Response to interpellation 2023/24:313 on improved menopause care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns improving healthcare for women's health and menopausal symptoms. KD considers it urgent to improve care for diseases that primarily affect women to ensure equal care 1. KD argues that the government allocated funds and tasked Socialstyrelsen with carrying out interventions 1. KD emphasizes the need for knowledge support based on evidence 2 and that a chief midwife is important for patient safety 3. S argues that help with menopausal symptoms is a class issue 4 and that the government's policy leads to a worsened situation due to cuts 4. S argues that a national knowledge support is needed 5 and that middle-aged women are often issued sick leave for exhaustion 6.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Louise Thunström has asked me what initiatives I and the government have taken to improve climate change care in Sweden.
It is important that healthcare for conditions and diseases that primarily affect girls and women is improved to ensure equal care. There must be clear care chains and referral paths for different prioritized conditions and diseases. Healthcare personnel's knowledge regarding the diagnosis, care, and treatment of these conditions and diseases shall increase. Knowledge and research on women's diseases and conditions shall be developed and strengthened.
During 2023, the government has allocated 1.8 billion kronor for the area of maternity care and women's health, and for 2024, the government allocates 1.6 billion kronor for the purpose.
In March 2023, the Government tasked Socialstyrelsen with carrying out measures for equal healthcare with a focus on diseases that primarily affect women and girls. Socialstyrelsen should follow up and evaluate healthcare from a gender equality perspective and develop relevant knowledge support and information initiatives for healthcare in close cooperation with relevant professional organizations. This includes considering the need to develop national guidelines for more diseases and conditions that primarily affect women and girls. This concerns, among other things, common diseases and conditions such as, for example, menopausal symptoms.
The State Board for Medical and Social Evaluation has been given a mandate to produce a knowledge base in the area of women's health. The mandate shall be partially reported by April 30, 2024, at the latest, and final reported by December 1, 2025, at the latest.
Furthermore, the Public Health Agency has been given a mandate to produce in-depth knowledge bases within the framework of the initiative on maternity care and women's health. The work shall, among other things, focus on the impact of menopause on women's physical, mental, and sexual health and be based on a scientific foundation. The mandate shall be partially reported by June 1, 2024, and June 1, 2025, respectively, and finally reported by June 1, 2026.
The Research Council for Health, Work Life and Welfare has been given a mandate, in collaboration with the Swedish Research Council, to conduct an analysis of the research needs within the area of women's health and diseases. The mandate was finalized on November 1 last year, and I hope that it will be able to constitute an important basis for the continued work with research in the area.
With that, I would like to thank Louise Thunström for the interpellation and I look forward to the debate.
Louise Thunström (S)
Madam Speaker! I thank the Minister for the answer. I am glad that we are having this debate today. Menopause is actually something that half of the world's population goes through. Almost all women experience some form of discomfort in connection with menopause, and six out of ten women state that they have suffered from moderate to severe discomfort.
I want to begin this debate by telling you about my personal experiences. It is perhaps an unusual approach when tackling a debate here in the Riksdag, and there will surely be those who will think I am being too private. As I stand here now, I feel that I am becoming a bit emotional because this has been a difficult time for me. But it is also a rare opportunity to have this arena to speak, and I intend to make use of it. I choose to speak about my menopause because I am not unique. I share these experiences with thousands of other women in Sweden.
Several years ago, I started getting pain in my hip, a pain that came and went. I went to the health center and to a physiotherapist several times. I underwent examinations, but they found nothing. Therefore, I was given exercises that I did at home. But the pain did not go away; instead, it began to move around. I got pain in my knees, in my ankles, and under my feet. There were new visits to the health center. I also began to notice that I wasn't keeping up as before. My energy changed, and there was some kind of filter in the brain that prevented me from taking in and remembering facts.
The thought of menopause began to come to me now. I had, in fact, started seeking answers on my own. But I received no response from the healthcare system. Unfortunately, I often felt questioned instead. I simply did not know where to turn to get help.
When I entered the Riksdag as a member after the 2022 election, the symptoms suddenly worsened. I couldn't sleep, became forgetful, lost my words, was unfocused, and could no longer manage to read. Getting through documents before meetings was like climbing Kebnekaise. I, who was previously used to performing and had a high work capacity, felt as if I was sort of withering in both body and mind. It sounds dramatic, but that is actually how it felt.
To make a long story a bit shorter, I finally got some help. I was in Stockholm, and here the healthcare facilities are close together. I started a hormone treatment. After four days, my hot flashes were gone. After two weeks, I could read a book and understand what I read. All the pain disappeared. And now I feel stronger and more energetic than I have in several years. All my symptoms were due to menopause.
The previous government tasked Socialstyrelsen in 2019 with mapping the care and treatment of menopausal symptoms from the perspective of equitable care. This was followed by a further assignment to describe what interventions are provided in both primary care and gynecological specialist care, as well as to assess measures to improve advice, support, and treatment.
We know how it looks. We know that women's knowledge about menopause is lacking. We know that the care does not have sufficient knowledge. And we know that the care is unequal depending on where in the country one lives.
When the Prime Minister, in his government statement, promised that an investment in the climate transition would take place, I was very pleased. I therefore wonder if the Minister, based on the knowledge available, can more clearly provide examples of which investments the government intends to make.
Anna Vikström (S)
Madam Speaker! I thank the Minister for the answer.
There are many women who wish for more information from healthcare regarding menopausal symptoms. The previous government highlighted this issue and, in March 2020, tasked Socialstyrelsen with describing what interventions are provided for menopausal symptoms in primary care and in gynecological specialist care from an operational, professional, and patient perspective. The assignment also included assessing the need for measures to improve advice, support, and treatment.
The results showed a need for improved information and guidance for women regarding menopausal symptoms, as well as large regional variations regarding advice, support, and treatment. It turned out that a majority of women desire targeted information from healthcare services about menopausal symptoms and what they themselves can do to alleviate the symptoms. Both women and healthcare personnel testified that women are referred between different activities and experience that it is difficult to obtain an adequate intervention.
In the report, it was proposed that a national knowledge support regarding advice, support, and treatment should be developed based on a holistic view of climacteric symptoms. And it is important that such a national knowledge support is developed and that its use is followed up.
Information, counseling, and education after the reproductive period is an area that has not been sufficiently developed, and many women have not known where to turn. But there are several good examples across the country of how menopause care has developed, even in primary care, in recent years. That these activities also receive many visitors shows that there is a need. But there are large local and regional variations.
It is also important that climate care is based on the best possible knowledge. There are good examples of research conducted in local operations - even in primary care - and whose results are applied locally, but it is needed throughout the country.
That is why we Social Democrats believe that a national knowledge base for menopause care, according to the National Board of Health and Welfare's recommendations, should be developed to ensure uniform, high-quality menopause care throughout the country. The Minister mentions that the National Board of Health and Welfare has a mandate, but it is unclear whether it specifically includes developing a national knowledge base or not. It would be very interesting to hear the Minister for Health and Social Affairs' comment on that.
Eva Lindh (S)
Madam Speaker! In Sweden, there is a health and medical care act which states that care shall be equal.
We know that today there is an unreasonable and non-medically based difference between women and men regarding access to care. Research also shows that women wait longer for emergency care and receive shorter sick leave than men for similar medical conditions. Research on diseases that primarily affect women often has low status and suffers from a lack of resources. We must ensure that women and men receive equal care regardless of illness. Women are also more often advised on self-care and urged to wait and see.
Another well-known fact is that women's diseases are low-priority, and that affects what we are talking about today: menopause care. I know many who, just like Louise, can tell of their own examples of how it has affected them in their everyday lives. This is something that we must take seriously, and therefore many were pleased that there was also a section on menopause care in this government's government statement. One feels that there are high hopes regarding that.
After this afternoon's debate on the healthcare crisis and reduced resources for healthcare, it is clear that several of us wonder what it will mean. Even if investments are made and it is said that this will be prioritized, a great deal of it will nevertheless be prioritized away in the basic situation. What will this therefore result in? Will it really become an investment in climacteric care?
Eight years - that is how long menopause can last. It is 20 percent of a working life. Therefore, it is important that this becomes an issue not only for healthcare but also in a broader perspective. In the UK, they have a strategy where every workplace should have a menopause policy. Some companies - and one municipality - in Sweden have actually done this voluntarily, and it has resulted in quite large differences for many of the women who work at those companies and in that municipality.
This is something I want to send with, because it is so incredibly important that one receives that response and that help so that one does not have to go with that pain for eight years, if that is actually what it is about, but receives the help one needs. But it is also important that we can ensure that professional life becomes bearable and good even during the eight years that menopause lasts.
The question is, therefore, how we are to reach the goals and the legislation we have regarding the fact that healthcare should be equal. Therefore, I join Anna and Louise and ask the question: How will the government, and especially the Minister for Health and Social Affairs, work towards improved menopause care in Sweden?
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you for the contributions, members! They reflect the situation well.
This concerns menopausal issues and the need for menopausal care, but in the government's mandate to Socialstyrelsen, we have a broader perspective. We mention both lipedema and migraine and many other diseases that specifically affect women and where one does not receive the care one needs. This shows that there is an equality aspect; that is why we include it in the whole. It is not possible to say that it is just a single disease that we lack knowledge or research on, but there is an equality aspect in this – an attitude that "you have to put up with a bit if you are a woman."
The Prime Minister also has a great interest in these issues, and together we visited Akademiska sjukhuset in Uppsala, where they do very good work with both endometriosis and women who suffer from ruptures in connection with childbirth.
I have met so many women who have not spoken about the consequences of their childbirth in the form of tears without thinking "I have to accept that because I have given birth." But there is care to be had! There is treatment, and there is help to be had. I have met women who have lived with great problems for 30-40 years. It is simply not explainable that so many people go around in life with such great problems and have not received the care they are entitled to - and the care that exists.
It is absolutely necessary that we work on building up knowledge, and that is why Forte received the assignment they were given. They have reported on this, which is a basis for us ahead of the research proposition. It is also necessary to spread information and to create the knowledge base that we have asked Socialstyrelsen to prepare. We do, however, write "relevant knowledge support," and I do not know if it is one or several areas. The profession is, so to speak, allowed to look at how this should be designed, but it is necessary with knowledge support so that we can also follow up on the issue.
We know that the National Audit Office has not seen results when they have audited investments in women's health from previous governments, and the risk is that it continues. When we now receive the basis, we must therefore find better ways to ensure that it reaches out - how do we follow up on this? We have a good agreement with Sveriges Kommuner och Regioner on the subject, I want to say. It was recently adopted. But it is up to the government to ensure that we have a follow-up - that we have the right agreement and that we follow up on it in the right way so that the money reaches the operations and has an effect.
One contributing reason why I still believe it can get better now is that we have appointed a chief midwife. We have previously had a chief nurse in Sweden, as well as a chief occupational physician and a chief physician, and since last year - August, I believe - we also have a chief midwife. I believe it is important that that competence is available to assist the government and the authorities. In that way, we have therefore placed a focus on this, because midwives are a part of the work with women's health. In that way, we strengthen both patient safety and knowledge, and I believe it is essential that we have done so.
Let me, however, return specifically to the question of menopause that Louise Thunström raised, Madam Speaker. Let me say there that I believe there are many women who recognize themselves. I have not had such severe menopause symptoms as the interpellator describes, and I am glad that I have been spared them. But those I had, and which are perhaps more common, still meant that I could not sleep until I received the medication that actually reduced the menopause symptoms and allowed me to live a more bearable life.
When it comes to explaining to those around you that this is something one experiences precisely because one is a woman, there is something there that creates a stigma, which makes it so that one actually does not tell. It is strange that we do not dare to be open about problems that affect women. It shows that we need to both raise the issues, as the interpellor does, and ensure information so that people receive an equal treatment and ensure that there are healthcare initiatives for everyone. There is no reason to withhold this; instead, one should be able to tell about this and receive the best treatment and also the best care.
Thank you very much for the questions! We will do our very best, but I have no plan today because the knowledge support is on its way from Socialstyrelsen. It is only when we have it in our hands that we can continue working on following up on it.
Louise Thunström (S)
Madam Speaker! What an interesting and exciting debate we have here tonight!
To get help with one's menopausal symptoms, one either needs to be lucky or ensure that one is very well-informed, lives in a large city, and has money. How one is affected by menopause and what help one receives is, to the highest degree, a class issue. There is research showing that women from socioeconomically weaker groups are three times more likely to suffer from an early onset of menopause, so-called premature menopause. The inequality in health truly shows when it comes to precisely menopause.
The government says it wants to invest in climate care, but what this government is actually doing is prioritizing high-income earners who live in large cities and those who can afford to pay 3,000 kronor for a doctor's visit. Otherwise, Sweden's women are being thrown into a healthcare crisis - 17 of 21 regions report that cuts are pending. It is about layoffs and closures. Healthcare in Gävleborg is saving 700 million. Östergötland is reducing by 600 positions. Over 5,000 doctors, nurses, and nursing assistants will be laid off this year.
This affects women particularly hard. When regions are forced into savings, it is not women's menopause that will be prioritized. Instead, women risk being hit twice, both as patients and as employees within healthcare. The majority of healthcare staff are women, and the cuts threaten not only their work environment but also the quality of the care they can provide. This government's policy leads to a worsened situation for women's health, both for those who work within healthcare and for those who are dependent on its services.
Madam Speaker! One needs, among other things, to ensure that menopause knowledge is included in doctors' and nurses' basic education and to develop a national knowledge support with a holistic view of menopause. One needs to ensure that women's own knowledge is increased and that it does not matter where in the country a person lives or how much money they have regarding the help they receive. One needs to ensure that midwives are given the right to prescribe hormone preparations and that hormone medications are actually available for those who need and want such. One also needs to secure the competence supply when it comes to healthcare personnel, including gynecologists and midwives, and counteract the inequality in health overall.
Initiatives on climate action worthy of the name will cost money. Is this government willing to allocate the resources required?
Anna Vikström (S)
Madam Speaker! I thank the Minister for the answer. I also want to thank Louise Thunström for the interpellation and for raising this important issue and for being so open about how she herself has experienced this.
It is good that the Public Health Agency has received a mandate on this, but it is not directly aimed at healthcare. The agreement with Sveriges Kommuner och Regioner is also good, but it contains no clear direction forward regarding how climacteric care is to become more equitable across the country and achieve higher quality.
Now there are oases of developed primary care for women in menopause all around the regions, but I do not perceive that it can be sufficient either for the government that it looks so different. It is important that the care becomes more equal and knowledge-based in this area.
The National Board of Health and Welfare considered that healthcare needs to have similar routines and that primary care should be able to play a much more central role. They therefore saw that what was needed was national knowledge support with a holistic view on climacteric issues, developed based on the best possible knowledge regarding the effectiveness of different interventions. This would lead to women across the country being able to receive more equal healthcare interventions. It also emerged that it was health centers and midwife clinics in primary care that felt these guidelines were needed to a greater extent. I think it should be very important to provide for this.
In short, we in the Social Democrats believe that this, as the National Board of Health and Welfare wrote in its report, indicates a need for a national knowledge support directed at the relevant healthcare activities and that can be used for knowledge expansion throughout the entire healthcare chain.
The Minister said that Socialstyrelsen shall - or should - produce relevant knowledge support, and we think that is very good. It sounds like a mandate has been given. We wonder, of course, when this will arrive, as it cannot be discerned from the documents.
Eva Lindh (S)
Madam Speaker! I thank the Minister for Health and Social Affairs, Louise Thunström and Anna Vikström for the debate!
I really think it is good that we are raising this issue, which is important for so many people. Almost all women have some type of menopausal symptoms; that should not be forgotten. 60 percent have moderate symptoms, and every third woman seeks or needs some form of treatment. That is many.
We have established that Sweden does not have equal healthcare. It is not equal. Women and men shall receive equal healthcare in Sweden - it is important that we establish this.
I do not interpret it as anything other than that the Minister for Health is engaged in the issue and truly has the will, and I really appreciate that. But my concern remains, because we now see how it looks in healthcare around the country. Will menopause care not become better but actually worsen during the coming years? This is a serious concern, and therefore it is important to raise this issue and that we can get answers from the Minister for Health. What can the Minister do to guarantee that menopause care becomes better for all the women who are affected, slightly or significantly?
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I cannot say when the knowledge support will arrive. Socialstyrelsen is expected to be finished with the assignment in about a year. If they finish something earlier, they can start sending it out and working with it, as they have the authority to do so. They can, however, also wait until the last day to present it. My hope is that this will come as soon as possible, but I also realize that it needs to be solid. It must, of course, be based on evidence, and one needs to capture the whole. Sometimes I know that my impatience is not good and that it is better to wait for it to arrive.
My work comes into play primarily when this has arrived, because with it in hand we need to review how we can ensure that it gets out. How do we ensure that employees in primary care receive knowledge of this?
One reason why we commissioned the investigation was the need for continuing education. There is a great deal that comes from different governments and from different agencies that never reaches the healthcare staff. They do not get the time to see what the new law, the new knowledge support, or the new findings entail, but they are instead forced to just work all the time. At best, if one has spare time, one can read up on it in one's own time.
If new guidelines have been issued for, in this case, menopause care, it must be the employer's task to ensure that they are looked at in your primary care or at your health center or primary care center. One must ask how one works with this. Does anything need to be changed? How does one need to work?
It is natural for the employer to provide space for employees to do this when new knowledge support, new guidelines, or perhaps a new law is introduced, but it does not work that way throughout Sweden. It is also quite few regions that have allocated money in the primary care grant for continuing education. Therefore, I believe there are reasons for us to have the investigation that we have commissioned, with Harriet Wallberg as special investigator, to look at different specialist authorizations and at the need for continuing education.
It is not enough that the state provides money. Previous governments have also had this. It concerns approximately 1.5 billion; this government increased it a little bit. But we are not getting any effect from it – that is what the Swedish National Audit Office has told us, and that is how the Riksdag has judged the whole thing. We have all acknowledged that we must get better results for the money when we spend it.
Therefore, it is important for me that we do not just collect money that is to be distributed to the regions so that they can use it, but that we also achieve an effect from what we do. This may well become a litmus test on whether it works – if we find better methods to reach out with new knowledge support so that it has an effect and so that women can ultimately say that it has made a difference and that they receive help in a better way, that they receive adequate help and that they receive knowledge and treatment based on the latest known evidence. It is important that one keeps up with those parts.
I believe that the government's research proposition will be important to provide support for research on women's health and diseases in a broad perspective - we are not to steer the research in that way.
Let us take it as a joint project to continue highlighting the issues. My mission in the government is to ensure that we achieve an effect from what the money provides in agreements and in the upcoming national knowledge supports that Socialstyrelsen is working out, as well as in the information initiatives that they will carry out.
I am glad that the interpellator raised the question, because it puts pressure on me. That is exactly how it should be done. Let us continue to jointly raise the question because there is a small stigma surrounding this and people might not dare to speak out. Therefore, I was glad that the Prime Minister was so engaged in the issue and that we jointly raised it during a study visit. It appeared in the media and gave a discussion about women's health. Let us hold on to this, because we do everyone a service if women's health is better prioritized.
Louise Thunström (S)
Madam Speaker! Menopause occurs at a time in life when women can live their lives to the full, but many are limited by a number of more or less severe symptoms. These symptoms could be alleviated or cured if care were available and knowledge were greater. There are, for example, large differences in the country when it comes to the prescription of hormone preparations, and there is reason to believe that many more women would be helped by precisely hormone treatment. Menopause also has symptoms that in many cases resemble exhaustion, and women of middle age are more often signed off work for precisely exhaustion. There are therefore great socio-economic gains in improving care for women in menopause.
The step towards change always starts at the grassroots, and women in my generation and coming generations will no longer agree to endure. I want women to be able to choose hormone treatment or the support or treatment they desire – because it is not everyone who can or wants to take hormones, which is also not some quick fix. But the option of choice must exist for every woman, regardless of location, money, or how well-informed she is, to get the help she needs. Today, that possibility does not exist.
I promise to follow up on this debate closely and perhaps in a year's time submit a new interpellation to the Minister. I do that for myself and for all other women.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank the interpellor and the other participants.
Louise Thunström raises an important issue for a large part of the population, and as I mentioned, it is good for everyone if we can provide women with good care for gynecological diseases. We have therefore given the National Board of Health and Welfare a mandate regarding those diseases that only affect women because it is a neglected area. We are all doing a service by highlighting this, and therefore it is wise to also put pressure on the government with an interpellation and to return to see that we have truly done something. A warm thank you to the member for the interpellation, and I promise to do my very best!
One should be able to get the help one needs in primary care. It is part of good care on equal terms for the entire population.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.