A leading reproductive and mental health charity announced its inaugural event, Marginalised and Menopausal, shedding light on the unique needs of historically marginalised communities during menopause. Hosted by Cysters at MAC (Midlands Art Centre) on May 11, it aimed to create a safe space for sharing experiences beyond hot flashes and hormones. Experts like Dr Nighat Arif and Dr Aziza Sesay facilitated discussions. Founder Neelam Heera-Shergill expressed pride, hoping to educate and empower marginalised communities. The event aimed to broaden treatment options and ensure voices were heard. It was a significant step towards inclusive healthcare conversations.
Asian Voice spoke exclusively to Dr Nighat Arif about this:
As a doctor specialising in women's health, what unique challenges do you believe historically marginalised communities face during their journey through menopause, and how do these challenges differ from those of other groups?
The biggest issue that marginalised communities face is the fact that they're under-researched because there are very few research projects that look into faith groups, and black and Asian communities. LGBTQ+. those with visual impairments, those who are in neurodivergent or poverty groups, those who are affected by domestic violence and that includes digital poverty as well. So, when those communities are left out of those conversations when it comes to women's health, they don't feel represented. We don't have the clinical data to back up any health initiatives that we want to use for them. Secondly, these groups are then rarely invited to the place of the table to make policies or advice as policies and assumptions are placed on them. And then finally, the biggest thing is that these communities do feel that they're others. So they form their own network of care by doing that. They feel that they don't have any trust in mainstream healthcare. They're like, well, you've done nothing for us. We managed to do it by ourselves. We don't need you. And so what happens is that if there's any misinformation with those communities, it just perpetuates further and further. So they become even more marginalised. The biggest thing we need to do is keep trying to reach out and build bridges to have integration.
The National Institute for Health and Care Excellence (NICE) recently announced Cognitive Behavioural Therapy (CBT) as a potential treatment option for menopausal symptoms. How do you think this alternative therapy could benefit historically marginalised communities, and what are the potential limitations or barriers to accessing this treatment for these groups?
It's important to stress that C BT has been suggested and it's only a suggestion alongside hormone replacement therapy. So it's not that you don't offer first-line treatment, you must always offer first-line treatment to everybody regardless of whether they are marginalised. Beauty, cognitive behavioural therapy is very nuanced when it comes to treatment for menopausal symptoms. And that's based on the studies that have been done by Myra Hunter who led a 10-year C BT research study for women’s breast cancer, you couldn't have HRT. So we know that actually even if you wanted to have CBT, it does work but it has to be alongside the other aspects of care in your toolkit. So hormone replacement therapy might be antidepressants, acupuncture, exercise, nutrition, supplementation, diet, or managing other underlying health conditions. So I'm all for CBT. But it has to be as part of a package of the rest of the care, regardless of whether you're marginalised or not in your experience.
In your experience, how do cultural and societal factors impact the experiences of historically marginalised individuals navigating menopause, and what steps can healthcare professionals take to address these factors and provide more inclusive care?
The biggest thing, as I said earlier is research. Communities don't feel that this is a conversation that's relevant to them, nor is it prioritising health. If you look at South Asian communities or migrant communities that are refugee communities fundamentally just want to survive. So, bothering with hot flushes or aches and pains is the least of their problems when they just want to have day-to-day things. And we are seeing that now in the current climate when poverty is huge because, at the moment, people are just literally fighting between heating and eating. So therefore, their health is at the bottom of the list; having that cervical screening, going for their breast screening, the managing of their menopausal symptoms are at the bottom of the list.
Also, lexicon in language, we don't have words in certain communities in British sign language, there is no word for menopause. We also in certain other languages, Urdu or Punjabi. We don't have a direct word for menopause. We have derogatory words. So again, it's taboo and it's embarrassing for women to talk about their bodies. Finally, education. It’s always education. When you're not educated about the signs and symptoms, or you thought it was just hot flushes and you don't realise that there are about 40 different symptoms of menopause or the fact that you think that that conversation isn't part of what you're experiencing. For example, if you're ADHD and you're menopausal and you're menopausal on top of that, where is the data? We don't have any.
As a GP and educator, how do you approach discussing menopause with patients from historically marginalised backgrounds, and what strategies do you employ to ensure that their unique needs and concerns are addressed in the healthcare setting?
Firstly, understanding the nuances. I get my communities from marginalised groups to tell me how they want to be addressed. You know what their gender preference is, whether they have any cultural things that they've tried listen to the person in front of you because they will tell you what they want and then do what they want you to do. And then also is that plugging into grassroots organisations who already have the trust like Cysters, like black women in menopause, these marginalised communities, understand the nuances and they're able to then educate me as a GP.
