Menopause is being added to NHS health checks: what you need to know

Towards the end of 2025, the government announced a plan to include questions in primary care NHS health checks in England that aim to increase awareness of menopause, effects of symptoms and impact on health.

This decision followed lobbying by menopause activists and politicians, as well as a long-standing drive by healthcare professionals to encourage menopausal health to be viewed as a marker for future health as well as a time of hormonal flux and physical change.^1. 

Positive actions at the time of menopause transition can reshape cardiovascular risk, bone density, cognitive and physical wellbeing and mental health.² Integrating menopause into NHS health checks signals recognition of this and, if done well, signposting could improve quality of life for many.

The clinical opportunity

Timing is crucial. Women typically enter perimenopause in their mid 40s, often at the same point that NHS health checks are offered to assess blood pressure, cholesterol, weight and diabetes risk.³   These present a clinical opportunity, inviting clinicians to provide evidence-based information and direct patients to other health care professionals if help is needed, particularly for symptoms.

Who conducts the health checks?

NHS Health Checks are often done by nurses but might be done by nursing assistants, associates or other allied health care professionals. It will be an opportunity to raise awareness and signpost patients to further help and education. The critical question is are nurses prepared?

Why menopause?

Everyone born with ovaries will go through menopause. The UK average age is 51 years, but there are some ethnic differences, both in the age of menopause and in symptoms experienced. Vasomotor symptoms (mainly flushes and sweats) are the most common but there is a myriad of symptoms attributed to menopause, affecting physical and mental well-being, examples include:

• Vasomotor: flushes, sweats
• Genitourinary: bladder frequency, urgency, nocturia, and vaginal dryness.
• Cognitive: concentration issues, memory lapses ("brain fog"), and sleep disturbances.
• Physical: skin itching, weight gain, and tiredness

Sometimes it is hard to know which of these are truly hormonal and which are consequences of other symptoms – the so-called domino effect. The impact for an individual is still that they can experience a time of physical unrest, anxiety and sometimes symptoms can be so severe that activities of daily living, including work are affected.

Is a couple of questions enough?

NHS health checks are not the place to be carrying out in depth menopause assessments or discuss therapy options with those with symptoms. Signposting will be key and practices that undertake health checks will need to ensure that staff asking ‘menopause questions’ know the usual signs of menopause, can reassure, educate and inform enough that those who need it feel comfortable to make another appointment. There will need to be an availability of clinicians, often GPs or nurses, to take these consultations. They will also need to be aware of so called ‘red flags’, which they must identify if they are not to miss very important clinical situations in relation to menopause.

Red flags

During the health check, women might disclose episodes of post-menopausal bleeding. This is bleeding in those over 50 years in whom periods have been stopped for a year or more. This is of significant medical importance. Even with one episode, investigations, such as a transvaginal ultrasound, are required. Furthermore, ongoing assessment of the endometrium might also be needed.

A 40-year-old might say that her periods stopped a few years ago, despite no hormonal contraception. Even if she feels well, this should alert healthcare providers for premature ovarian insufficiency (POI). Moreover, the health consequences of POI – which can include menopausal symptoms, fertility issues, and long term negative impact on cardiovascular and bone health if left untreated – should not just be ignored.

A patient might mention very heavy or prolonged bleeding or bleeding after sex, each of which might be suggestive of pathology. This too needs to be followed up.

What do nurses and others need to consider if asked to do health checks?

There could be a large number of requests for menopause consultations because of this intervention. Is the practice ready for that, who will see these individuals after the health check?

Do those who are doing the health checks understand the menopause transition, what is normal, what is not? Are they familiar with hormone replacement therapy; the benefits and risks for most women, when and how it may be used? It is vital that those on the frontline receive education around menopause if they are to use that very short moment of contact to be useful.

What resources will you use for signposting? Practices need to agree on sources of information – is it evidence based, in line with NICE and local clinical guidelines? Is it accessible for your patient groups? Do you need languages other than English, resources other than written? This all needs to be prepared.

What about equity of access?

Evidence from marginalised groups tells us that there is a lack of relevant information for them, that there are barriers to access in health care settings, and an absence of data in these groups.

Such groups include:

• Disabled and neurodivergent communities
• Ethnic minority communities
• LGBTQIA+ communities
• People living in poverty or homelessness
• People who have experienced domestic abuse
• Women and people in prisons

If the NHS Health Check is to be truly effective, the onward care must be culturally specific and relevant to those who are often underserved by traditional healthcare models.

Is this only England?

While England is the only nation with the specific "NHS Health Check" brand (the 40–74-year-old screening), Scotland and Wales have launched their own distinct specialist programmes to improve menopause care. Under the Women’s Health Plan (2026-2029) in Scotland, each health board aims to have a menopause specialist and the NHS Inform resource has been updated for easy access to accurate information for all.⁴ In Wales, the aim is to have a Women’s Health Hub across every health board.⁵ In Northern Ireland there are proposals for a Women’s Health Plan underway and it is currently at the research and listening stage.

Conclusion

The inclusion of menopause in the NHS Health Check is more than an administrative update. Used well, it could be a brief opportunity to start to transform how we support women. It sends a clear message that menopause matters. By making support accessible early on, we can shift away from reacting to symptoms only when they become a crisis and move toward a model of proactive, long-term health management. It’s not the whole answer to excellence in NHS menopause care but it’s a step in the right direction.

As nurses, we are uniquely positioned to lead this transition. Our role goes beyond ticking a box – it is about providing the space for a conversation that can change the trajectory of a patient’s long-term health, from cardiovascular and skeletal protection to physical and mental well-being.

Kathy Abernethy MClinSci RN, is director of the menopause course (education for nurses) and of Coombe Menopause Clinic, South West London. Trustee and past Chairman of the British Menopause Society and Registered BMS Menopause Specialist. 

A version of this article was first published on our sister title, Nursing in Practice.

References

1. British Menopause Society Council https://pubmed.ncbi.nlm.nih.gov/21693497/ June 2011
2. Lobo, R. A., et al  Prevention of diseases after menopause: Climacteric: Vol 17 , No 5 – Get Access June 2014
3. NHS England NHS Health Check – NHS.  Updated Aug 2023
4. Scottish Government Women’s Health Plan: Phase Two 2026-2029 2026-2029  Jan 2026
5. NHS Wales The Women’s Health Plan for Wales – NHS Wales Performance and Improvement Dec 2024