather than a problem to be dealt with. At a time when confidence can be low but anxiety high, this was a positive message to hear and I plan on sharing it and passing it on."

"Sometimes you feel alone, but I can see from the webinar this is across the board, thank you for giving me this insight. I used to feel really guilty at having taken some time off as if it wasn't that important what was happening to me; now I have seen the stats I understand better how this is affecting all women."

• A resource pack, including a recording of the webinar, has been produced to support delegates, interested individuals and organisations to learn more and action learning on effective menopause workplace support.

More information can be found at: ALLIANCE Menopause and Workplace Resource Pack

3. Menopause, sexual wellbeing and relationships

"It was a transformative event"

• A third webinar on menopause, sex and relationships with Dr Claire Macaulay was held in October 2022. This built on Claire's menopause mythbusting video on NHS Inform and provided information and support on the impact of menopause on your body and your sex life, emphasising the right to pleasure.

"It was mind-blowing as it included things that I had never considered to be part of the menopause, everyday things that would never have come up elsewhere."

Support for Employers

Women need employers who understand how their employees can be affected by the menopause, what they need to be successfully supported in the work place and to be equipped with the knowledge and tools to deliver this for their workforce.

In August 2022 Close the Gap – in partnership with the Scottish Government – held a webinar for employers on menopause and the workplace.

Close the Gap has developed a guidance document for employers on how to provide workplace support for those experiencing symptoms of menopause.

More information can be found at:

Menopause and the workplace – what can you do as an employer? Webinar and blog

Close the Gap | Blog | New employer resource on creating a menopause-aware workplace.

Menopause and the Workplace – What can you do as an employer? – YouTube

Creating a menopause aware workplace

Creating a menopause aware workplace