 The next item of business is debate on motion 17347, in the name of Christina McKelvie, on it's time to end the stigma of the menopause. Would those who wish to speak in the debate please press a request to speak buttons, and I call on Christina McKelvie to speak to and move the motion for 12 minutes, please minister. Thank you very much, Presiding Officer, and I'd quite like to have started the debate with a splash today, which obviously I have done. I am very pleased and proud to be opening this debate on behalf of the Government debate, which I believe is the first ever Government debate held in the UK on menopause, so this Parliament should be proud of itself today. It's coming at a time when this issue is finally getting the rightful attention that it deserves, that women deserve. I think that we can all agree that the menopause has always been stigmatised, ignored or treated as a joke at best and used as a way to degrade women at the worst. Just as women are not a homogenous group, the impact of the menopause on women varies significantly. Some women will experience menopause at a significantly younger age, either naturally or because of surgical or medical intervention, for example as a result of cancer treatment. For many, research says that 10 per cent, the negative impact of women on women is life changing. Women and girls in many cases are unprepared for the changes caused by menopause, so they suffer in silence. Invisible. They feel too ashamed, inadequate or embarrassed to seek help, and many women are actually unaware that help is possible. We have to change that to support them through the menopause and the stigma that surrounds it. Make it and the women dealing with it visible. This debate today, I hope, will help towards that. MSPs from all parties are talking about the menopause openly and recognising the impact it can have. I want to thank everyone here today and say that I am proud that women and men in this Parliament are here today to discuss such an issue in public on the record that all too clearly needs discussed. As we mark the 20th anniversary of this Parliament, maybe a debate like this on the menopause shows just how much we have grown up. To help to illustrate the impact of menopause to the chamber, I thought that it would be useful to highlight some of the 34 known symptoms. The most common are night sweats, hot flushes, irregular or very heavy periods, fatigue, inability to concentrate, loss of libido, mood swings, hair loss, insomnia, weight gain, joint pain, depression and, Presiding Officer, clumsiness. There are just a fraction of the health issues that women face. We know that, and most women will be dealing with multiple symptoms while juggling work and a busy family life or maybe with carrying responsibilities. It is not solely raising the issue as a minister for equality for me. It is much wider than that, and I know how it feels personally, and I am sure that many women across the chamber do, too. I thank the minister for taking the intervention. She also recognised that the symptoms that she mentioned there are also the symptoms of underactive thyroid. Quite often, when women have that, they are not tested because they are told at a certain age that it is the menopause, and therefore they are not even tested. Christina McKelvie? Absolutely. I would recognise that, and I am sure that Elaine Smith would realise that the comments that I made about many other things being a suite of health issues that women face would be one of them. During my time in office, I am determined to make a real difference to women who need help and support with the menopause. A big part of that is to get people talking about it, getting women talking to other women, to share information on what works and what does not, to highlight the issues that Elaine Smith just intervened on, to listen to the issues that each other face, offer support and reassurance. For some women who told me that thought that they think that they are losing their mind and that we are not all alone in this, some women all feel the same way. It is about sharing some of that lived experience. Women telling each other their war stories from a war that only they know about will not change their experience or the experiences of younger women who will face the same battles in the future. That is why it is so important that wider society pays attention to listen to women's experiences and learn from them, be it their partners, family members, employers or health practitioners. That is why I am so pleased to see the work being done and undertaken now by the elected members, our trade union bodies, women's organisations and even in the media. I know that many of members will have seen the coverage on the BBC breakfast at menopause-themed week last week, and that shows just the breadth and the depth of issues facing women, young and older. Also, the ground-breaking documentary by Kirsty Warke and the insightful articles by Mandy Rhodes, editor of the Hollywood magazine, have both opened up about their own experiences, which women have found absolutely relatable. They have helped to make this issue in those women visible. That is why today's debates and events, including the recent menopause festival that I spoke at last month—yes, we had a festival—and the menopause cafes, both founded by the very wonderful Rachel Weiss up in Perth, is why they are so important. They are raising awareness and shining a light on a hidden taboo subject. We are continuing to build on that momentum, gathered from all of this activity, which also includes the Scottish Women's Convention conference held in February and the upcoming Festival of Aging that the Scottish Government has funded, which takes place this Thursday, the 23rd of May at Glasgow Caledonia University. That will continue that public conversation. The festival is aimed at delegates as well as the public, so I am delighted that it will extend the reach of the conversation even further to a much wider audience. All of that awareness-raising work will ensure that the deafening silence around the menopause is no more. Women are reclaiming the airwaves, and they have grabbed the foghorns, and we are all prepared to shout about it, to make themselves heard as well as seen. That is why it is so important to take action, simply because the women have the right to be well. The menopause affects women physically and mentally, and sometimes to devastating effect. We know that most women go through the menopause between the ages of 48 and 55. The symptoms can last for over 10 years, and we know that the average age of menopause is 51. However, as I have already said, it can happen to some women much, much younger. There is also an economic imperative for addressing the impact of the menopause. We all know that our population is ageing. On 3 April, I published a fairer Scotland for older people, and one of the areas that it considers is the change in Scotland's population demographics. There has been a 5.5 per cent increase in employment rates of women aged 50 to 64 in Scotland since 2008, which means that we have more women in the workforce. With more than 60 per cent of women between 50 and 64 in employment, more are now working through and beyond the menopause. Add that to the potential impact of Brexit on key areas of our workforce, and you can see that it is absolutely essential that we keep our workers whose skills and experiences are so important in employment for as long as they want to be. That means changing workplaces to ensure that it allows us to work flexibly and that employers really understand the needs of their employees. That makes good business sense, but it is also the right thing to do. Despite employment law being currently reserved to the UK Government, which limits the actions that we can take, we are finding opportunities to promote the agenda of fair work and workplace equality. That includes the rights of women experiencing the menopause, and I can highlight some progress here. I would like to commend the work of the STUC Women's Committee, which carried out a survey on the menopause in the workplace on October 2017. The survey investigated the experiences of women, how Scottish employers are responding to this issue, and what resources the STUC Women's Committee could develop for women in the workplace. Over 3,000 women participated, and it found that 99 per cent of respondents either did not have or did not know if they had a workplace menopause policy. 63 per cent said that menopause had been treated as a joke at work, and 32 per cent said that menopause was treated negatively in the workforce. The Women's Committee is now collating menopause policies and information from affiliate unions and members' workplaces in order to develop a best practice model for distribution. It is very welcome indeed. Also, due mainly to the work of Deputy Provost Councillor Collette Stevenson, South Lanarkshire Council has now implemented a menopause policy, supported across all the groups in South Lanarkshire. That is now being used by many other employers, including local authorities, as a model for the development of their own guidance. I have made sure that the Government is updating its current menopause policy into guidance and support for women and their managers, as we should be leading, for example, and we had five menopause cafes across Government just a few weeks ago, all of them oversubscribed, so that means that there is a need and a want there. We are also encouraging all employers, including other public bodies, to update and or provide menopause awareness training and guidance for their managers. Our recently published Affair Scotland for Women gender pay gap action plan includes actions to support women affected by the menopause. The action plan sets our commitment to fund a feasibility study for a centre for flexible work in Scotland. The centre, a UK First, would design, test, embed and scale new approaches to increase the availability of quality, flexible work in Scotland. We are also funding several projects through the £750,000 workplace equality fund to support the development of age and close of workplace practices. In partnership with Impact funding partners, we supported a workplace equality fund business to business learning event in March to share good practice, including lessons learned on the adoption of more age-inclusive working practices. We are expanding the fund further, so that, importantly, it will now seek to encourage projects that provide support to female workers during the menopause. A great list, but I am not finished yet, Presiding Officer. We also have refreshed the great gender and diversity element of the Scottish business pledge to give employers access to information advice on issues such as the menopause, as we know older women are impacted by the gender pay gap. It is clear that the menopause can be one of the contributing factors to women's lack of progression and career choices, based on their need to manage their health, both mental and physical. We are committed to working closely with women's organisations and trade unions to gain a clearer picture of the issues that are involved in order to identify other areas where action needs to be taken. I am sure that many members will tell us some of those ideas today, and I am looking forward to hearing them. In conclusion, Presiding Officer, I would like to read the words of Agnes Talmay, chair of the Scottish Women's Convention, as she introduced to conventions menopause survey results earlier this year. Nearly 1,000 women took part in that survey, and they cannot be ignored. She said, and I quote, "...menopause covers much more than just a physical transition. We hear about workplace discrimination on a daily basis, but we very rarely hear about this in relation to such a crucial issue as a menopause. This is, for a number of reasons, stigma, fear of demotion and fear of being singled out as too old. These women are carers, they are workers, many are of the very backbone of our communities and their societies, and yet they are made to feel ostracised by a perfectly normal event that every woman goes through." What we need is information and understanding from the outset, from pre-menopause to what comes after. We need to listen to women with direct lived experiences. Policymakers and politicians must understand the impacts that menopause has in order to affect change. I totally agree with Agnes Talmay, and that is why I am very proud to move the motion today in my name. I now call Annie Wells for round eight minutes, please. I would like to thank the minister for bringing this topic to the chamber today. Although around 50 per cent of the population will experience the menopause at some point in their life, it unfortunately remains an incredibly taboo subject. For far too long, women have felt not able to talk about the menopause openly, with the wider impact being a society that has little understanding of its symptoms. I am really pleased that we are having this debate today to raise awareness of the menopause and to help end the stigma that surrounds it. However, what exactly is the menopause? The menopause is when a woman stops having periods and is no longer able to get pregnant naturally. It is a natural part of ageing that usually occurs between the ages of 48 and 55, as we have heard. Most women will experience menopausal symptoms, some of which can be quite severe and impact significantly on their everyday activities. Those can begin months or even years before your period stops and can last up to four years after. Symptoms include hot flushes, night sweats, low mood and anxiety, reduced libido and problems with memory or concentration. The impact on women's life is significant. A British menopause society survey found that over half the women who had gone through the menopause said that it had a negative impact on their life. Over a quarter of women said that they felt less outgoing in social situations and felt more isolated. A third said that they no longer felt like a good company. To hear those statistics makes me feel quite sad and, having spoken to many women who have experienced menopause, they feel as though no one is listening to them. If I am completely honest over the past few months, I have felt the start of the symptoms of the menopause. I have been a little anxious about what is to come, but this debate has come at a ripe time for me as I have been able to learn more about it, which I am sure will make the process easier. What is clear from those statistics is that there are significant implications for women's mental health, as well as physical health, and those need to be addressed. For me, much of the time boost stems from this being a part of our lives that we do not necessarily want to think about, let alone talk about. The danger of that is that we do not normalise talking about it and we are not mentally or physically prepared for when it does come or not able to support or understand the experiences of someone in our life who is going through it. Normalising talking about it is absolutely key to this debate, and it is important that this is done from an early age, particularly when one in 100 women will experience the menopause before 40. Men tour incredibly important to this debate and has already been raised. The BMS found that 38 per cent of men said that they felt helpless when it comes to supporting their partners through the menopause, and a third say that they often end up having arguments because they do not understand what their partners are going through. Those, again, are significant statistics, highlighting that this is not just a women's issue that affects everyone in society. How do we start the discussion? Education, talking to one another or simply just saying the word menopause in our everyday conversations? I was really pleased too to see the BBC coverage in last week as part of its wake-up to menopause campaign. So many people have come to me, friends and family, to talk about it, and there seems to have been a very wide reach. There were segments on a variety of issues, the story of a young woman who began the early menopause at just 15 and a short film by a BBC presenter opening up about her own menopause story and my favourite clip following a group of women in Wales who found that wild water swimming alleviated their anxiety and menopause symptoms. What we need to do now is keep the momentum going. There are great initiatives out there already, as we have heard. The menopause day is held in October every year, presenting an opportunity for us to mark the progress that has been made each year and continue to raise awareness. As we have heard, the creation of menopause cafes across the UK has allowed women to discuss the menopause with no set agenda. Those cafes give women the opportunity to talk about their symptoms and share information on what has worked for them. At the University of Leicester, a menopause specific policy has been introduced. As well as male and female university staff being encouraged to say the word menopause three times a day to help normalise it, women are encouraged to confidently announce in a meeting when they are having a hot flush. I am having one now, so that is okay. On the last point, it is in the workplace that vastly needs to improve support for women experience in the menopause. In the same BMS survey, 47 per cent of women in employment who needed to take the day off because of the menopause said that they would feel uncomfortable with disclosing the real reason. 45 per cent of women experiencing strong symptoms felt that that had a negative impact on their work. Only yesterday I met a couple of ladies in Glasgow and sat down and had a coffee, a cake and chatted about the menopause. They contacted me during mental health awareness week last week because they felt that it was having a detrimental effect or an impact on their mental health. Despite one of the ladies being signed off by a GP for severe menopausal symptoms, she was facing a disciplinary action although having been in the company for over 25 years. That was going on at the same time as her struggling to cope at home, leaving her feelings isolated and not knowing where to turn. Hearing about this first hand really highlighted to me just how stressful the menopause can be for some women. As with any health problem, physical or mental, we need to embed an understanding of menopause into the workplace culture so that women are not suffering alone. Again, that is where a better understanding of the symptoms of menopause would be very helpful. Many women struggle with concentration and, if employers do not understand that, it is easy to see how the situation arises. The Equality Act establishes the importance of reasonable workplace adjustments and those could include anything from considerations of temperature control to the use of flexible home working. I welcome the work of the Scottish Women's Convention and this week I want to ask a number of employers in the public and private sector what measures they have in place to educate managers on the menopause and to support women's experience in it. I will happily share those responses once I receive them. I am keen that this is an area that we continue to build on for years to come. I wonder if it would be important to mention on the record that some more information about how physio can help with stress and continence for women. That would also be something that might add to the debate. I absolutely agree with Elaine Smith on that point. We have to remember that there are lots of different ways that we can get the help and support. It is not just that one size does not fit all, so we need to be proactive and have discussions. I am grateful to have had the opportunity to speak in today's debate, and I am pleased that it has been so consensual. For many women, this natural process is a time of anxiety and distress, and, for that reason alone, it deserves our utmost attention. The first step towards de-stigmatising the menopause is to talk about it in a way that normalises it, allowing for everyone in society to become more knowledgeable about what women experience during this time. By the time we reach world menopause in October, I really hope that we can talk about some of the changes that we have already seen. I thank Monica Lennon for around seven minutes. Around 400,000 women in Scotland are experiencing the menopause transition right now. It is a normal part of life, but, as the motion states, the menopause has been a taboo subject for too long. As a convener of the cross-party group on women's health, I am proud that the menopause was one of the very first issues on our agenda. I know that it will mean a lot to women across Scotland that the minister is putting the menopause front and centre. That debate is very welcome. Our actions must match our ambitions, and I hope that we will see real progress in the provision of menopause care across the NHS and an end to stigma and discrimination. As of at the time, we all became more clues up about the menopause. Yes, it is effectively when women stop getting periods, but I know from my campaigning interests around access to period products that people still get embarrassed talking about these natural processes. Symptoms—there are many, there are too many, I believe—linked to the menopause can last for several years. It is important to recognise that everyone's experience will be different. Some lucky people have fewer symptoms at all. Menopause is not an illness, but its effects can be damaging to health, especially if support is lacking. Post-menopausal women can lose up to 20 per cent of their bone density, caused by a lack of estrogen, and are by far the most common group to be diagnosed with osteoporosis. Women can limit the effects by staying active, making healthy nutritional choices, getting out in the sunshine to get more vitamin D, cutting down on caffeine and alcohol. It is all very easy. Although most commonly experienced by women in their 50s, some women do experience early menopause. Campaigner Katie Johnston shared her story with the cross-party group on women's health, after she underwent voluntary menopause in her early 20s to manage the crippling symptoms of endometriosis. It was great. We all tuned into the BBC last week, although not every morning, but to see the menopause being talked about when people are eating their breakfast—I think more of that on the telly, please. I was quite struck by Susan, who was featured. Susan talked about feeling up and down, depressed, teary, forgetful and described feeling a bit scared that she did not really know what was happening, what was going on. She was experiencing perimenopause. Women with down syndrome tend to reach the menopause earlier than the general population, sometimes 10 years earlier. Because of that, the symptoms can sometimes be missed or overlooked. Meeting the needs of women with disabilities is an important area of work. More generally, a survey conducted by the Scottish Women's Convention highlighted at almost two thirds of women felt that there was not enough information available at the beginning of their menopause and that symptoms such as fatigue and anxiety that had been indicating perimenopause were not linked. A Scottish Labour health spokesperson, I have been campaigning for improved menopause care for women across Scotland, including improved access to menopause clinics. At the last count, only five health boards in Scotland offered a dedicated menopause clinic. No matter where women live in Scotland, they should have access to high-quality menopause care. Perhaps the minister can give an update on that aspect later in the debate. We should all be grateful to the many organisations who are doing fantastic work to champion the menopause agenda. The Scottish Women's Convention holding their menopause conference in February this year helps to increase visibility. I have been following the work of the Scottish Women's Committee closely. Their groundbreaking report published last year looked at the experience of women in the workplace during the menopause. To echo the words of Sharon Edwards, who came along to our CPG, Sharon and the Scottish Women's Committee are right when they say that there should not be an issue that is surrounded in secrecy. We should not be designing our conversations to a whisper. The menopause in the workplace survey highlighted some really disheartening figures. 63 per cent of women said that menopause had been treated as a joke in their workplace. It is unacceptable, but I wonder if any of us are actually surprised. The minister is right to reference journalist Mandy Rhodes. Mandy has been refreshingly open in speaking about her experience of the menopause. She said that other women have opened up to her saying that they felt ignored, rejected, humiliated, and that is just by the medical establishment. Many women have said that, in the workplace, they feel disregarded, overlooked and isolated, all because of the way other people react to the menopause. We know that we have a lot of work to do. We have all heard the comments that she must be on her period every time a woman is having a bit of a bad day, and she must be going through the change when it comes to jokes about hot flashes and assumptions about the menopause. We agree that those so-called jokes are not actually that amusing. It is almost the anniversary of the Bank of England's deputy governor apologising for describing Britain's sluggish and slow and underperforming economy as menopausal. What does that say about bankers, I wonder? Women experiencing the menopause should not be put down or written off and neither should their contribution to our economy and society. Yes, menopause can be challenging, it can be tiring, but it can also be liberating, signalling a new chapter and a sense of freedom. With more and more women working into their 50s and 60s, workplace policies and practices need to catch up. Employers are not being asked to make onerous changes, but a good menopause policy should be a minimum. My members' bill for universal provision of period products would also help those experiencing the menopause to manage unpredictable and heavy bleeding. The Scottish Parliament's women's network was instrumental in helping this Parliament to become the first in the world to make free period products available to staff and visitors. That started from a conversation about the menopause at work in the building. I pay tribute to Pam Corry and her committee and for also bringing Dr Hillary Jones of the Tele to Parliament to educate men and women and managers in the Parliament about the menopause. Like the minister, I also commend Rachel Vise, who launched her first menopause cafe in June 2017, offering women in her home time a pair the chance to share the experiences and access peer-to-peer support. That movement is inspiring. I am optimistic that Scotland is making progress. Only last week, North Ayrshire Council announced the development of a menopause policy following in the footsteps of South Lancer Council, who, working with the trade unions, already have a pioneering policy, and councillor Kelly Stevenson should be congratulated for driving it. I am delighted to support the motion and fully agree that raising awareness of the menopause is a good thing, and we should all commit to doing so. There has been increasing awareness of health issues affecting women, such as endometriosis and menopause in recent months. Some of that good work is taking place here in Parliament, including through the cross-party group on women's health. The debate is extremely timely and it is a welcome contribution to making sure that the menopause is not an invisible part of a woman's life. We know that menopausal symptoms can range from insomnia, distress, anxiety and even palpitations. Those can be extremely debilitating, but the old assumptions are hard to shake off. It is still seen as something that women just have to go through, like painful periods, no matter the cost to their health or wellbeing. As the motion rightly says, the menopause has for too long been seen as a women's issue. The STUC's 2018 report revealed that almost two thirds of women in the workplace are within the age bracket when women, on average, go through the menopause. As has been mentioned, 99 per cent of respondents reported that they either did not have or did not know of a workplace menopause policy. That is everyone's problem. Respondents reported having to take sick days because of symptoms that could result in disciplinary action being taken. Given that around half of the workforce is female and that the vast majority of women will go through the menopause while off a working age, it is really incredible, frankly, that it is appalling that this gap in provision still exists. Nor should we assume that those who experience the menopause are all of a certain age. Around one in 100 women experience the menopause before their 40. Some women enter early menopause because of medical treatment for conditions like endometriosis, as a result of hysterectomy or simply genetics. Transgender and non-binary people may be affected by menopausal symptoms, so it is important that workplace support is in place for all who need it. I thank all those who contacted me with their experiences before the debate. They welcome the debate. I was contacted by one constituent who had a full hysterectomy at the age of 26 as treatment for endometriosis. She told me about the difference HRT is made to the quality of her life but that it is becoming increasingly difficult to get access to prescription due to fears about side effects. HRT is not appropriate for everyone and there are certain risks and side effects associated with its use. However, it can be life changing for some women. The Royal College of Obstetricians and Gynaecologists advises that the effects of HRT have been studied worldwide and research shows that for most women HRT works and is safe. The college also says that healthcare professionals should discuss individual risks based on research evidence at consultations. It is important that potential risks and benefits are explained fully to women so that they can make an informed choice about treatment options. Endometriosis UK have done some great work on this issue and have developed a menstrual well-being toolkit in conjunction with the Royal College of GPs, which contains helpful tips for managing menopause in primary care. As the minister noted, 63 per cent of respondents to the STUC survey said that the menopause had been treated as a joke at work. There really needs to be a culture change here so that women feel confident and supported to talk about their experiences without fear of ridicule or dismissal. I, too, applaud initiatives such as the Menopause Café. I believe that it has led to flush fest, a festival dedicated entirely to the menopause. It is important that this message permeates workplace culture. The STUC and the NASUWT have already produced guidelines for employers. NASUWT, for example, recommends that employers provide awareness training for managers, paid time off for treatments such as HRT and flexible working patterns. We need those provisions. They will improve working conditions for those experiencing the menopause, but they will also allow us to retain experienced staff. This is about equity. We cannot hope to tackle the gender pay gap until women are no longer penalised for having periods, getting pregnant or going through the menopause. The more open we are about those issues, the sooner we can dismantle old stereotypes and break down the barriers that working women—indeed, all women—still face in 2019. As the minister reminded, it is the first opportunity that the Parliament has had to debate the menopause. I congratulate the minister on bringing the debate to the chamber, giving it a visibility, as she rightly said. As the motion rightly states, as women themselves are rightly and clearly stating, this is not just a women's issue—the problems relating to stigma, the implications in terms of inequality, whether in the workplace or in terms of access to health services. Those are things that need to be addressed by all, no matter age, gender, faith, etc. If we are to bring about full gender equality, whether that is in the struggle around equal pay, gender stereotypes or menopausal stigma, we need to start by talking about it by raising awareness. As men, I freely admit that we have absolutely no comprehension of what women experience during menopause, although I assure the minister that I have come to terms with my own clumsiness over the years. That experience can vary enormously from one woman to the next, with a wide range of symptoms and reactions, causes and implications. At the very least, however, we have a responsibility to listen, to support and to respond. Anything less represents a failure on our part. Seeing menopause as a normal part of life is also key to removing some of that stigma, to lifting the taboo. It is the strong underlying message of Louie's mentions video, menopause journey and a lot of the programmes that we have seen through the course of last week. I also think that there are strong and compelling arguments for saying that at the root of menopausal stigma lies the issue of health inequalities. Of course, menopause manifests themselves every day in all sorts of ways, but nowhere is it more obvious, perhaps, than when women go to their GPs with symptoms of menopause and do not get the support that they need. That is not always the case, of course, but too often it can be. To make matters worse in certain circumstances, doctors dismiss symptoms as menopause when they are actually signs of something more serious. Clearly, that can have grave consequences. Indeed, we hear of cases where women have been misdiagnosed, has had depression and been placed on antidepressants, others have presented with palpitations, then have been referred to cardiologists, some patients with urinary symptoms have been referred to urologists and others have been simply told that it is, as others have said, just the menopause so there is nothing that can be done. Whilst the 2015 NICE menopause guidelines are a step in the right direction, healthcare professionals need greater resources to enable them to accurately identify the menopause and better support women. It is also fair to say that the menopause can disproportionately affect those women who are already vulnerable within our society, leading to detrimental effects both on their mental and indeed their physical health. In a recent report produced by Engender, focusing purely on women with disabilities, the overwhelming majority felt that they received poor or no information about menopause, its health implications, symptoms or how to manage those symptoms. More worryingly, they felt that doctors were not available to give information in an accessible way or to spend time with them to discuss any reproductive health concerns that impacted upon them. From the focus groups that took place, the main recommendations appeared to emerge, highlighting how essential it is to ensuring that a learning disability or specialist nurse was available to speak to women about the menopause. A lack of resources was also highlighted through this work by Enable. Much more needs to be done in areas for which this Parliament has responsibility to this day. GPs and health professionals remain unable to effectively support women due to a lack of training and awareness. Women with disabilities are not incorporated into the reproductive narrative or in policies, and, as Annie Wells and Alison Johnstone highlighted, there is still no work for these policies surrounding the menopause. All of that can leave women feeling alone or, as the minister reminded us at the start of the debate, feeling invisible. We are still not doing enough to tackle menopausal stigma, and it is about time that change. That is a shared endeavour. We all have an interest in seeing that situation improve, even if the stakes for some of us are higher than they are for others. For now, however, I thank and congratulate the minister once again for enabling Parliament to debate this important issue this afternoon and to give it the visibility that it needs and deserves. I am really pleased to be speaking in this debate, and I am delighted to hear that it is the first ever debate in the chamber in the menopause and in a UK Parliament. I congratulate the minister too for bringing it forward. As long as I can remember, the menopause has always been viewed as a bit of a joke. There are mugs, napkins, aprons, car stickers—you name it—all emblazoned with so-called hilarious slogans about, quote, the change. We have heard the statistics from the STUC Women's Committee, and I think that it is worth repeating that 63 per cent of women said that menopause had been treated as a joke at work and 32 per cent said that it had been treated negatively in the workplace. That is simply unacceptable. It is certainly not a joke if you are one of the many women more than half who said that they experienced negative and distressing symptoms. Let us be clear that menopause is not an illness. It is a natural part of ageing for more than half the entire population, but it can be debilitating and affect women's everyday lives, as we know. The Scottish Government wants there to be a greater understanding in the society of the symptoms that can cause misery for many women. That is why we need to talk about it to raise awareness and end the taboo. Presiding Officer, there are increasing numbers of older women in the workplace, just to ask the waspy women, and many more will experience the menopause while still at work. Some will sail through it, others will not. We know that stigma is worse for women in a male-dominated workplace, and 99 per cent of those surveyed did not know whether there was a policy within the workplace. Presiding Officer, this is 2019. Managers and employers must be growing up enough to support women and to let them know what is available to them. The Scottish Government wants to set a positive example in this area and is currently reviewing its workplace guidance, as we have heard from the minister. The menopause is just one of the barriers women can face in the workplace because of gender and age. I hesitate to use an old cliche, but I will. If men experienced the menopause, I doubt that they would even be having this debate. Taboo subjects appear to be a common factor when it comes to debating women's health issues. Menstruation—this is period positive week, by the way—endometriosis, thyroid conditions, IVF treatment and much more are often swept under the carpet when it comes to talking about them and being open about them in the workplace. We are making some headway. The Scottish Government is currently working with women's organisations and trade unions to get a clearer picture of the issues faced by women going through the menopause to identify other areas of action that may be taken and the minister outlined what they are. They seem very positive indeed. Targeted training, awareness-raising and working with employers to provide menopause-related advice are finally beginning to happen. The world's first menopause café, as we have heard, was held in Perth in June after the excellent TV documentary presented by Kirsty Walk, which was probably the first time that the subject has been aired on a prime TV slot. After an inspiring debate, a resolution was passed at the SNP conference in April for employers to give menopause training. However, I think that I am taking up Alison Johnson's point that more research needs to be done into treatment types aside from from HRT. I think that it is fantastic for some women, but obviously it does have some side effects and we must continue to research other remedies. It is no longer acceptable for women to attend the doctors with a range of debilitating symptoms to be told that it is just their age. It is not acceptable for employers to jeopardise a women's career by showing a lack of understanding or respect about this perfectly natural progress. For employers who are not responsible enough to do that, ultimately, the joke is from them and they will be left behind as society moves on. It is indeed a privilege today to speak in this debate this afternoon, and my wife was delighted that I am as well. Gosh, having to bear children and then later in life subjected to the menopausal symptoms, women do have to cope with a lot. I salute their courage enormously and very much indeed to you all here today. Now the menopause has been a transition in life that has often been easily dismissed. It has been labelled as an unimportant or an uncomfortable topic of conversation, particularly when involving us men. However, in my humble role as a Commonwealth Parliamentary Association's male champion for women in Scotland, although I recognise that no women here needs me to speak on their behalf, I am keen to dispel any stigma or barrier that women can face. In the workplace, especially, the taboo of menopause certainly exists, and this taboo has caused a lack of understanding and sometimes even a general feeling of embarrassment. The underlying thinking is that it is solely a women's issue and not the concern of anyone else. This simply should not be the case. I fully understand this, slightly contrary to what Ron Mackay just said about us men, particularly in supporting my wife during some difficult times when I was overseas with my job some 2,500 miles away in the Balkans, and I had to fly home on some occasions to support her and my four children as a result of that. The menopause can, for some, feel like a stage of life unrecognised and easily dismissed, and indeed, as the Faculty of Occupational Medicine highlighted, the menopause is a hidden health concern. We can forget that it is a natural health condition just as the serving of clear practical guidance and support as any other. It is important to note that menopausal symptoms are different from each woman and can vary depending on where they live, be it in Scotland or indeed in the Commonwealth. Those different factors can affect the severity of their symptoms, with that in mind raising awareness needs to be attuned to the spectrum of experience that women have. There is zero benefit in fuelling the taboo of menopause, especially as part of the problem, of course, can be plain ignorance. It is encouraging, therefore, to see more readily available advice and guidance, and indeed, only through more open communication about its symptoms can we better understand how women can feel and the support that they need. That is especially the case if they are in a workplace environment. It is alarming to note that a quarter of women over 50 have considered reducing their work hours due to the menopausal symptoms. Without the support, the danger is that more women might feel that they cannot continue to work. One of the most important areas where awareness can start is with the employers. Employers are the key to destigmatising the menopause, especially if they implement a workplace menopause policy. Indeed, the 2018 report of the STUC's Women's Committee on this very topic showed that of those who took part in the survey, most said that they either did not have or did not know if their employers had this policy in place. I am sure that we all agree that this would be a much-needed policy to have in place with all employers. Stemming from this, employers need to encourage training on how best to deal with the menopause in a workplace culture. The practical training for colleagues is the key to proper education on women's experiences. Through that, we can foster understanding, awareness of the practical steps that we can take to help each other. Further options such as flexible working and small adjustments to the working day are almost most definitely worth exploring. For example, the UK Government through the Women's Business Council has implemented an employer toolkit that suggests physical adaption options to the working environment, designed to encourage flexible working. I hope that employers can be equipped and encouraged to do their part in that way. All those efforts strive to raise awareness and start the conversation. Indeed, I welcome the number of campaigns that we have seen to date. I wish to do that. For example, the BBC's daily work up to wake up to the menopause week this month was an eye opener, also particularly in the workplace. Further, the world menopause day is marked every October raising awareness of the health issues connected with the condition. Campaigns such as that are all about opening up the conversation and encouraging active communication on how women can feel well supported and better understood. That is how we can de-stigmatise the menopause. To conclude, I hope for an open and supportive dialogue about the menopause. That is how we truly validate the condition and ensure that women are supported, especially in their workplace, in this country and throughout the Commonwealth. Efforts to raise awareness have certainly helped to break the taboo, but it will take a real and practical change in the working environment with commitment from everyone to truly address that issue. There are a raft of subjects that are firmly in a box marked. Things that your granny says you should keep to yourself. Periods are in there, and there is a lot of weight down to campaigners and period poverty and tampon tax, of which I count myself one. The taboo around talking openly about menstruation has been eroded. The menopause is in that box, too. With all due respect to our grannies, not talking about the symptoms of menopause is doing us no favours, because menopause, as everyone has said, is a natural part of life. Women in the workplace have been coping silently forever. If we have been managing life whilst keeping our symptoms hidden, we can manage it even better if those around us understand them and give us an extra bit of support when we need it. I do not want that to turn into a debate that gives people more reasons not to employ older women, because we do cope, but we cope in secret. There is limited information about the menopause and its impact on women in the workplace, yet, by law, all workplaces should have an effective gender-sensitive policy in place. That is entirely consistent with the provisions in the Health and Safety Work Act, the Workplace Regulations, the Management of Health and Safety Work Regulations and the Public Sector Equality duty, which is part of the Equality Act. However, I wonder how many perimenopausal women, if they just went in to speak to their boss and asked them what their policy is on the menopause, would get any kind of an answer. I feel for the boss that has been asked as well, because would they even know that they had one? Right now, those of us who are perimenopausal—I am one, Emma Harper—has made me a fan out of the business bulletin. We might have extremely heavy periods that come with no warning and cannot be dealt with very easily. We might have those debilitating severe hot sweats that do not just happen at night. I might have to leave a room suddenly to deal with either of those things. I might not be able to sleep, and a flexible working pattern might help me to get through a period of insomnia. All those things do not mean that I cannot do a good job, but they just mean that I can have to do it a wee bit differently from time to time. It is not a consistent thing as well—it goes in peaks and troughs. However, I am lucky—I am the boss—in my constituency office, I can work around that. What if I was working at a tell-and-test school? What if I was working at a shift? What if I was managing a petrol station or something like that? A lot of people have mentioned the survey of the STUC Women's Committee. I will not rehash that. However, if a third of female employers feel that menopause was treated negatively as they heard it and talked about it as a joke, they are less likely to even bring it up at work, because they do not want to be ridiculed. However, I was very pleased to discover last year in October that the SNP-run South Lanarkshire Council was the first to grasp the nettle and the first local authority in Scotland to introduce a menopause policy to help to support its female workforce. It has already been mentioned by the Deputy Provost, Collette Stevenson. She said that it is an important issue for an organisation of any size to recognise the support. Our council colleague, Councillor Katie Loudon, along with our minister, Claire Hawke, brought forward a motion in line with that at the SNP party conference, and it is now our party policy. I will be writing to Aberdeenshire council to ask what, if any, policy it has in place. I know that some of my councillor colleagues have already directly raised the issue. However, what could a policy look like? It could consider the specific needs of menopausal women and ensure that the workplace environment will not make their symptoms worse. Paid time off for treatments such as hormone replacement therapy or CBT, but flexible working patterns will make reasonable adjustments to workplaces such as flexibility in breaks, remote working and flexible start times. It strikes me that smokers probably have more flexibility than anyone to go and take breaks whenever they want than women suffering from the menopause. Introducing a culture, a respectful culture, where menopause is talked about respectfully between colleagues. Whatever we get out of this debate, it is welcome that we open up that box and we are talking about it, but I just want to say one other thing just about clinical interventions. I would also like to go into a doctor's surgery and we offered advice that is not just will put you on HRT. There are lots of coping mechanisms out there, and I would like our medical professionals to look outside the clinical interventions and help us out in that as well. Thank you very much and I call Elaine Smith. Thank you, Presiding Officer. I was not actually sure whether I wanted to take part in this historic debate today. As I have already spoken honestly about my thyroid problems in the chamber, so discussing yet another personal health and wellbeing issue, I thought might be challenging. Of course, there are connections with thyroid and menopause, which I will come back to if I have time. It was refreshing to see women on BBC breakfast, as others have mentioned, talking about the menopause along with their families, who are obviously also affected. There were some innovative ideas for helping symptoms, but much as I like swimming, I am not sure that I fancy swimming in freezing cold water, as was mentioned earlier by Annie Wells. However, if it helps, I would say that you should go for it. There have also been wider media discussions and political discussions that have helped to encourage a new culture of talking openly about the menopause, and, of course, ending the stigma of the menopause should not be necessary. Why should a natural physical process affecting half the population have a stigma attached to it at all? Sadly, it does, and so clearly we need more discussion, information and understanding, so that the menopause is everybody's issue and not just the women going through it. I took some soundings about the debate and what people might think in the workplace, and some of the comments that I got included. My colleagues are always sleeping in and coming in late, she's tired, she's grumpy, moaning about aches and pains, too hot, too cold, suffering from anxiety and very emotional. I suppose that anyone working or living with a woman going through the menopause would recognise some or all of those symptoms, but, instead of those kinds of comments, it would be better if people recognised that their colleague or their manager is going through the menopause and then they might better understand what she has to deal with while also working. It might result in more support, more empathy and adjusted workplace conditions. For example, cool water being available, flexi hours, relaxation of a uniform policy, if there is one, and provision of fans. It doesn't help, obviously, that women are having to work until they are much older, whether they like it or not. For women in poverty, there is little hope of early retirement and, instead, they could be doing two or more zero-hours part-time jobs trying to make ends meet. I think that this kind of debate will help to raise awareness and, obviously, it's the first of its kind. Congratulations to the minister for that, but we also need action for workplace assistance, and we need better medical help and advice. I ought to have said that the workplace assistance is, of course, something that is being pushed for by the STUC. I mentioned thyroid problems earlier. I want to briefly touch on how the menopause can be even more difficult for thyroid sufferers who, as we know, are mainly women. As I mentioned in the intervention to the minister, women are often not being tested for thyroid disorder later in life because of the symptoms that have been similar to the menopause. However, thyroid problems can increase the risk of complications associated with the menopause. For instance, during the menopause, women are more likely to develop osteoporosis, a condition that we know for bone densities reduced. Similarly, the risk of cardiovascular disease increases, and thyroid conditions also increase the risk and can interact resulting in complications. I think that if women on thyroid medication are then prescribed HRT or choose to take it, they need to be monitored closely, and I would say preferably by an endocrinologist. Overall, thyroid disorder is an area of medicine that needs much more research, including its impact during the menopause. When I was the deputy president officer and chair in a session, I kept a fan under that desk, but I only used it when the camera was clearly on another member. I would sneak it out, I would use it, and then I would hide it again. However, really, I should have felt more empowered to use that fan when I needed to do my job more comfortably. Recently, I went out with my husband van to a local bar. I was only in the door when I suffered a terrible hot flush, and without asking or saying a word, Karen, one of the staff, handed me a fan. That kind of sisterly understanding and help is extremely welcome. Overall, and in conclusion, we need flexible working solutions, we need more support and practical help, specialist women's clinics, specialist nurses or at least more time with the GP. What we don't need are misogynistic jokes, a lack of understanding and predominantly male doctors telling us that it's just the age, so get on with it. Mandy Rhodes at the conference said that some subjects wait for a whole generation to catch up. The menopause has now found its time. This is generation M. Let's get behind it and embrace this particular change. Thank you very much, and I call Stuart Stevenson, who will be followed by Joan McAlpine. Thank you, Presiding Officer. Just a quick word to Monica Lennon. I've sat round the boardroom table at the Bank of England on a number of occasions. I, of course, left banking after 30 years to come into politics to improve my reputation. Just a little thing that Elaine Smith has just illustrated perhaps about the advice that we all sometimes receive about things. The last thing that you wish to do if you have a hot flush or you're sweating or your temperature is rising is to take a cold drink. The reason for that is that a cold drink will boost your system and turn the temperature up, because when the cold drink hits your stomach, it's very close to blood vessels and your temperature rises. That's why in the Middle East people drink chai banana, which is warm tea, because putting something warm in your stomach lowers your temperature and reduces the flush. Medical advice often doesn't cover these very, very simple things, but, of course, the whole issue of the menopause is not simply a medical issue, it's not just a physical issue, it's a social and employment issue. Of course, it's not just an issue for women, but it's also an issue for us men. I'm glad that I think that four of us are going to speak in this debate today. It's an issue for us, perhaps simply because we are there to provide support for those closers who are affected by this issue, but we also may find ourselves employed by women or employing women who are affected by this. We will also meet casually and formally women who are affected by it. I may say that Elaine Smith very effectively concealed the use of the fan in previous sessions, and I congratulate her on it, but she deserves every support for that. We will meet pre-menopausal or peri-menopausal women who are worried about how—I really don't have time, do forgive me—how we men may react to the menopausal symptoms. I think that we men have a duty to be part of an environment in which women feel comfortable about the menopause because it's something that will happen to all our female friends, relatives and people we meet. It's part of men learning to deal with their hormone issues, which largely take us to have more aggressive responses to circumstances that we find uncomfortable about. We have to learn to be much more supportive in our relationships with people that we love and people that we meet and people that we bump into, placing neither the male nor the female in a superior or inferior position to one or the other, but simply to recognise that there are differences that arise from gender. It's interesting that Professor Mary Minkin of Yale Medical School has done some research on the effects of that and found that Swedish, Danish and Norwegian women are most likely to report that going through the menopause is better than they expected, but she found that women in the US, the UK and Canada say that their experience is worse than expected. That tells us that this is not simply a physical and hormonal change, but it's also something about the information that people have and how society reacts to people. We've heard some references to diet exercise and attitudes to getting older. I'd like people to like older people a bit better, being the only septogenarian, speaking this afternoon. In Japan, the older revered, but here we're more likely to be pitted. Presiding Officer, just in conclusion, we've talked a little bit about employment, and the DWP is reporting that the highest increases in recent times in employment are in the 60, 64 and 55, 59 age group. That's what Engender has told us. I very much welcome the debate and the opportunity to participate in it. I hope that I'll leave the debate a little better informed and a little better prepared to deal with the effect in men and women of the menopause. I'm tempted to say thank you Dr Stevenson for your medical advice. I call Joan McAlpine to be with all my Alice and Harris. Thank you Presiding Officer. I'm delighted to speak in this debate today and I'd like to congratulate the minister on the energy that she personally has put into banishing the stigma of the menopause. Getting this topic to the chamber for the first time ever is a significant achievement, but the fact that we haven't debated it before speaks volumes about where Parliament has placed female priorities in the past. I also want to praise the STUC Women's Committee and the Scottish Women's Convention, which have done so much invaluable work in this area, as we have heard, and also to highlight some best practice. NHS Dumfries and Galloway has provided specialist menopause clinics and a helpline for over 20 years and regularly provides information services to public and staff. In this week, in the wonderful new DGRI hospital, we saw an addition of BBC Breakfast focused on the menopause as part of its wake-up to the menopause week, and the show's Jane McCubbin interviewed clinicians, including gynaecologist, osteoporosis specialists and GPs in the region, about their excellent work. I would like to take this opportunity to thank them for all they do and hope that others around Scotland will emulate them in the future. In researching this speech, I was quite surprised to discover that human female menopause is almost unique. Apparently, the only other comparable mammal species where females live well beyond the child-bearing years is killer whales. Make of that what you will. I would venture to suppose that it is because older women are as fierce, as impressive and beautiful and determined as any pod of orcas. A number of female academics have researched the purpose of the human female menopause and observed that the most successful societies depend on the contribution made by older women. There is even a term for it in anthropology, which is called the grandmother hypothesis in pre-industrial societies. The presence of a grandmother vastly improves child mortality, for example. Anthropologists have also noted that the benefits of having lots of healthy older women go beyond childcare and family responsibilities. They often do large amounts of the work—physical work, social organisation and community cohesion. They were observed to be the linchpins of many successful traditional societies. Of course, that observation can equally be made about our own complex modern societies. The opening of the conference on menopause earlier this year, the chair of the Scottish Women's Convention Agnes Tomey, had this to say that those women are carers, workers and the backbone of our communities and our society. She is absolutely correct in that assertion, which means that ensuring that menopausal women are healthy is not just essential for the wellbeing of those women themselves, which is of course extremely important, but it is important for society as a whole. However, as we have heard, society as a whole often still does not get it. That is illustrated by the findings from that survey from the STUC Women's Committee, which found that one in three women said that menopause was treated negatively in the workplace, while almost two in three found that it was treated as a joke. Agnes Tomey said in the same speech that the stigma attached to menopause illustrates much of the wider inequalities women experience in a variety of areas. She is absolutely correct in that the wider discrimination against women is on the basis of their biology. Younger women can experience discrimination because of their ability or their perceived ability to get pregnant and they certainly face discrimination as a result of motherhood, and now we understand that that discrimination persists into middle age and old age because of the menopause. Second wave feminist writing in the 1960s to the 1980s had an analysis of that patriarchal society based on the understanding of biology, which found that women suffered that collective discrimination as a sex class. We have made considerable progress since then, but women still suffer significant discrimination, especially poorer women and disabled women, whether it is through period poverty or low pay because of motherhood. I therefore welcome the minister's own comments when she addressed the Scottish Women's Convention earlier this year, when she pointed out that the Equality Act 2010 protects women against workplace discrimination on the basis of sex and age, and we should use that legal framework more effectively to tackle the discrimination that they face as a result of menopause. I agree with that, and I suggest that fulfilling the public sector equality duty is very important for all organisations, and it is particularly important that they gather information as they are legally obliged to do on the protected characteristic of sex. It is increasingly the case that many organisations through poor training are confusing sex with gender or even gender identity, but menopausal women suffer discrimination because of their biological sex, and it is vital that we recognise and record that. I would like to end on a positive note by returning to the earlier point that menopause can be a positive thing. It frees women from the fear of unwanted pregnancy and the inconvenience around men's situation, often pain. Jeremy Greer said that it could be viewed as a liberation because the pressure put on younger women to look beautiful, to be attractive to men is itself a type of prison, and menopause is opening the door of that prison and finding a new stage in life. As I said, post-menopausal women are the linchpins of our community. My personal experience of that was having two older women help me to bring up my children while they had careers themselves and were carers for other disabled relatives too. Menopausal women are extraordinary, they are not a problem, they are an asset. I am glad that we have had this debate today where we can celebrate them. I say to members that I have been light-touch on timings because we did have some time in hand but two minutes over is maybe just a little bit too light-touch. I call Alison Harris to be followed by Fulton MacGregor. I am grateful to be given the opportunity to speak in today's debate, the first here in the Scottish Parliament, following the success of the debate on world menopause day in the House of Commons back in October last year. The menopause can affect adult women of almost all ages, although the average age in the UK is 51. I thank other MSPs who have listed the many symptoms already today. My first experience of the menopause was from seeing my mum. I think that she had it really quite tough and I know that it went on for years. She was always renowned for having a fan in every handbag. Here I am. I have reached that age and I must confess that I too carry a fan in every handbag for those moments and I am quite happy to lend it out should anyone need it. At night I now feel like I am constantly doing the hokey-cokey in my bed, my legs in, out, in, out all the night. I try and deal with those things with a bit of humour because I find that it helps me personally. I do not know if any others here have seen the menopause musical. I have and it was actually very funny. Not because the menopause is a joke, because it is not. I was laughing more in empathy than anything else. I recognised myself on that stage. The show did a really good job of normalising a taboo subject. When I say taboo, I mean in public or workplaces. It is easier when I speak to my girlfriends about it because it is what we are all experiencing. However, it is quite a different story when you are in a business meeting or on a train or the bus during rush hour. When you suddenly feel one of those moments coming on, it can make you feel quite anxious and fill you with absolute dread. I know that it is not just me. An ITV tonight's survey in 2016 found that a quarter of women had considered leaving their jobs because of the effects of the menopause. Fortunately, I have come to terms with dealing with it in a working environment. I now just come right out and openly say that I am having a hot flush. However, I know that not every woman feels like that and where they work. They work in places where they just cannot say that. A survey for BBC Radio 4 women's hour last January revealed that 70 per cent of respondents did not tell their bosses that they were experiencing those symptoms. That is a huge number of women. We need to make workplaces more understanding of the menopause, because it really is just a fact of life, part of being a woman. It is the same as when you are younger and you hit puberty and your periods begin. I am a firm believer that these facts of life shouldn't get in the way of your own life or career. We have to think about what we can do to help women to navigate through these stages of life in the easiest possible way. From developing workplace measures that reduce the anxiety around talking about the menopause, to educating children and young people so that the topic becomes normalised in the future, raising awareness is one of the best ways to do that. I would like to join others in thanking Rachael Vise and her work in establishing menopause cafes throughout the UK, which have allowed women to speak with others going through the exact same experience as them. To build on that, there is more that we can do to reduce the stigma around the menopause. I know that because fantastic strides have been made in the last decade towards reducing other stigmas. Mental health has gone from something that we did not talk about to a national focus. Tackling stigmas head-on and normalising them is a proven way of making things better. On the menopause, perhaps we can begin to set those wheels in motion here today. I call Fulton MacGregor. Mr MacGregor is the last speaker in the open debate. I would like to thank the minister for bringing this important subject forward. It is fair to say that we can be proud for debating this for the first time in the chamber. I certainly agree with the motion that, for too long menopause, it has been a subject that is just treated as a joke in something that is a bit taboo. Before speaking this debate, I was a bit worried about standing up here and speaking, not because I do not think that we should be talking about it, but as a man, as a male, what do I know about that subject? The conversations that I have had over the last day or so in preparation of speaking today have revealed to me that I am probably exactly the person who should be standing up here and speaking to my male colleagues as well. I have learned quite a lot about how important it is that we normalise the subject of menopause. In the way that we are making strides in mental health, we are hopefully getting to a place where people are feeling more able to speak about it in their workplace and in other scenarios. We should be moving on a similar road with menopause. Every woman should have access to information, education advice and emotional support to empower them to take control of their health and wellbeing during this normal phase of life. Too many women have been told that it is just a natural phase and that they will just have to get on with it and have heard others speak about that really powerfully today. However, as we have also heard, the symptoms can vary widely and in many cases little advice or support is given. There is still much fear and confusion around the subject of hormone replacement therapy amongst both doctors and women, with 67 per cent of women recently served, as we have already heard and said that there was a general lack of support or advice for those going through the menopause. Who would not be worried about hormone replacement therapy and the possible consequences, even the words themselves, can cause dread? As Rona Mackay said, what if this was commonplace for men? I know that there is a minority of men who perhaps need hormone replacement therapy, but it is not anywhere near the same scale. What if it was more commonplace for men? I think that we would be talking about this very freely and there would be supports already in place. It would be a different subject altogether. We know as well that work presents yet another challenge. In the health survey published in October 2014, 70 per cent of female workers said that they felt unsupported, one in five felt their symptoms were affecting their work and one in 10 had considered quitting. Nine out of 10 women said that they were unable to talk to her manager or her colleague, 18 per cent they needed to take time off, one in 50 was in long-term sick leave, but few disclosed the new reason for their absence. I just find those statistics shocking. I hear that, as has been mentioned by Gillian Martin and by the minister, the good progress has been made in my neighbouring South Lanarkshire Council, and I am pleased that two of our SNP councils and North Lanarkshire councils, Anderson and Fortheringham, lodged a motion that was passed in October 2019 that ensured that North Lanarkshire Council are committed to further planned work to ensure that a policy should be introduced to positively impact on the female workforce with the council providing appropriate support to women who are experiencing symptoms of the menopause. However, since October last year in this past, there has been no progress on the creation of a policy by the North Lanarkshire Council officials, none. I backed up just today by an email to Councillor Caragher who spoke to the council and confirmed that no work had been done on developing a policy, and she said that I was told that it was felt doing so would complicate matters, as the council already has mechanisms in place to better assist, but it was accepted that better knowledge of those mechanisms was required. What makes us worse, Presiding Officer, is that 79 per cent of North Lanarkshire Council's workforce are female. To have not even bothered to work on a policy that will affect over three quarters of your workforce at some point is just simply unacceptable. Now, I do understand that there are policies in place such as special leave, flexible working hours, in a short term basis, stuff like that, but to not act in a policy that the neighbouring South Lanarkshire Council has done is disconcerting and bad practice. If I have time, Presiding Officer, I can say that I am well over time. As I said, when I first decided to speak in the debate, I did not think that I had been in that position, but it has been a very much learning company, Presiding Officer. I think that every woman and man deserves to understand this phase of life, because for too many individuals, and the relationship to suffer because of a lack of understanding of menopause, and I am happy to leave it at that, Presiding Officer. Thank you very much. Before I move to closing speeches, I am asking myself where for art now, Mr Corry. No doubt, he will be giving me a little note. Presiding Officer, a little note, Mr Bowman, you are going to make sure that it happens. I now call Pauline McNeill to close for Labour, followed by Rachel Hamilton. Thank you, Presiding Officer. It is time to end the stigma of the menopause, and I believe that we are helping to do this by debating it today, thanks to Christina McKelvie for bringing in the first ever debate to the Scottish Parliament. In fact, I thought 20 years ago that it would be inconceivable that people would be prepared to come and take part in the debate. Never mind a Government minister bringing it forward, but I think that it shows how far we have come, that we are prepared to talk publicly about an intimate health and welfare issue that, hopefully, women who read this debate and see this debate will give them some encouragement to talk about it themselves. I think that it is a liberation that we can talk about the menopause and not the change. I think that it is Alison Johnson who said that. We have heard from Elaine Smith and Alison Harris perhaps who should have some Scottish Parliament edition fans. It would certainly be well used, that is for sure. Breaking the silence on the menopause, when Kirsty Walk spoke out about it, she talked about her experience brought on by hysterectomy, as many women have to do early in their life. That brings on the menopause, because you are not producing estrogen anymore and that has office consequences for your health. Sharon Edwards from the SDUC Women's Committee has been mentioned many times. It is worth repeating that, for far too long, the menopause has been an issue shrouded in secrecy, resigned to whisper in conversations between women and many jokes about hot flushes. Annie Wells talked about that women who no longer felt that they were good company, and it is the sad reflection. As Monica Lennon said, there are up to 34 symptoms that you can possibly have. It struck me that if a woman does not know what she is about to face, then how does she know what she needs from her partner? I think that that is important. It needs to be done. If you know what the battle ahead is, most women will be able to take that battle on. I think that that is why the services need to wrap around that principle. I think that Maurice Golden said that what he summarised is the pain of womanhood, puberty, periods, childbirth, smear tests, mammograms, pre-menopause and menopause. We should be shaping our services accordingly. It is meant to be a natural process, but there is a hell of a lot of pain attached to some of that. Despite all that, we know the women who have come through it and they still remain brilliant and hard working. Liam McArthur rightly described it as a health inequality that we have to put right. There are others who have talked about that. That means that there has to be changes in the workforce because the demographics have also changed in employment in the workforce. We have more older women. Many women are reluctant to share their experiences of their symptoms with their employers—naturally—GPs, friends or families because of a lack of understanding in society. It is clear that we believe that that must change. The SUC Women's Committee survey last year had a 3,500 people that women responded to that. 6 to 3 per cent said that the menopause had been treated as a joke at work. The largest increase in employment rates during the last 30 years are older women. Women aged 55 to 59 has increased about 20 per cent. The symptoms of the menopause can have negative impacts on women's economic participation. The workplace environment can significantly affect the women's ability to manage their symptoms at work. For example, inadequate ventilation, which has been talked about, the lack of appropriate toilet facilities, crowded workspaces and inflexible working arrangements are the issues that should be at the top of employers' agendas and trade union agendas when they are negotiating better policies in the workplace. Doctors too need better support. Nearly two thirds of GPs in the UK do not feel confident treating the menopause. That has to change because if GPs do not feel confident, then how can the women themselves only have received training or managing the menopause? That is particularly concerning for us. Almost two thirds of women responding to the Scottish Women's Convention service felt that there was not enough information available to them when they first identified the symptoms relating to the menopause and how to manage it. Of the 3,500 women who responded to the Scottish Women's Committee service, more than half of the participants who took part in that were already going to the menopause. I hope that this is a subject that we return. I think that the job of politicians here in this Parliament is to work together and not only to identify to remove the stigma and taboo of talking about the menopause, but to shape the services accordingly, the kind of services that women need and to talk to the people who need to change their attitudes. That is, presumably, a lot to do with the workplace and I think that the world would be a better place. I thank everyone, including the minister, for bringing this to the chamber. Finally, we are starting to see society move in the right direction when it comes to the menopause, but there is still a long way to go. Let's be clear that menopause, as many have pointed out, is completely normal, as normal as pregnancy or periods. However, my mother and my grandmother have never talked about their experience of menopause, and I really believe that it was quite normal to walk around wearing a cotton sundress in the winter. It is an unavoidable fact that most women go through the menopause and we have heard today that it affects women in many different ways. Despite that, there remains a certain stubborn stigma about it. Maurice Corry highlighted sharing experiences and, indeed, how the first steps towards de-stigmatising menopause is to talk about it in a way that normalises it. It is completely normal, as many have said today, and this should not be a taboo subject. I want to thank my Conservative colleagues Annie Wells and Alison Harris for speaking about their own experiences and, indeed, Rachel McLean MP, who led a menopause awareness campaign. She believes that too many women are not getting the treatment that they deserve. During a speech in the House of Commons on World Menopause Day 2018, she highlighted the need for better education. She said that menopause, and I quote, needs to come into the school curriculum and be part of what schools are talking about. Let us look at how we can do that, because surely it is not that hard. I could not agree more with that statement, as it is extremely important that we teach not only young women and girls about it but also young men and boys, too. It was so refreshing that three men spoke today in this debate. By providing factual education, whether it is through NHS or through schools, about the symptoms, women can prepare for what is to come, what to expect and, in turn, increase the ability for their own families and friends and work colleagues to be aware of what is happening. That is something that I would ask the Scottish Government to do, particularly when it comes to young persons' personal and social education lessons. What about the workplace? Many have talked about the workplace here today. Employers have an important role to play and should be encouraged to introduce support policies into the workplace. Alison Johnston spoke about a workplace menopause policy. Maurice Corry talked about the Women's Business Council, which has developed a toolkit for employers, which enables employers to make adaptations in the right workplace environment and to support flexible working hours and to raise awareness of menopause. Many people in the chamber spoke about the workplace. Alison Johnston reminded us that half of the workplace is female. Gillian Martin also said that it is right that menopause is not a reason to not employ older women, which was highlighted by Joan McAlpine, who spoke about the benefit of older women in society and in the workplace. Stevenson spoke about that, too. It is worrying that one in four women over 50 consider cutting their hours due to menopausal symptoms. It is not just something that we should load on to employers here. We should also do what Liam McArthur talked about, which is to deal with the health inequalities. How important that is that menopausal symptoms are correctly identified and managed by GPs. Again, it is something that Elaine Smith is a fantastic advocate about and talks about the symptoms and the similarities of underactive thyroid compared to menopause. It is so important that we use research to advance treatment. Getting the symptoms right and working alongside employers is perhaps something that will bring it to the fore, destigmatise it and allow women to stay in the workplace for longer. The BBC today has unusually received compliments. Lots of members have talked about the welcome BBC breakfast launch, Wake Up to the Menopause campaign. They ran a week of menopause clips looking at everything from symptoms to workplace issues, educating the public on how women may feel and what help people can offer. It followed the menopause in me, a documentary by Kirsty Walk. She has been absolutely fantastic in breaking down the stigma. The documentary goes in some way in tackling the negative perceptions that women face because of menopausal effects. Her involvement in the programme came because of her own sudden and unexpected experience. She had a medical menopause at the age of 47 after hysterectomy and coming off hormone replacement therapy because of fears over its link to breast cancer. She felt that, because the menopause was never spoken about, she was isolated and felt unable to talk about her experiences. Perhaps today's debate will allow other women to feel comfortable or more comfortable about speaking about their experiences with other women and, indeed, men and perhaps their children and their workplace. The isolation aspect was recently highlighted by the British menopause society survey, which found that 23 per cent of women feel isolated as a result of menopausal effects. We need to see greater societal change in order to help women to feel comfortable about speaking more openly about their experiences, not for others to be critical or judgmental or prejudiced against women experiencing the menopause. In conclusion, it has been really encouraging today to hear contributions from across the chamber. I am really scared about going through the whole thing myself and listening to everybody's experiences, but I do not think that I have ever spoken about it in public, so it is amazing. I am glad that there is a strong recognition from all parties that we must do more to tackle the stigma. I commend the British Menopause Society for their work that they have done and the support that their volunteers offer right across the country and the cafes that we have heard about today. It is people such as them that make a real difference to women's experience. I hope that, going forward from this debate, we can see the Scottish Government set out their next steps in supporting Scottish women. I thank all members who have contributed to this afternoon's debate. It is important that Parliament has come together to send an ambiguous message that we support and value women at all stages of our lives. Before I go any further, can I congratulate the Parliament itself, who I know will shortly launch its own policy on periods and the menopause? Like others, Alison Harris and others, my first experience of the menopause was my mum. What I remember was irritability, tiredness and tearfulness, but it was never explained and it was never spoken of. As a young girl, I remember being very anxious that something was wrong with my mum. Being an imaginative young girl, I think that I had a dead and buried a couple of times, but it was never ever spoken of. Before I turn to what members have said, can I just, in passing, thank Pauline McNeill for recognising that women who have come through it are brilliant and hardworking, and that is a very personal thanks from me. Annie Wells talked about the menopause as a natural part of ageing, and it is. The problem is that the experience of women in the workplace and elsewhere is that somehow what is happening is not natural. Somehow it is our fault. We are being difficult and we are being troublesome. For us as women, it can also be a hard thing to face up to, because what it signals, whether we recognise it or not, is the end of our capacity to naturally conceive and whether we rail against it or not, we have subsumed the notion that conception and the bearing of children is an essential part of our femininity. It is also a signal that our life and our lifespan is finite, and those things are hard to face up to. Yes, it is important to recognise physical symptoms and the post-menopausal impact on our physical health, but it is also very important to recognise the psychological effect on our mental health, not just of the symptoms, but sometimes of what it feels to us that this means. We will all have read the very helpful briefing from Engender. I had not been aware of this, but he pointed out that the mental health strategy makes no difference to menopause, and in fact there are only four references to women. Two of those are in relation to perinatal mental health. Is that something that could be looked at for the next update to the strategy? I will come to that in a minute. I am not sure that the mental health strategy should mention the menopause, but I think that the delivery of our work on mental health and our work in primary care should absolutely recognise the potential impact on women's mental health of the menopause. I am very happy to take on the spirit of that, if not exactly what is being asked for. In terms of health more widely, there is a real need, I think that Alison Harris touched on it, but it occurred to me strongly through the debate for wider education, particularly in primary care, where some of the issues that Elaine Smith raised on the assumptions that are made about women and some of the misdiagnosis and some of the failure to recognise the interrelationship between other conditions and the menopause and medication, where some of that can be found. For the majority of women, of course, experiencing menopause symptoms, appropriate management advice and treatment should be available through primary care services. Where there are more complex issues, for example, with other medical conditions, the medication referral is made to secondary care. People have touched on what the health service does in terms of the menopause. There are specific menopause clinics in NHS Dumfries and Galloway, Fife, Grampian, Lothian and Tayside. In health boards, specialist gynaecology services are also available for women. In addition, there are a number of additional clinics recognised by the British Menopause Society in Glasgow, Clyde, Highland, South Lanarkshire, Ayrshire, Arran and elsewhere. What we recognise is that there is a need for significant additional training, particularly in primary care, so that the understanding is there among the wider primary care workforce. In some of the work that we are undertaking, I am very happy to commit to looking at that again. Education has to go further than primary care or a medical workforce. Realistic medicine, so well advocated by our chief medical officer and her team, centres on meaningful conversations between people and healthcare professionals. To do that, to have that meaningful conversation as a person on the other side of the desk, from the GP or the advanced nurse practitioner or whoever it might be, we need, as individuals, to be more confident and more knowledgeable. While I want us to avoid over-medicalising what is a natural part of our life, I think, and Alison did mention that, we need to start our work much earlier with young women and girls. We need to know that menstruation is normal but be ready to recognise the symptoms, for example, as we have mentioned in other debates of endometriosis and not allow them to be confused with just a heavy period. We need to understand as women what is happening in our bodies and be prepared to argue and confident in our knowledge, to argue our case and present what our needs are in primary care and elsewhere. Knowledge is powerful and normalising all of this natural bodily functions and changes to our bodies is entirely critical in that regard. As Leah McArthur said, ending inequality at every level starts by talking openly and listening well. I am very happy to commit today in this debate to working across Government with colleagues in education and elsewhere to increase information, starting in schools absolutely where that needs to happen but all through our health service to improve the information, increase what is available, improve understanding and support women in health-related issues that we face. There is indeed more for us to do and I will continue the discussions that have begun with the chief medical officer and others about how much more we can do to raise awareness and strengthen menopause services in Scotland. Finally, much of the debate has focused rightly on the workplace. NHS Scotland is our largest employer and many of the issues raised and discussed here today that women will face in other workplaces will indeed be faced by women in health and social care. It is the case that NHS Scotland does not have a standardised policy on the menopause. I hope that members will take my assurance that it will very soon. On that point, we have discussed the fact that many councils do not have policies either, but rather than simply criticising them for that. I wonder if the minister would agree with me that we should take a cross-party approach to encouraging them to put policies in place. I absolutely agree with that. I would be pretty poorly placed to criticise another organisation for not having a workplace policy on this issue when our own health service right at this minute does not. I will take that forward, but I think that it is right that what we do collectively is encourage all employers, be they private or public sector, to take this issue seriously, to develop those workplace policies and that we offer them support where that is helpful to them in order to do that. Normalising all of this is part and parcel of your life as a woman. Normalising it, talking about it, asking for the support and the help that we need, be that from the health service, be it more widely from our employers, be it more widely from our society or indeed, intimately from our partners, is something that we should encourage to happen. I think that we were described as generation M by Mandy Rhodes. I do not want future generations to be generation M. I want this generation of women to be the ones that normalise this, end the stigma of working with men and with others across our country so that young women coming through do not have to face some of the issues that women today have had to face in this regard. Thank you very much, cabinet secretary. That concludes our debate on its time to end the stigma of the menopause. The next item of business is consideration of business motion 17368, in the name of Graeme Dey, on behalf of the Parliamentary Bureau, setting out a change to tomorrow's business. Could I call on Graeme Dey to move the motion? Thank you very much and no member has asked to speak against or for the motion. Therefore, the question is that motion 17368 be agreed. Are we all agreed? We are agreed. Now, there is one question at decision time today. The question is that motion 17347, in the name of Christina McKelvie, on its time to end the stigma of the menopause, be agreed. Are we all agreed? We are agreed. That concludes decision time. We will now move to members' business, in the name of Colin Beattie, on International Museum Day. We will take a few moments for members and the minister to change seats.