Menopause and Wellbeing in Blackpool

Healthwatch Blackpool were commissioned by Public Health Blackpool to gain insight into individuals' experiences with the menopause and perimenopause.  They undertook an online survey, interviews and focus group discussions, reaching 556 people in total.

When discussing the physical symptoms related to menopause, the majority of individuals reported experiencing symptoms for 1-2 years, and most commonly experiencing one or more symptoms daily. The most commonly reported physical symptoms were tiredness and fatigue, problems sleeping and hot sweats, with individuals sharing that these symptoms also impacted their mental health due to feelings of anxiety. When asked about the impact on their mental health specifically, 65% experienced changes to their mental health as a result of menopause. Similarly, the majority of individuals reported experiencing mental health symptoms for 1-2 years and daily, with the most common mental health symptom being poor concentration/brain fog. 

When discussing their experiences with healthcare professionals, 68% of individuals self diagnosed their menopause due to both physical and mental health symptoms, with 78% subsequently approaching their GP in the first instance for support. Positive experiences with healthcare professionals were mostly attributed to having a clear diagnosis of menopause and subsequent timely intervention through appointments, advice and access to medication. Individuals who reported negative experiences cited the lack of knowledge of healthcare professionals as being the main contributing factor. An absence of a menopause specialist was perceived as an issue, leading to limited knowledge of symptoms and treatment options, in some cases referencing outdated views on HRT, misdiagnosis and incorrect advice. Individuals shared that their experiences would have been improved had they felt listened to and that their concerns were validated. The biggest barrier identified by individuals was navigating the healthcare system, in particular access to GP appointments or menopause specialists. 

When discussing the impact on work, the majority of individuals reported that menopause impacted their ability to work, both due to physical and mental health symptoms. This was mainly attributed to mental health symptoms such as brain fog and anxiety, and physical symptoms such as tiredness/ fatigue and hot sweats. The majority of participants reported feeling comfortable discussing work adjustments with their employer, mainly due to approachable colleagues and a supportive work culture. Examples of good practice were adjustments such as flexible working and physical adjustments such as access to fans. For those who did not feel comfortable discussing work adjustments, this was due to feeling that either their employer would not understand or being unsure of who to approach within their organisation. Interestingly, when asked if they had asked for workplace adjustments, the majority had not discussed this with their employer.

The majority of individuals also reported that menopause had impacted their relationships with loved ones and friends. Relationships with partners, children, wider family and friends were largely impacted due to feeling less tolerant and more irritable than usual. This led to individuals avoiding social interactions, as well as experiencing feelings of anxiety around socialising. Communicating with loved ones appeared to be mixed, with individuals reporting positive outcomes when being able to comfortably discuss their menopause with partners, children and friends. When discussing the impact of menopause on their day-to-day life, the majority of individuals reported most commonly experiencing a lack of self-confidence and self-esteem, leading to a decline in self-worth. Positive experiences related to menopause were mainly due to HRT enhancing their daily life, through improving mental and physical symptoms. Conversely, when asked for any additional comments, the majority of individuals chose to further discuss the negative impact menopause has had on their mental health, referencing anxiety, depression and in some cases, suicidal thoughts. Most commonly, individuals sought advice and support from friends, in many cases due to them also sharing this experience, evidencing the importance of peer support for individuals experiencing menopause.

According to the healthcare professionals Healthwatch engaged with, 50% had received menopause specific training, which was mostly completed as part of continuous professional development (CPD). The primary reason for choosing to complete this was due to personal experiences with menopause. Gaps in knowledge were identified by healthcare professionals, with the most common being around the use of hormone treatments such as HRT and testosterone, exacerbated by continuous changes of guidelines within the healthcare field. Other areas where health professionals felt they lacked knowledge is with the co-morbidity of menopause with other health conditions such as fibromyalgia, mental health and cancer. It was also identified by a number of healthcare professionals that more knowledge and training in supporting transgender patients was required. 

When discussing access and resources, the majority of healthcare professionals reported using online avenues to disseminate information. Access to resources such as contraception, HRT and stock issues for certain medications were highlighted as being a key issue for healthcare professionals supporting patients. Healthcare professionals would like access to clearer referral processes to menopause specialists, as well as considerations of the wider determinants of health, such as social/financial factors and access to preventative care through educating patients. Healthcare professionals also felt that there were barriers for patients accessing mental health support due to long waiting lists and unclear pathways. Healthcare professionals discussed patient management and reported facing challenges when discussing HRT as an option, due to continuous developments and managing expectations of what HRT can do for their symptoms. Healthcare professionals also reported challenges with meeting patients’ accessibility needs, including language barriers and supporting members of the transgender community. At times, healthcare professionals faced difficulties discussing lifestyle changes with patients, such as exercise, diet, alcohol consumption etc. due to some patients being unreceptive of making these changes alongside any medical interventions.

When supporting their loved one experiencing menopause, individuals felt more confident discussing emotional and social needs and less confident discussing physical needs. To enable them to feel more confident having these discussions, loved ones felt that increased education and access to information about menopause would be helpful. In particular, information about the symptoms, management options, local support and resources would aid loved ones in feeling more confident during these discussions. Male respondents highlighted a strong desire for being empathetic and helpful to their partners, but felt their current knowledge of menopause was too limited to enable this. Suggestions were also made regarding embedding menopause education within formal education settings. 

Furthermore, individuals discussed the emotional challenges of supporting their loved one through menopause, noting in particular the strain this has had on their relationships. Some discussed how feeling the need to protect their own emotional wellbeing often led to relationship breakdowns. Another challenge identified by individuals was the mental health challenges faced by their loved one, including the onset of anxiety and depression and the significant variation of moods. Loved ones felt this was further exacerbated by the lack of support from healthcare professionals, leaving them trying to support the individual’s symptoms and at times, feeling overwhelmed by this. Partners also highlighted further strains on relationships due to increases in arguments and communication breakdowns, as well as a reduction in intimacy. 

As well as educational upskilling, loved ones also highlighted the need for community provision via local support groups, exercise clubs or menopause champions.