All four UK nations have released women’s health plans and strategies in recent years. With practice nurses playing a key role in women’s health delivery and the menopause, Madeleine Anderson explores how the role is uniquely equipped to support patients in this area.
Through a series of interviews with nurses, she considers what more can be done to ensure the profession has the right menopause training and that this can be put into action
Feeling unprepared
Registered nurse and local menopause lead Jacqui McBurnie first developed an interest in the menopause when she began to experience some early menopause symptoms while working as a project lead for NHS England around a decade ago.
‘I didn’t connect the symptoms. I didn’t know they were menopause related. I was a bit unprepared,’ Ms McBurnie, told Nursing in Practice.
Looking for support for her symptoms, Ms McBurnie initially reached out to her human resources (HR) and occupational health (OH) teams, but neither avenue was able to give the precise support she needed.
So, she decided to take things into her own hands, and invited colleagues to a lunchtime meeting to discuss whether or not they felt supported during the menopause, and if they didn’t, what could be done to fix this.
The local lunchtime sessions quickly grew, with Ms McBurnie eventually founding and leading NHS England’s national menopause network.
The unique role of the practice nurse
Looking back on the early days of the network Ms McBurnie, who is now menopause transformation lead at North East and North Cumbria Integrated Care System (ICS), says many of the nurses who joined were looking for clinical based resources that they could share with their patients and use to counter the ‘myths and misinformation’ that patients were hearing about the menopause.
For Ms McBurnie, general practice nurses (GPNs) are in an especially strong position to use their relationship with patients to share thorough and accurate clinical advice, as well as offer interpersonal reassurance and support, she says.
‘I think it’s really critical that women have that platform from the nurse they’re seeing for other things, and the practice nurse has a really unique position to make that contact with that woman while doing other things, like a routine screening for example,’ she says.
Beyond coming from an ‘informed position’, nurses can also ‘give real confidence and support the decision making of their patient’. They can encourage them to speak about their menopause symptoms, and guide them through the different treatment options that are available to them, Ms McBurnie notes.
Rebecca Hall is an advanced nurse practitioner (ANP) working in primary care and lead nurse for the E4 Network PCN in Chingford. She currently runs the women’s health hub at Barking Havering Redbridge University Trust.
Ms Hall first developed an interest in the menopause on a ‘foundations of menopause course’ that she went on following increased demand for menopause support and services from patients at her practice.
She believes practice nurses have the core skills and approaches required in high-quality menopause care, including strong communication and a holistic approach to health. Most importantly, she says the trust and connection that many practice nurses have with their patients makes it far easier to develop continuity of care for menopause patients.
‘They’ve already got the relationship, women will feel comfortable mentioning menopause systems if they have noticed them. But lots of women don’t notice them because they creep in,’ she explains.
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GPNs are in a unique position to mention the menopause at various stages in a women’s health journey, like when delivering women’s health checks, adds Ms Hall.
‘It’s not unusual in primary care for women to specifically raise concerns about the menopause, and they may discuss wider symptoms and not know that they are linked to the menopause, like discussions of vaginal soreness while doing smears,’ she explains.
‘With these earlier discussions of women’s health, often the questions or conversations that come up are relevant to the menopause. It’s really about making the most of that.
‘Practice nurses play a key role in equipping women with the confidence and the skills and abilities to sometimes just describe what they’re experiencing and the impact that has on their quality of life.’
Putting training into practice
For Ms McBurnie, formal training alone is only sufficient as a baseline and to give nurses some confidence in discussing the menopause with patients.
‘We need to get and develop experiential training to continue and promote what we’ve learnt from a course,’ she says.
‘What can’t be understated is the need for formal and experiential training, we can’t just do one or the other. We have to have both.’
Ms McBurnie says menopause training is also vital to help avoid ‘wasted appointments’, with women having to attend multiple appointments before the menopause is raised as a potential cause of their symptoms.
Ms McBurnie approaches menopause training ‘like a muscle’ that needs to be used regularly to keep working effectively. Beyond accessing clinical based training, nurses want to have the confidence to apply this training and take on new leadership responsibilities with the information they have been given, she adds.
She says she is now hearing of a nation-wide rise practice nurses who are being asked to provide menopause care, with some nurses being asked to lead on the menopause on behalf of their practice, or take forward more of a specialist role in that area.
‘So, if we’re going to support primary care GPNs, then the GPNs need to be supported to keep up their training and to develop the confidence to keep progressing.’
Acknowledging the need for continued support, Ms McBurnie recognises that the independent nature of GP practices can make it harder for nurses to take the time for additional training and to have conversations around putting any training into practice.
‘So, the pressures around dealing with competing demands might be heightened when chronic disease management might be higher up than menopause, and that might compete with training or allocation of training funding,’ she says.
Some GPNs struggle to access regular training as found in a recent exclusive Nursing in Practice survey which saw over a third (36%) of general practice nursing staff say they spend one hour or less per week on training and development opportunities.
Encouraging conversations
Group consultations can be a vital and effective means of providing patients with clinical advice in an open environment that is free from stigma and offers a chance to engage with different generations of women at different stages of their health cycle, says Ms Hall.
‘Enabling nurses to talk about the menopause takes time, but it could be massively meaningful for women and for the nurses who have got all of this amazing knowledge,’ she said.
Ms Hall says the stigma around menopause has improved in recent years, but that many patients and clinicians still struggle to know the correct and most effective language to use when discussing menopause symptoms and offering clinical advice and care.
‘Women are more aware of the menopause, but they may not be aware of the terms, and they won’t be able to find all the knowledge themselves,’ the ANP explains.
Beyond uplifting patients, encouraging practice nurses to confidently discuss the menopause also offers valuable professional guidance, but training must align with different professional’s needs and level of experience, Ms Hall continues.
‘For clinicians, the training also needs to be targeted differently depending on the professional group that is being engaged with, such as ANPs, nurses, nursing associates (NAs) and health care assistants (HCAs).
‘Enabling nurses to talk about the menopause takes time, but it could be massively meaningful for women and for the nurses who have got all of this amazing knowledge.’
‘Menopause is not just an event, it’s a transition, it’s a change and a journey,’ she added.
Over medicalising the menopause
The ‘over-medicalisation’ of women’s healthcare can be a barrier to effectively managing conditions with symptoms that do not necessarily require medical intervention, according to Nia Boughton, a consultant primary care nurse for Wales and the only nurse to hold that title in the country.
‘We’re not trained like medics, and I just fear sometimes that our roles are becoming very, very medicalised, and that’s often not what patients need, particularly around women’s health, and I think that’s a really important point,’ she told Nursing in Practice.
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She warned that because many of the symptoms’ women describe also have a ‘physiological reason’ which can be exacerbated by emotional distress, that only approaching women’s healthcare via a medicalised route would overlook the precise needs of each patient.
‘If I was just to approach women’s healthcare from this very medicalised route, then you would just never get to the nub of the issue,’ she says.
Menopause awareness for the workforce
Nearly three quarters of the NHS England workforce are female, and around 20% are potentially experiencing menopause symptoms at any given time.
‘I think a lot of NHS staff would advocate that menopause awareness in the workplace [needs to be] embedded, so policies become a visible commitment to the female workforce and others that experience the menopause,’ she says.
Ms McBurnie is pushing for menopause awareness to be made statutory through mandatory training for healthcare staff that encourages women to vocalise their menopause symptoms and ensures managers are ‘equipped’ with the language to speak about the menopause.
‘Managers should feel confident to raise it as a topic and to actually offer flexibility and support colleagues to allow them to be their best at work,’ she adds.
In 2022, NHS England signed the Menopause Workforce Pledge to try and demonstrate a commitment to supporting employees experiencing the menopause.
The year before, NHS England published its first internal menopause policy which included specific guidance on how line managers can support through the menopause.
While referring to ‘women’ in this article, all three nurses acknowledged that people who do not identify as women can go through the menopause and deserve appropriate menopause care.
Women’s health across the four nations
England
In the summer of 2022, the Department of Health and Social Care (DHSC) published England’s first women’s health strategy.
The 10-year strategy includes plans to improve access to women’s health services, addressing disparities in health outcomes, promoting information, education and training, and improving public and professional awareness of how women’s health can impact workplace experiences.
Central to this strategy was the development of women’s health hubs, which aimed to better integrate women’s health services into the community. However, the hubs were only given two years’ worth of funding to support their delivery.
In January, health and social care secretary Wes Streeting dropped targets for women’s health pubs as part of the reduction of NHS spending and targets
Scotland
In 2021, Scotland published its women’s health plan for 2021/25. The plan included efforts to improve how women’s health is ‘managed’ in general practice, including suggestions for ‘at least one clinician’ in every practice to be ‘well informed and confident’ in providing hormone replacement therapy (HRT), which is commonly used to treat menopause symptoms.
Related Article: Myths and facts about the menopause and HRT
Wales
Last December, the women’s health plan for Wales was published and included long-term plans to train GP practices and primary care professionals to better manage older women’s health conditions and to promote prevention and screening opportunities.
It also introduced plans for a ‘scoping exercise’ to better understand workforce capacity to deliver menopause management at GP practice and primary care level.
As a short-term goal, the plan also proposed providing training, tools and resources to support frontline professionals to provide preconception care.
Northern Ireland
Having launched its women’s health action plan in 2022, the Northern Irish government is currently working on what the updated plan will involve. The plan, which will cover up to 2027, will identify priority actions across women’s health services and scope out where additional investment is required.
It will be used to set out priorities for a longer-term Women’s Health Strategy for Northern Ireland.
