There are moments that feel, in real time, like genuine cultural shifts. Davina McCall sitting in front of a camera in 2021 and talking frankly about menopause was one of them. Two million viewers. Pharmacies reporting surges in HRT requests. Women describing the feeling of finally being seen. The conversation around menopause, which had been conducted largely in whispers for generations, suddenly had a mainstream platform and a visible permission to exist.

Four years on, it is worth asking the question that tends to get lost in the ongoing momentum of awareness campaigns and awareness months and awareness everything: what has actually changed?

The honest answer is: some things, and not enough.

The conversation

This is where progress is most visible and least deniable. Menopause is now discussed in newspapers, on radio programmes, in HR meetings and, occasionally, in Parliament. High-profile women including Lisa Snowdon, Jo Whiley and Gabby Logan have spoken publicly about their experiences, extending the cultural permission that McCall's documentary established. The Equality and Human Rights Commission has released formal guidance on menopause in the workplace, outlining both support options and legal obligations for employers. A Menopause Employment Champion was appointed by the government, a role that did not exist five years ago.

The stigma has not disappeared. But it has shifted. Women report feeling less alone in naming their experience, and that is not nothing.

HRT access

This is where the picture becomes more complicated. The documentary's immediate effect on HRT demand was dramatic, but demand running ahead of supply created its own problem. The subsequent HRT shortage, which left women unable to access prescriptions they had only just been encouraged to seek, was a significant failure that sat awkwardly alongside the official narrative of progress. Supply issues have since improved, and the introduction of the annual HRT prepayment certificate in 2023, which capped costs at around £30 per year for all HRT prescriptions, was a meaningful practical step. But access remains uneven across regions, GPs remain variably informed, and the women who need specialist care still face waiting lists that can stretch to years.

Workplace policy

This is where the gap between conversation and reality is most stark. Bonafide's 2024 State of Menopause report found that 76% of women said they had no workplace accommodations for menopause. Seventy-six percent. In the year that followed one of the most significant public conversations about menopause the UK has ever had.

Some large employers, HSBC, Channel 4, Deloitte among them, have introduced menopause policies, manager training and internal support structures. These are genuine developments and they matter. But they represent a fraction of the workforce. For the majority of women, the experience of managing menopause symptoms at work remains what it has always been: private, unacknowledged, and absorbed into the general performance of being fine.

Helen Tomlinson, the UK's first government menopause employment champion, remains optimistic about the direction of travel. "We are the generation that will make women's health in the workplace an everyday conversation," she says. That may be true. But everyday conversation and everyday support are not the same thing, and the distance between them is where most women are currently living.

Women leaving the workforce

This is the metric that matters most and is hardest to shift. The Faculty of Occupational Medicine estimates that nearly eight in ten menopausal women are in work, which means the scale of the issue inside organisations is significant. What we do not have is reliable, longitudinal data on how many women are reducing their hours, turning down promotions or leaving the workforce entirely because of inadequately supported menopause symptoms. The anecdotal evidence is substantial. The systemic data is not, which makes it easier for the problem to remain underprioritised.

What we do know is that the financial penalty for women who leave is severe and lasting. Average earnings drop by 4.3% in the four years following a menopause diagnosis, a figure that compounds over time and contributes directly to the gender pension gap that follows women into retirement. The cost to employers of losing experienced senior women is estimated to exceed £1.5 billion annually. Neither figure has meaningfully improved since 2021.

The verdict

The cultural shift has been real. Menopause is no longer unspeakable, which matters. But being spoken about and being properly supported are two different things, and for the majority of women navigating this transition at work right now, the conversation that has opened up around them has not yet translated into the practical conditions that would make the experience genuinely different.

That is the honest state of play. Progress worth acknowledging, and a long way still to go.

For guidance, resources and support across every stage of menopause, visit QVC UK's Menopause Your Way hub.