by Kathie Bishop
The Effects of Class on the Menopause Experience
Although my blogs are littered with free advice on how to deal with peri-menopausal symptoms naturally, I recognise that a lot of those options aren’t available to people in the working class because they aren’t free to implement. While I think most people don’t need HRT to deal with their menopause transition, people in the working class are more likely to struggle with anxiety, depression, exhaustion and hot flushes than more affluent people and therefore probably the most likely to need it and here’s why (Muir, 2022).
The cost of eating well
Food is a huge way to support a perimenopausal person through their transition but things like fresh fruit and veg come at a cost. Not only do they cost money to buy but they go off more quickly than canned goods and many ready meals. Most people are concerned about the actual monetary cost of eating healthily but a Harvard study found it costs $1.50/day more to eat more healthily, less than many initially thought (Harvard.edu, 2014). This isn’t a small amount to many living hand to mouth but we also can’t ignore the cost of someone's time. These foods take time to prepare, time someone who is working full time, may not have at their disposal. I’ve seen Lidl are now doing amazing boxes of not-perfect fruit and veg that you can get very cheap but you’ve got to be pretty savvy to figure out what to do with it all before it goes mouldy.
Free labour
It’s also common for people who are spending all their income on rent, bills and food each month have various pressures placed upon to provide their labour for free to support their family whereas others might pay for someone else to do those things (Muir, 2022). People who are in the working class are likely to come from parents also in that situation. This means that when their parents get to the age where they need additional support and care, their children step in to do things like clean their house, do the weekly food shop and more. But people in their middle age often have teenage children to care for, feed and clean up after as well. A patient of mine once called this the sandwich years. Sandwiched between two generations that they must support.
The cost of children
Children are a blessing to most, but as the Roe v Wade issues in America have highlighted, children cost a lot of moola to raise. Poverty and babies go hand in hand for many people. The more babies you have, the worse off you are. A compounding factor on top of this is anyone having to raise children on their own. Single parents take twice the risk of poverty than couples and because women tend to be the primary carers this disproportionately effects women (OPFS, 2020).
What can we do about it?
HRT is a realistic treatment option for people in the working classes who need to continue to work, don’t have time to eat more healthily, and whose families are dependent on their free labour. Ironically, women who get themselves on HRT tend to be healthier and wealthier in the first place and it’s most readily available in postcodes which are more affluent (Muir, 2022). Those people are more able to make natural adjustments like eating better and controlling their stress levels than someone without that monetary availability. I think we should be assessing someone’s suitability for medication free on the NHS not just on their symptoms but also on their ability to mitigate symptoms themselves. I think the NHS should be able to prescribe healthy eating vouchers for those in need (which I think they already do). Ultimately, if HRT was made available over the counter for anyone to buy who has the cash then anyone who really wants HRT and can afford it can get hold of it, this leaves the NHS funds available to those who need it for free and puts the power back in the hands of the woman, over her own body.
References
Muir, K. 2022. Everything You Need to Know About Menopause (but were too afraid to ask). England:Gallery UK
Harvard.edu, 2014. Eating healthy vs. unhealthy diet costs about $1.50 more per day. Available at: https://www.hsph.harvard.edu/news/press-releases/healthy-vs-unhealthy-diet-costs-1-50-more/.
OPFS, 2020. The impact of poverty on single parent families. Available at: https://opfs.org.uk/wp-content/uploads/2020/10/OPFS-briefing-on-single-parents-lived-experience-july2020_edited.pdf