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Opinion

“Menopause can no longer be ignored if we are to close the gender health gap”

By Harriet Bradley, NHS GP and medical director at Kry Livi

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Despite 13 million women in the UK experiencing perimenopause or menopause, awareness and understanding of this transformative life stage remains behind the curve.

A natural part of female ageing, menopause marks 12 months since a woman’s last period and the end of her reproductive years. During this time, many women experience symptoms that can be intrusive to their daily lives, such as hot flushes, poor sleep and concentration and low self-esteem.

Mental health can also be negatively impacted. And these symptoms can start well before you’ve reached menopause – perimenopause marks the first changes you experience when your hormone levels shift, the average age of perimenopause is 47.5 years, but it’s different for everyone.

These symptoms are compounded by the challenges menopausal women continue to face when it comes to areas such as access to specialist healthcare, relationships and careers.

In a post #MeToo world, menopause and women’s health more broadly should not be an afterthought. More needs to be done to breakdown the barriers for menopausal women and support them through this time.

Dealing with mental health impact

Dr Harriet Bradley

While menopausal women face a myriad of physical symptoms, a significant and less visible challenge is the effect on mental health. As hormones fluctuate, women can experience mood swings, anxiety and/or depression.

According to the Menopause and the Workplace report, produced by the House of Commons Women and Equalities Committee, over 60 per cent of women experienced anxiety or depression as a menopause symptom, while nine per cent say they had suicidal ideation.

Menopause also affects emotional wellbeing with a study by Family Law Partners finding that 80 per cent of women say perimenopause/menopause symptoms put a strain on their children and/or family life.

Many women find themselves managing these symptoms while trying to continue work and family life as usual, leaving them in a no-win situation.

While many of these health issues are inevitable, better access to specialist services is key to alleviating symptoms.

Additionally, increased awareness and support from family members and employers is crucial for improved wellbeing during the menopausal transition.

Barriers to appropriate healthcare

Disparity in access to specialist menopause services is a key issue and British women face a postcode lottery with 58 per cent unable to access services locally.

While GPs are well placed to deliver primary care for most menopausal issues, specialist support is sometimes required.

Yet, depending on location, women face a disparity in the level of care offered and stretched resources mean that women experience delayed access to specialist healthcare.

There also appears to be a menopause education gap amongst GPs whereby 30 per cent of women feel their doctor doesn’t know enough about it. Training issues can be addressed through ensuring menopause education is delivered at all stages of medical training.

The toll on working women’s careers

Women of menopausal age – on average between 45 and 55 – are the fastest growing demographic in the UK workforce. Yet many of these experienced and highly qualified women are considering leaving or have left work because of their menopausal symptoms and the lack of support from employers.

One million women in the UK have left their jobs due to menopause, which has knock on effects on household finances, the gender pay and pension gaps as well as the number of women in leadership positions. More importantly women are forced to leave their careers early, often with detrimental impacts to their finances, health and self-esteem.

In my industry, 30,000 female doctors in the menopausal range have significantly reduced their hours or left medicine altogether. This is a worrying statistic – in addition to the loss in medical workforce at a time when we need more doctors.

Without female healthcare professionals who have lived through and understand patient needs, menopausal care will likely worsen. It also leaves fewer women in the profession to advocate for better employer support.  So, what can be done to help address these challenges?

Increasing understanding and the reach of health services

Digital health can play an integral role in scaling and improving menopausal care, helping to overcome accessibility issues and provide greater education and information. For example, video GP appointments can reach those in areas where access is otherwise difficult, thereby helping to mitigate the disproportionate menopausal barriers caused by the postcode lottery.

Online resources and tools are a great way to empower patients and upskill GPs by providing them with the most up-to-date information for effective menopausal treatment. Adaptive digital content and information enables healthcare professionals to provide tailored resources and personalisation to help women get on the right treatment pathway.

Livi, for example, offers on demand virtual training sessions covering topics from menstruation to menopause, for healthcare professionals and GPs across the UK.

Cultivating inclusive environments

Better education and awareness are also needed for employers, colleagues and family members to reduce the burden on individuals and create supportive and inclusive environments both at work and at home.

Workplace menopause policies can also help to provide recognition, remove stigma and encourage conversations, as well as clearly signpost support. Lastly, employers should consider flexible and sustainable career options for women.  

As a fundamental part of the female experience, menopause can no longer be ignored – especially if we are to close the gender health gap.

Businesses, governments and the healthcare industry need to work together to increase understanding of menopause and provide access to appropriate healthcare as well as provide better support for women in the workplace.

It is time to properly address the challenges that a significant proportion of women continue to face on a daily basis.

 

Harriet Bradley is a practicing NHS GP and medical director at Kry, Europe’s largest digital health provider.

Opinion

How tech in retail can improve customer experience

By Victoria Roberts, Victoria Roberts Marketing

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Tech in retail is transforming the shopping experience. Despite the popularity of online shopping, brick-and-mortar retailers are investing in technology to support steady revenue and customer loyalty.

Technology in Retail: Changing Shopping Habits

With technical advancements in a wide range of industries, many people estimated that in-person visits to clothing stores would soon die out because online shopping offered more convenience. 

Retail footfall year-on-year change in the UK April 2024, by location.

Retail footfall saw a decrease of 7.2 percent in April 2024 in the United Kingdom (UK), driven by shopping centres.

However, retail businesses have the potential to attract more customers than ever before if they embrace the opportunities new technologies have to offer. 

Here’s how tech in retail can improve the customer experience for the better. 

Streamlined Checkout Process

One of the many great things about technology is its ability to streamline time-consuming tasks.

We all know the frustration of standing in line at the checkout while the person at the till counts their cash at snail’s speed.

It’s frustrating and takes up precious time.

Retailers are aware of this and they know it’s causing a loss in customers. So, they’re taking action. 

Now, retailers are utilising the benefits of technology to streamline the in-store checkout process.

Payment solutions like a portable card machine let customers purchase through contactless payment either by tap-to-pay on their phone or contactless cards. 

Card machines can help speed up your overall checkout time, reduce long queues in your store and incentivise impulse purchases.

Additionally, with many card machines for small businesses being portable, retailers can accept payments from anywhere – whether in-store or at a pop-up event. 

RFID Tags

RFID tags are essentially sensors that allow retailers to manage a real-time inventory.

RFID tags track items as they are taken off shelves and moved from one place to another.

RFID tags are a great way to monitor products and customer habits so that the in-store experience can be optimised to boost sales and increase convenience. 

RFID tags are also being used to improve the customer experience by providing product information, allowing customers to request new sizes, and even including the ability to call store assistants for some in-person support.

This high-tech solution is transforming the way people shop and supporting retailers with their inventory management like never before.

Smart Screens

Smart screens have been around for a while now.

You’ve likely come across them when filling up your drink at a restaurant and choosing from the array of options. 

However, smart screens aren’t just limited to restaurants.

They’re now available in retail; improving the customer experience by supporting a more convenient shopping experience.

Clothing retailers are utilising touchscreen technology to help customers view products and build their wardrobes.

Smart screens offer retail customers the convenience of online shopping in-store.

By enhancing the customer’s experience in this way, retailers are seeing an increase in sales and customer loyalty.

Self-Service Machines

Self-service machines have been in supermarkets for many years now.

And they’ve made quite the impact, reducing queues and eliminating the need for small talk at the till.

Reports reveals the number of self-checkouts in supermarkets have increased from 53,000 to 80,000 over the past five years

But now, self-service machines have made it into retail stores and they are changing how shoppers checkout. 

While retail stores offer in-person assistance at the till, many people are shy to approach real people and would rather purchase their shopping without any interaction.

Retailers hoping to boost customer satisfaction and retention are utilising this technology to improve their service.

Digital self-scanners in retail stores allow shoppers to look up products, scan prices, and purchase items independently.

There’s no need to ask for help or stand in a queue at the till.

This allows for a seamless shopping experience and keeps customers returning time and again.

Chatbots

Chatbots in retail stores are harnessing the convenience of technology to offer the convenience of an in-store shopping assistant.

Rather than trailing around the store in search of help, customers can communicate with a Chatbot and receive an immediate and personalised service.

Whether it’s a question about sizing, prices, or an item’s availability, chatbots are a great way for retailers to offer one-to-one customer support without hiring extra staff. 

What’s more, this kind of customer service can become tiring for humans who get fed up answering the same questions repeatedly.

So, Chatbots are a great alternative. They allow customers to receive support as and when they need it.

Click and Collect Services

We all love the convenience of click-and-collect at the supermarket.

Someone else does your shopping, bags it, and all you need to do is pick it up? Yes, please! 

Now, click and collect is being introduced in retail stores to help retailers market their products, boost sales, and sell to more customers. And it’s working.

The click-and-collect economy in Northern Ireland is worth over £1.34bn.

Click-and-collect technology isn’t just a convenient, money-saving option for customers, it’s also a great way for stores to attract more customers through their doors. 

In-store Virtual Reality Experiences

Retail brands are harnessing the power of virtual reality to heighten the in-store shopping experience.

Virtual reality allows shoppers to explore a product within a virtual environment.

For example, people shopping for clothes can get a better idea of how they’d look by virtually trying them on. 

Virtual reality is supporting in-store purchases by making shopping more accessible and convenient.

Whether shoppers want to visualise a product in a particular space or they want to understand how an item of clothing might look (but they don’t have time to try it on) virtual reality makes this possible.

Virtual reality gives customers the confidence they need to make a purchase.

Summary

Technology has had a significant impact on people’s lives; changing the way we do almost everything – from shopping and banking to work and social interactions.

And the retail industry is no exception.

As you can see, technology is transforming the way we shop.

It’s improving the customer experience by giving back control which in turn builds trust and increases loyalty. 

Retailers introducing technology into their stores are not only setting themselves apart from the competition, but they’re setting themselves up for success.

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Opinion

The continued struggle for female representation in drug trials  

Dr Janet Choi, chief medical officer at Progyny

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Dr Janet Choi, chief medical officer at Progyny

The exclusion of women from drug trials undermines efforts to ensure equitable and effective healthcare for all individuals.

In 2002, the Women’s Health Initiative (WHI) was forced to pause its study on hormone therapy’s effect on menopause symptoms due to results showing it increased the risk for breast cancer, stroke and heart disease, and thrombotic events like pulmonary emboli.

Over 20 years later, in May of this year, JAMA published a review of this study and determined that, given current available hormone therapy formulations as well as risk/benefit analysis, younger menopausal women may actually derive significant benefits from menopausal symptom relief with appropriately prescribed hormone therapies.

The initial study had looked at women who were older and typically years post-menopause – the average age of the study participants was 63.3 years – and the age-related changing of blood vessels, among other things, may be the key to shifting from greater risk to greater benefit with hormone therapy.

I wish this more measured summary of the study’s findings and recommendations had been headlined back in 2002 – and I imagine thousands of my OB/GYN colleagues and billions of menopausal women over the years feel the same.

Yet, due to these 2002 over-generalised published findings, doctors and patients shied away from hormone therapy, which led to unnecessary suffering for many symptomatic menopausal women.

The irony of the WHI study is that after decades of women being excluded from clinical research, Congress finally passed an act in 1993 requiring that the National Institute of Health (NIH) enrol women and persons of colour in clinical trials.

On the heels of this landmark decision, the intentions of the WHI study were excellent – a first of its kind for women – but may have unintentionally set back women’s health innovation.

The reality

If you’re wondering why we are just now reevaluating and reinterpreting findings made in a 2002 women’s health study you may (or may not) be shocked to learn that while there is growing inclusion of women into research trials, they are still underrepresented in key therapeutic research areas, such as cancer and cardiovascular disease.

Excluding women from drug trials can have several harmful consequences. First, it can lead to a lack of understanding about how medications affect women differently than men, as their physiological responses may vary due to hormonal and metabolic differences, among other factors.

This can result in ineffective or potentially harmful treatments for women. It can also hinder progress in medical research by preventing the development of sex-specific treatment approaches.

Additionally, while the amount of research conducted on the behalf of women has grown in the past two decades, research involving pregnant women has been restricted.

This leads to a limited understanding of how best to medically care for pregnant women: for example, less than 10 per cent  of prescription medications have been studied enough to understand the impact in pregnancy on both the woman and her foetus.

While the NIH and American College of Obstetricians and Gynecologists (ACOG) both acknowledge pregnancy as a “medically complex” state that can alter metabolism of medications, and the course of various diseases, increased pregnancy-specific data needs to be collected to optimise the care of women in pregnancy.

Another recent, glaring case study: initial COVID vaccination trials did not include pregnant women, which led to restrictions on the availability of the vaccines as well as restrictions of the use in pregnant women with dire consequences – as unvaccinated pregnant women are more likely to develop severe COVID infections requiring ICU admissions and are more likely to develop other pregnancy-related complications like preeclampsia and preterm birth.

How do we move forward?

The exclusion of women from drug trials undermines efforts to ensure equitable and effective healthcare for all individuals.

It’s crucial for the government and pharmaceutical companies to put more resources and funding into women’s health so we can have a deeper understanding of how to treat diseases that impact over half of the population, for more female and diverse talent to enter the medical field – either as doctors, researchers, healthcare executives – and to incorporate how biological sex can affect medical treatment into provider education.

And, for pregnant women, the answer was proposed by ACOG back in 2015: “A more careful examination…points to the need for evidence-based consideration of pregnancy exposure in research rather than broad exclusion of all pregnant women”.

If evidence demonstrates minimal risk to the foetus as well as potential benefit to the pregnant woman, why should she be denied the right to give informed consent to enrol in a clinical trial?

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Opinion

‘Women are left in limbo’: how telemedicine can cut down NHS gynaecology waiting times

By Kat James, director of new projects at Consultant Connect

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Almost 600,000 people in England are waiting for gynaecology treatment. It is clear the current system is not fit for purpose.

The NHS, across the board, is struggling to reduce waiting lists, but gynaecology health, in particular, has been sent to the back of the queue.

Referral numbers are about 60 per cent higher than pre-pandemic, which represents one of the three highest specialties in terms of volume increase since pre-COVID.

Not only are women left feeling neglected, but longer wait times also result in them needing more complex treatment or even emergency admissions to hospital.

Then, there is also the impact on family life, work, and women’s mental health. A survey of the Royal College of Obstetricians and Gynaecologists found that four-fifths (80 per cent) of women said their mental health has worsened due to the wait and that one in four of those whose mental health had deteriorated, pain was given as a reason.

More than three-quarters (77 per cent) of women said their ability to work or participate in social activities had been negatively impacted.

One of the main stumbling blocks impacting patient waiting times is the disconnect between primary and secondary care. Often, patients who have faced long waits for their appointment are discharged after their first hospital appointment and told that their care is best taken care of by their GPs.

The good news is that new ways of working better connect primary and secondary care and ensure patients receive the right treatment first time. If applied at scale, these solutions considerably reduce waiting lists.

For example, giving GPs immediate access to speak to a consultant on the phone for specialist advice and guidance for their patient. In ordinary circumstances, a GP would have to call the hospital switchboard or send a written advice request which might take days to be answered.

Often, these queries would go unanswered or aren’t transferred to the correct department, resulting in patients being referred sometimes unnecessarily or presenting at a busy A&E department.

Technology like Consultant Connect allows GPs to directly “hunt down” a specialist consultant from a pre-defined rota for expert advice via a phone call, ensuring GPs can direct their patients to the right care first time. This service is available for gynaecology in almost 50 NHS areas across the country.

In Coventry, for example, a 54-year-old patient presented with obvious advanced gynaecological cancer. While the two-week wait referral had already been made, the GP couldn’t move the appointment sooner than 14 days later.

Meanwhile, the patient started deteriorating, and the GP considered an urgent admission. The GP used Consultant Connect and, within seconds, was connected to a gynaecologist, who then arranged for the patient to be scanned that day. The patient got the care they needed and avoided an acute admission.

In June 2023, the service expanded to cover a menopause advice and guidance line as referral data in one local area showed increased referrals relating to menopause-specific questions, many of which did not require to be seen in a hospital setting.

This meant that trusts weren’t seeing patients who needed to be seen, and patients with menopause symptoms were on waiting lists for a prolonged duration without management plans.

With the new Consultant Connect Menopause line, GPs can get through to a consultant with special interest in menopause matters within 26 seconds.

Data shows that 87 per cent of calls resulted in the GP receiving “enough” advice for their patient to benefit from an immediate treatment plan via their GP rather than waiting for a hospital appointment with a specialist unnecessarily.

Another way to tackle the wait problem is to leverage remote ways of working, which opens access to a new pool of workforce that otherwise wouldn’t exist.

Consultant Connect runs a network of NHS consultants who review gynaecology referrals remotely, with no need to travel to local hospitals and with consultants choosing their own working hours. This is often attractive to consultants who work part-time in hospital or are on parental leave, for example.

For patients, it means they get access to treatment plans faster: the remote working consultant determines the urgency of a referral and writes up a management plan, which means that treatment can start immediately.

Often, the health problem can be resolved through this plan, and for those still needing to be seen, it means they come to their first appointment on a more informed basis.

At the same time, it ensures patients are on the correct pathway, and any diagnostic test needed for a diagnosis are initiated in a timely manner.

Last year, Consultant Connect’s team triaged over 5,000 gynaecology referrals across the UK, resulting in 43 per cent of referrals being safely removed from the waiting list.

Many of these patients were returned to their GP with a treatment plan devised by the consultant. By fast-tracking urgent cases, women are not put through unnecessary stress and pain while waiting to be referred to a gynaecologist. Among these referrals, one in ten cases were upgraded to the urgent and suspected cancer pathways.

By reviewing current systems to make them more joined up and to allow for efficient ways of working, we can speed up care for women and make sure that clinicians have the right tools to help the NHS deal with the mounting gynaecology backlog.

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