The baffling approach to menopause in Sweden....
And the implications for women in perimenopause and menopause
When you think of Sweden and women… what comes to mind? Possibly, this is where women have achieved big strides towards equality. If we look at EU Gender Equality figures, we might be smiling.
With 83.9 out of 100 points, Sweden ranks 1st in the EU on the Gender Equality Index. Its score is 15.3 points above the EU’s score.
Since 2010, Sweden’s score has increased by 3.8 points, mainly due to improvements in the domains of power and time. However, its score has not changed since 2019.
It certainly equates with my vision of Sweden. Strong women who believed themselves to be equal to men.
I grew up in dark, dreary 1970s London with a Swedish mother. She championed body positivity and openness about how bodies work. Menopause was something talked about on a lower level, but I knew about my mother’s heavy periods and her migraines, which featured large in our lives. And that my maternal grandmother Lily had uterine prolapse that she kept in place with a ring; she never hid that issue.
So, when I arrived in Sweden in 2017, I was tired and burned out from corporate life in Sydney. ( God, I love that city, but she’s like the ever-demanding, beautiful blonde, and it wears you down. You need a break from time to time.) I expected the menopause conversation to be well advanced; it is burgeoning in the UK, and fast forward 5 years, the UK, the US and my home of Australia are advancing menopause conversations at a rate of knots, even into the heart of government.
The UK has led the conversation about menopause. Not only has menopause become a topic of public conversation due to efforts from women in the public eye, but there has also been a lot of positive action among UK workplaces.
In 2022, data from the Chartered Institute of Personnel and Development indicates that 30% now offer some awareness-raising, guidance, or training for managers or a policy.
The US has begun to step up, with Jill Biden spearheading her White House Initiative on Women’s Health, which openly includes menopause. The current Australian government backing motion into a Senate enquiry on menopause is fresh off New South Wales’ Perimenopause and Menopause Toolkit launch. A free resource designed to address women's issues by raising awareness in culturally and linguistically diverse communities.
But in Sweden … people asked me why I am working with menopause; who wants to talk about that? Today, apart from a very good Swedish-language podcast, Klimakteriepodden, and the vocal voice of blogger Monica Björn, the conversation remains quite low-key. I applaud my connection, Helene Strandkvist, for her work on raising the holistic support women need now.
But generally, the conversation is still mostly in women’s magazines and occasionally on the radio and TV. No celebrities or high-profile clinicians are stepping up and championing change in workplaces or the heart of government. And, of course, no separate organisation like the British Menopause Society or NAMS, etc., is working to develop guidelines for healthcare practitioners to provide information to the public.
In fact, health is an area, despite the EU data saying different, where women in Sweden are failed routinely. Women are treated to an inferior degree than men, according to the national guidelines for cardiovascular health.
Women with knee joint osteoarthritis, hip osteoarthrosis and spinal stenosis have more symptoms and greater functional limitations than men after surgery.
The National Alzheimer's Study Swedish Alzheimer Treatment Study shows that women with Alzheimer's disease received three hours less home care per week than men in the same situation.
Therefore, it wasn’t so surprising but still deeply shocking that when a nurse practitioner in Partille, a suburb of Gothenburg (and one of the few areas of Sweden where the local government offices are embracing menopause at work programme) was reported by Dr Carin Algemark Berndt to IVO: The Health and Social Care Inspectorate (IVO) igovernment agency responsible for supervising health care, social services and activities, after a private lecture in September 2023 where Lena shared her personal menopause journey and talked about how she got inspiration for her thesis on women in menopause/menopause care.
Women across Sweden report horrific experiences of gaslighting and ignorance, seeking help from both the public health sector and private gynaecologists. A very common response to women seeking help and asking about hormone therapy is to be told that perimenopause doesn’t exist and that it was "invented by social media 3 years ago". Huge amounts of funds are spent on women going to therapists and being told they have stress-related illnesses. How big is the dark count "sick written due to menopause-related symptoms"?
Stress is, of course, a huge compounding factor in our perimenopause symptoms and definitely needs to be addressed as part of a wider strategy to manage this life transition. But to label everything as stress-related shuts women out seeking the right support in terms of medications, nutrition, exercise and correctly tailored mental health. CBT is huge in Sweden, but if your provider does not know about menopause, how well-equipped are they to help?
Then, a potential watch out. We are moving into a world where we trust outsiders and possibly their data less. The isolationist USA or British Britain isn’t just bad for trade. It damages our ability to seek out and use correct data in the healthcare field, too.
Sadly, Sweden has already shown the way. Women who quote US or UK menopause data to their clinicians are too often told, "There is no SWEDISH research that shows that xx works / is safe / can be used."
Usually, it is an argument to refuse to prescribe, for example, bioidentical hormone therapy, particularly progesterone, or to acknowledge the existence of perimenopause or that mental health factors are part of this transition.
Of course, interesting follow-up questions are right away:
1) What is the difference between a Swedish woman's body and a (for example) French woman's body? Research is missing—it's just not Swedish.
2) Why does the research necessarily have to be Swedish? Because Swedish researchers have better ethics and morals than in other countries? Or that they use more reliable methods?
Maybe in the post, I wanted to highlight that we can sometimes be fooled into believing that gender equality is improving and flowing through to healthcare. If anything, it highlights how much we need to keep fighting for better healthcare for women, more gender-equal healthcare research, and to raise our voices louder. There is a huge need for focused training of healthcare professionals. We truly need Menopause Out Loud!
If nothing else, it shows that there's much to do in one of the world's most equal countries.