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Women from marginalised communities are experiencing difficulty accessing menopause care because of a lack of cultural awareness, short GP appointments, and a lack of tailored information, a report has found.
Madhu Kapoor, 60, who is of South Asian heritage, waited seven years for her own symptoms to be correctly diagnosed and to access medication.
Ms Kapoor, the founder of M for Menopause, which offers employers support in addressing issues surrounding menstruation and menopause in the workplace, began noticing changes in her skin and nails in her early 40s.
Blood tests did not reveal anything unusual, but symptoms included having difficulty sleeping, night sweats, weekly migraines, irregular periods, joint aches and bouts of forgetfulness.
At the time, she was working on the frontline for a government department.
“I loved what I did,” she told The i Paper, but “when I was attending meetings I would just have this knot in my stomach” because “I couldn’t remember things, I couldn’t absorb any information”.
Individuals from the LGBT+ community, as well as women with disabilities, women from ethnic minority groups, and those living in poverty or homelessness, gave evidence to the All-Party Parliamentary Group (APPG) on Menopause.
The APPG report found that menopause symptoms can be misinterpreted by healthcare professionals who lack cultural awareness around the different terms used by ethnic minority women, who might, for example, say they are experiencing fevers when referring to hot flushes or night sweats.
Recent NHS data on hormone replacement therapy (HRT) uptake shows Black women are five times less likely to be prescribed HRT (5.2 per cent) compared with white women (23.3 per cent). Asian women are four times less likely (6.2 per cent) to be prescribed.
Women from some ethnic groups generally experience the onset of menopause earlier than the UK average of 51. For Indian women the average is 46.7 years, while for Pakistani women it is 47.16 years.
Another study has also shown that confusion with existing healthcare conditions, such as diabetes in South Asian women, can lead to delayed diagnosis of menopause.
In some minority communities, menopause is a taboo subject which is not talked about or is attached to embarrassment surrounding aging and the loss of fertility.
‘I started to doubt who I was’
Despite experiencing menopause symptoms, Mas Kapoor could neither find adequate support from her boss, nor find clarity from her GP.
Madhu Kapoor waited seven years for a menopause diagnosis “I started to doubt who I was,” she said, but when she tried to speak to her manager, “all she spoke about was targets”.
“I didn’t know what was happening to me, so I went to the GP regularly,” Ms Kapoor added. But there were “no conversations about that it could be symptoms to do with menopause, so I was just having tests” for potential issues such as fibroids.
“I could express myself but I still wasn’t getting through to my GP,” she said. “I guess how I was expressing myself didn’t really give her a picture of what I was going through. I would say to her that ‘I feel like killing someone,’ because I had so much anger inside me, and she goes ‘oh, don’t worry about it’.
“When you’re listening to a professional medic, you trust what they are saying,” she said.
‘I was told I was too young to have menopause’
Ms Kapoor said that while her GP followed the correct process, she never took in what she was really going through or experiencing.
“I asked her: ‘Do you think I’m going through the menopause?’ and she was going: ‘No, you’re too young’,” Ms Kapoor added.
After seven years of struggling with these symptoms, Ms Kapoor was finally diagnosed at the age of 50, in the same month that she resigned from her job. She was initially prescribed herbal medication, and “had to fight to get HRT”.
Ms Kapoor now works with women struggling to be heard over their perimenopause symptoms. Many women won’t go to their GP, anticipating difficulties getting an appointment, while others may not feel comfortable explaining why they are there, and others will find it difficult to set out their situation within the appointment time slot, or be discouraged when they have to see different doctors each time.
“It’s 10 years” since she received a diagnosis, Ms Kapoor said, “and how much has changed regarding GP services?”
Individuals from the LGBT+ community, as well as women with disabilities, from ethnic minority groups, and those living in poverty or homelessness or other marginalising situations gave evidence to the All-Party Parliamentary Group on Menopause (Photo: Peter Dazeley/Getty Images) Sonia Davis, who is from the West Midlands, has incomplete paraplegia after an accident at the age of 51, meaning that she is in constant pain and uses a wheelchair.
She began experiencing symptoms of the perimenopause including anxiety, brain fog, night sweats, poor sleep, goosebumps, and itchy skin in her early 50s. When she went to the GP, they thought it was connected with another condition she has, autonomic dysreflexia.
Occurring in individuals with spinal cord injuries, autonomic dysreflexia can cause dangerous spikes in blood pressure that can be life-threatening. Common signs include headaches, heavy sweating, goosebumps and anxiety, meaning that it “sort of mimics symptoms of the menopause”, Ms Davis told The i Paper.
The APPG report found that GPs are likely to have a limited awareness of the interplay between pre-existing conditions and menopause, and that the questions they are required to ask leaves less time for disabled women to be truly heard.
‘Not enough time to listen’
Ms Davis said her GP believed the anxiety and poor sleep she suffered was linked to her disability.
But she knew her symptoms related to something else, and “started to get this fear” about whether her medication was causing problems “or if it was something more serious”.
Ms Davis added that she didn’t blame the doctors she saw, and that “the NHS do the best they can”, but there is “not enough time to listen”. Once issues relating to her disability had been discussed, “before you know it, my time was finished”.
Sometimes she felt that she wasn’t seen in the same way as an able-bodied woman, and that medical professionals would “forget that you have periods” meaning that her reproductive health was “overlooked”.
She has also faced issues with examination couches, some of which are not adjustable, making “transferring from your chair to the bed impossible”.
“You build yourself up, wear the proper clothing, and you’ve got someone to go with you, and then when you get there you can’t even get onto the bed! Then they tell you that your appointment is cancelled,” she said. The issues would lead to “a longer waiting time to be booked into a more accessible healthcare building”.
Eventually, Ms Davis said that a “lovely doctor” at her GP practice, who was a similar age, recognised her symptoms and referred her to the menopause clinic.
Women with disabilities ‘must be at the table’
Ms Davis, who is a volunteer at the Spinal Injuries Association, said she appreciates the Government has committed to rewriting the women’s health strategy, but that women with disabilities, especially paralysis and spinal cord injuries, “must be at the table”.
“These things aren’t going to be highlighted and there is not going to progress” unless you include people with “lived experience”, she said.
An NHS spokesperson said: “We have seen a huge rise in menopause awareness with more women feeling able to access the care they need, but we know there is more work to do – women shouldn’t have to be sharp elbowed when it comes to getting a diagnosis and support for menopause, and we’re rolling out neighbourhood women’s health hubs to ensure all women have access to the care and tools they need to manage their symptoms.
“Access should be equal for all women, and every GP should be following clinical guidance on menopause to ensure that when a woman presents with symptoms, a conversation about menopause happens first time – and we are working with local health teams to reiterate guidance.”
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A Department of Health and Social Care spokesperson said: “It’s unacceptable that women from ethnic minority backgrounds and disabled women are facing barriers to getting the care they need.
“That’s why we’re taking action – marking a landmark step forward in women’s healthcare by bringing menopause advice to NHS health checks so women can get support sooner, and renewing the Women’s Health Strategy.
“We’re making progress in improving women’s health, including cutting gynaecological waiting lists, making emergency hormonal contraception free in pharmacies, and ensuring women’s voices are heard through Martha’s Rule and Jess’s Rule.”
If you think that you are experiencing perimenopause symptoms, you can access support through organisations such as The Menopause Charity and Women’s Health Concern.
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