We’re about to hit peak menopause. A huge rally is being planned at Parliament Square on Tuesday – with a host of celebrities, from Mariella Frostrup to Davina McCall and Rod Stewart, shining a spotlight on to the issue. Labour’s Carolyn Harris is leading the charge in parliament, with cross-party support for her calls for better care and free prescriptions for hormone replacement therapy.
But I’d like to stop the focus on the suffering for a second, and make an economic argument instead. Simple maths shows us that the criminal neglect of the menopause in our health sector is costing the UK economy £10bn, as women walk out of their jobs at this time in their lives, according to analysis by the menopause support app Balance, using data from the Office of National Statistics and the Fawcett Society. One in 10 women surveyed for Channel 4 who worked during the menopause said they had quit their jobs due to symptoms, while 14% had reduced their hours and 14% had gone part-time. Imagine if these women had got the help they had needed – perhaps by being given the new, safer, body-identical hormone replacement therapy, and stayed in work? That’s a massive recruitment and training saving for workplaces.
Let’s apply this specifically to the NHS (where Liz Truss says she wants to make savings). Around half of the NHS workforce is aged 45 or above, and 77% of it is female – which is a significant proportion of women at perimenopausal or menopausal age. There are presently 40,000 nursing vacancies alone. Using the Balance formula and analysing data on the cost of training and recruiting NHS staff, I estimate that if one in 10 menopausal women in the NHS leave their jobs – as is the case in the wider population – then if those women were instead retained, it would save the health service around £700m. Are you listening, prime minister?
In the wake of the documentary I produced a year ago, Davina McCall: Sex, Myths and the Menopause, demand for HRT drugs surged by 30% in the month after broadcast, and has continued to grow. There are now half a million prescriptions for HRT in England each month – double the figure from five years ago. But one senior NHS executive I spoke to recently said that GPs are already too overwhelmed to cope. “They’re inundated already and they don’t have time to deal with this extra demand.” A small investment at the early stages of menopause can reap huge rewards. Once a woman is happy on HRT – which may take a couple of visits – the wider health impacts of long-term hormonal deficiency (joint pain, type 2 diabetes, cardiovascular disease, colon cancer, osteoporosis and dementia, to name a few) are lessened. Which is potentially a lot of future GP appointments saved.
The NHS’s Quality Outcomes Framework pays GP surgeries for diagnosing depression, diabetes and osteoporosis, among other problems – but not menopause. One of Harris’s proposed changes is to include menopause in that framework, to encourage GPs to spot menopausal symptoms – which in turn could make huge cost savings.
Why? Because menopause is a long-term hormonal deficiency, and when oestrogen disappears, on average at the age of 51, women’s bone density decreases. According to the Royal Osteoporosis Society, half of women over 50 break a bone due to osteoporosis, far more than men. Weight-bearing exercise might help a bit, but what actually helps the disintegrating of bones is usually HRT – which, used early enough, can help to reverse osteoporosis. Using transdermal oestrogen raised bone density in the lumbar spine by more than 3% in two years, according to a 2017 study.
Consider this rough calculation. An HRT prescription costs the NHS around £120 per patient per year, according to NHS data. A hip replacement costs the NHS on average around £12,000.
The sums are encouraging. But there may, understandably, be many people who do not know the good news about the new body-identical HRT, and still associate it with causing breast cancer. Indeed, if you search “HRT” on the NHS website, you still get this: “Find out about hormone replacement therapy (HRT) … and what the main risks and side effects are – including how it can raise your risk of breast cancer.”
It’s true there’s a small increased risk of breast cancer for women who take the old combined HRT, which contained synthetic progestins. But the new HRT extracted from soy has molecules of progesterone and oestrogen that are exact copies of your own hormones. An observational study of almost half a million women in the UK Clinical Practice Datalink showed that those using body-identical oestrogen and/or progesterone had no increased risk of breast cancer.
Even more encouraging is the 20,000 GPs and other healthcare professionals who have taken the Menopause Charity/FourteenFish “Confidence in the Menopause” online course in their spare time. As that NHS executive said to me recently: “It’s time we caught up with women’s knowledge.” I’ve been talking to businesses and banks recently about the menopause, and the men in the boardroom are keen to be allies, but it’s when they hear the economic argument that their eyes light up. Perhaps they will be the agents of change. I remember covering the 1992 Clinton/Bush US presidential election campaign years ago, when Clinton’s spin doctors came up with the simple slogan, “It’s the economy, stupid” and won. Perhaps our slogan should be: “It’s the menopausal economy, stupid.”