Response to interpellation 2023/24:510 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
KD argues that the government is working towards equitable health and medical care for women through mandates to agencies 1. KD emphasizes that the government allocated 1.6 billion SEK for women's health in 2024 and that knowledge bases shall be used to ensure functioning care throughout the country 1 2. KD emphasizes that primary care with continuity and specialist knowledge is crucial 2. KD considers investments in primary care to be urgent 3. KD wants to move from knowledge bases to practical implementation with less administration 4. KD considers that one must have a holistic view of health 4. S considers that women have not received sufficient attention 5. S considers that economic cuts risk worsening the care 5. S considers that Sweden must ensure support for women's well-being and sexual health 5.
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! Lars Mejern Larsson has asked me how I can work for improved menopause care in Sweden.
In response to previous questions from Lars Mejern Larsson (response to written question 2023/24:319 and response to written question 2023/24:539), I have emphasized that it is important that healthcare for conditions and diseases that primarily affect girls and women is improved to ensure equal care.
Care for menopausal symptoms is an important issue that is also covered by the Tidö Agreement, and the government is implementing initiatives in this area through assignments, which I have mentioned in my previous answers. I mentioned that the government has, among other things, given the National Board of Health and Welfare an assignment to carry out measures for equitable health and medical care with a focus on diseases that primarily affect women and girls. I also highlighted that the National Board for Medical and Social Evaluation has received an assignment to produce a knowledge base within the area of women's health. Furthermore, I pointed out that the Public Health Agency has received an assignment 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 assignments are ongoing, and we are awaiting reports on them.
I have also mentioned in my previous answers that the government for 2024 allocates 1.6 billion SEK for the area of maternity care and women's health. Within the framework of the initiative on maternity care and women's health, the state has entered into agreements with Sveriges Kommuner och Regioner which, among other things, mean that the regions shall carry out measures to develop and adapt care for the needs of girls and women.
With that, I would like to thank Lars Mejern Larsson for the question and I look forward to the debate.
Lars Mejern Larsson (S)
Madam Speaker! I thank the Minister for the answer.
In the shadow of silence lies an area that has for all too long been surrounded by taboo and oversight, even though it affects half of the population in a deep, personal, and painful way. I am speaking about menopause, a journey that every woman begins sooner or later. It is a journey that is not only a natural part of life's cycle but can also entail profound changes in physical, mental, and sexual health.
Menopause is a white concept and quite vague for many. Generalizations are something most can squeeze out if you ask them what they know and can about menopause, but the ignorance is great generally. There has not been enough talk and particularly much information provided about menopause. This needs to be changed.
Many still live in the belief that women in menopause are in their 60s or 70s, which may indeed be true, but the truth is that the transition that menopause entails begins much earlier than that, for some already in their 40s. One is then in the middle of life, and many women suffer from quite unpleasant symptoms. In addition to hot flashes and sweating, it is common with joint pain, muscle pain, sleep problems, anxiety, worry, mental distress, mood swings, memory problems, dry mucous membranes and not least diminished or lost libido.
The period for the entire transition can last up to ten years. The change can begin long before the last menstruation.
To suffer from reduced libido or a reduced possibility of a good sex life, in the worst case for the rest of one's life, is to be deprived of a part of the quality of life. In connection with the estrogen level dropping, the sexual arousal can take longer than usual. Thoughts of sex decrease, and the feeling of orgasm changes. There is help available for dry mucous membranes, but it is more difficult to get help for reduced libido for women in Sweden today.
Many women testify that they are not taken seriously when they seek care for their symptoms. Often they are told that they are exhausted or that they are depressed. Rarely is the connection made that menopause could be the cause. They are sent home with a prescription for an antidepressant medication, which then does not help.
Sweden has lagged behind when it comes to working to improve the treatment of menopause-related issues. The risk with that is that women do not feel listened to and that they then seek help in other countries or, even worse, from unscrupulous actors online.
Madam Speaker! It is time that we raise the level of knowledge among doctors and gynecologists regarding menopause-related issues and how these issues can be treated effectively. Increased knowledge is also needed regarding the effects and significance of different medications.
Sexual desire varies from person to person. But do all have the same access to hormone treatment, which can affect sexual health?
Madam Speaker! I wonder what measures the Minister plans to take to break the taboo surrounding women's sexual health during menopause and to ensure that adequate and equal care is available for all women regardless of where in the country they are located.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you, Member, for the interpellation and for what the Member said! I believe that the Member themselves contributes to removing the taboo. Other Members of Parliament have previously done so - I have had several interpellation debates on this issue. I believe that it contributes to reducing the taboo or the stigma that exists around the questions. Warm thanks to the Member and other colleagues for doing this!
If we dare to tell what menopause is and what consequences it has, I believe there is a greater chance that women will dare to seek care. Just as I mentioned in the previous interpellation debate, many say that they believe this is something one has to accept because one is a woman. This may not be linked to childbirth, but even in this case, many believe it is so: that it belongs to being a woman to suffer from menopause and feel unwell. But that is not at all the case. There is care and treatment to be had. There is often quite a lot within physiotherapy, where one can also get help. The healthcare system has the opportunity to offer adequate help.
But then the care, just as the member points out, must be listening. We know that it is better the more we can build up a primary care with continuity. It is about the fixed doctor contact and that it is the same person so that one can build a relationship and get to know each other. Then it will probably be easier to tell about this. It will also be easier to provide the best care when one knows the person's entire situation.
Is it always new people that one meets, there is a risk that it becomes exactly as the member points out. One gets the wrong diagnosis. One ends up with the wrong assessment. An expanded primary care, I believe, is therefore an important part of this.
Women's healthcare must also be expanded, so that one has the specialist knowledge required to assist in the work. That is why both this and previous governments have invested strongly in women's health. That is why this is included in the Tidö Agreement, and that is why we have given these assignments and special funds for it.
We believe that we need to talk about this, assign tasks and improve the knowledge base. We will receive an answer from the authorities later this year. But it is also about ensuring that we specifically talk about that this is something that is happening and that there is care to be received. You do not need to go with difficulties. You do not need to suffer. There is help to be received from the public sector, from the health and medical care.
I am very pleased that the member is engaged and raising the issue. I hope that when we gradually receive the knowledge bases that the government has ordered, we can find ways to ensure that this is implemented throughout the country, so that the care one receives does not depend on where one lives.
Earlier today, I spoke briefly with the director of healthcare in Norrbotten. If you live in Norrbotten, it is truly not possible to receive all the care you should receive because of a lack of competence. One does not have the competence supply one desires in either healthcare, dental care, or other areas. One lacks staff.
In Norrbotten, we have what we call the green revolution. There are fantastically many jobs within certain sectors. But we are not getting those who need to work in school, healthcare, elderly care, and everything else that is required for the whole society to function. We therefore have troublesome problems with unequal healthcare in the country.
Again: When we receive the guidelines and knowledge base we need for women's health, where menopause is an important part, it is my mission to ensure that this can be implemented, carried out, so that we actually know that the entire country is covered by this. Wherever one seeks care as a woman, one should then receive care.
When we have the underlying documents, I will return to the Riksdag regarding how we best ensure that this is implemented. But now we are at the stage where we have ordered knowledge documents – I am glad we have done that. We will return to how we implement this.
Lars Mejern Larsson (S)
Madam Speaker! I believe that we must work together to break this taboo, because it persists. Now it is not at all sufficient.
It can involve pain in muscles and joints, stiffness, headaches, and an increasing number of migraine attacks. It can be foggy in the head. It can be like walking with a box over one's head with a feeling of not quite keeping up. One can have concentration problems and poorer memory. One can be depressed, tired, and exhausted without having done anything special. It can involve weight gain.
It is a long list of vague and diffuse symptoms, each of which may appear insignificant. But the sum of them reduces experienced, healthy, and resourceful individuals, who initially have plenty to give and contribute to society, to those on sick leave and early retirees.
I shall quote a woman who took hold of her vague problems just over two years ago together with her doctor:
My doctor and I agreed that I should try hormone treatment. First, I started with thyroxine, which is a hormone that affects the metabolism in the body and which for many women drops during menopause and causes problems even if the levels are within what is considered normal values. I took a very small dose, but already after three months my health improved considerably. Half a year later, I also started with estrogen/progesterone treatment and experienced further improvement. Now, two years after I started treatment, I am back to myself again. I am strong, can do everything I need to and want to, and feel ready to participate and work until I am 70 - at least.
Madam Speaker! This was a testimony from a woman in the prime of her life.
Menopause is not a disease, and women are, of course, affected differently by all the symptoms that can arise. But despite it not being a disease, many women are affected in a way that reduces their general health. Their relationships are affected. Not least, their ability to work can decrease. In the worst cases, they are signed off sick, quite often on the wrong grounds and unnecessarily, I want to assert.
According to Försäkringskassan, women account for 79 percent of all sick leaves due to stress-related mental ill-health. Women are also overrepresented in the same category in the age range 40-60 years, an age range that coincides with the period of hormonal transition that menopause is.
Madam Speaker! It is not entirely incredible that there can be a connection here. It should be a great societal gain to ensure that women receive relevant diagnosis and help so that they can avoid being signed off sick for symptoms that are completely natural. That is how it should be if we are now serious about wanting everyone who can work to work, Madam Speaker. I previously presented one of all the testimonies. I am interested in how the Minister will work so that more doors will be opened to improved menopause care in Sweden.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I believe it has emerged from previous written answers, from all the work we are doing, and from what I have presented here. The Government is truly taking the issue seriously. We have given assignments, but I cannot answer how it will turn out before I receive this back. It is an impossibility. I must await what the authorities come back with and the knowledge bases that we have decided.
But as I have mentioned earlier: The interesting thing is not just to order these and get new guidelines, as we have done for many years in Sweden. Today we have too many layers of knowledge management. The interesting thing is that this is also being implemented and that it is the correct basis in terms of what is being implemented.
I completely agree with the member's assessment of the effects when one does not receive the care one needs. Regardless of the reason for the difficulties, one should always be met by a healthcare service with the best treatment. In healthcare, one should also be able to make a diagnosis, provide treatment and, if needed, rehabilitation and aftercare in the best possible way. That is how our law is designed in Sweden. Every region operates under that law, not its own. Every region operates under the Health and Medical Services Act. That is why there are directly elected politicians and taxing rights to enable this.
But the government also has the opportunity to support in certain issues. We do so within cancer care, when it comes to increasing care capacity, and when it comes to women's health, because we assess that it is an area that requires special prioritization and special focus, even though I am, of course, aware that every regional politician wants to do everything for their residents. But I believe that governments are needed to also push in certain issues where change and improvement are needed so that it will truly become good for people. And women's health is such an issue.
When it comes, however, to what treatment one receives – the member was referring to hormone treatments – I, as Minister, will not judge what treatment a person should receive. That is, of course, a matter for the profession. But the member points out an important issue: that one is met by a knowledgeable person who knows what it entails, knows what is available to offer, and can provide the overall assessment that is needed in the situation that one finds oneself in.
That is why primary care is so important – that it is well-established, that one has a reasonable number of patients so that one can build continuity and get to know one's patient and understand what their whole life looks like. The examples the member gives where the diagnosis is mistaken, we can say even if we are both laypeople, may be due to not having the opportunity to build continuity and a relationship. If it is a hurried visit, one can end up wrong.
That is why the government's work to expand primary care is also very important. There we have 3.3 billion kronor this year, and an additional ½ billion kronor will be added next year to improve primary care and good and close care. I assess that it is very important for us to be able to achieve good women's health, good care for women, when it comes to various ailments and diseases that one suffers from linked to being a woman.
Many thanks to the member for the interpellation, but also for the fact that we, as I understand it, jointly want to work to break the stigma but also ensure that it truly becomes good for women throughout the country.
Lars Mejern Larsson (S)
Madam Speaker! A woman asked me: Is there something wrong with me? No, I said.
But many women have not received the deserved attention they need. With all due respect, I am, just as the Minister touched upon, in the highest degree a layperson. As the Minister also mentioned, I have written questions, motions, and now I stand here and interpellate. I do that because I am trying to use these tools to draw attention to the consequences for those affected, the costs to society, and the need for information and education within healthcare when it comes to the issue of menopause.
With the economic cuts within the healthcare sector that we are now seeing, I am afraid that women's needs during menopause will not be given priority, but will instead be worsened.
Women face double risks, partly as patients and partly as employees within healthcare where they constitute a clear majority. Regional politicians, as the Minister pointed out, testify to the healthcare crisis which risks jeopardizing not only the working conditions for these women but also the quality of care.
Sweden must ensure that all women receive the care and support they deserve, not least when it comes to such a fundamental aspect of women's well-being as sexual health.
Madam Speaker! It is time to transform the recognition of the problem's seriousness into concrete action. Better climate change care is good for the affected, it is good for the companies, and it is good for Sweden. The question is whether the government is willing to allocate the resources required.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank the member once again for his commitment. Just as I began my speech, I believe that the member's commitment contributes to removing the stigma. The more often we talk about the issues, the more often we highlight them and speak about the fact that help is available and that one has the right to receive help, the more we contribute to reducing the stigma and the taboos that exist around this.
As I said in my answer to the member, this is about physical, mental and sexual health. It is about the whole human being. We must have a holistic perspective.
I was asked if the government intends to continue with this. Yes, we are at the same level as previous governments in terms of providing support, so there is no discussion there. As I have said, I do not intend to simply land on the fact that we have a good knowledge base. Now they actually must become a reality. The Swedish National Audit Office has followed up on what has been done. The opposition and the majority have spent the same amount of money over many years on this. But when the money does not produce an effect and women all over the country say that they have not noticed this, and when midwives also say that they have not noticed the money, we must consider how it is being used. How can we do it in a different way? That will be an important issue for me.
Not least, as I mentioned in a previous interpellation debate, I have, together with Sveriges Kommuner och Regioner, initiated a piece of work that I hope to be able to complete this week. I hope that we move from inventing a lot of new knowledge bases to implementing them and following up to ensure that it becomes good – that there is less administration and more reality. This will be a prioritized task for me moving forward, and I am glad that the member seems to think the same. Warm thanks for the commitment! We continue the work together.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.