Menopause is an inevitable and natural process that affects biological women. Symptoms are wide-ranging and affect people in different ways, but treatment can help you manage the effects. Here we will check whether private health insurance covers menopause treatment and the support offered by some insurance companies.
What are the symptoms of menopause?
Menopause is when hormone levels change and menstruation stops. This means that you will not be able to conceive naturally (although this is possible with specialist infertility treatment).
Menopause generally starts anytime between the ages of 45 and 55, but it varies from person to person, so it can be earlier or later. Menopause symptoms also vary and you won’t necessarily have them all, but typical features include:
- Irregular periods that used to be regular (although you won’t necessarily be aware of this if you’re on birth control pills).
- Hot flashes sometimes accompanied by dizziness.
- Difficulty sleeping as well as night sweats.
- Palpitations when you can feel your heart beating faster than usual.
- Joint pains.
- Changes in your body (usually weight gain, but if you lose muscle mass, you could also lose weight).
- Skin problems such as dryness or irritation sometimes cause acne because hormone levels change.
- Decreased sex drive, pain in the dryness of the vagina, itching or discomfort during sex.
- Recurrent urinary tract infections (UTIs).
In addition to physical changes, you may also notice mood changes. For example, you may experience anxiety, mood swings and bouts of low self-esteem. Brain fog (loss of memory and concentration) is another common symptom of menopause.
Keep in mind that if you’ve had a hysterectomy or oophorectomy (where your ovaries are removed), your surgery may trigger menopause. However, your consultant should discuss this with you before any surgery.
What is perimenopause?
Perimenopause is the period before menopause when you experience symptoms but still have periods.
Perimenopause ends when you have not had a period for 12 months. At this point, perimenopause becomes menopause.
How can menopause symptoms be treated?
You can treat menopause symptoms with HRT (hormone replacement therapy), which can only be prescribed by a doctor.
If you think you have entered menopause (perimenopause), you should talk to your GP about your symptoms and options. You don’t have to take HRT (and it’s not right for everyone), so talking about what you can do in general can be helpful if you prefer to avoid medication.
What is HRT?
There are two main types of HRT available: one is estrogen only and the other is a combination of estrogen and progesterone. You can receive HRT in several ways, for example, tablets, patches, implants or an IUD. Your doctor will discuss which option you feel most comfortable with, so don’t be afraid to ask about the pros and cons of each.
If you experience other effects, such as a low sex drive, your doctor may also offer treatment that includes testosterone.
HRT is not covered by private health insurance. However, it is offered on the NHS, but you will have to pay for it. The good news is that from April 2023, HRT drugs are significantly subsidized.
You can now buy a subscription certificate (PPC) which entitles you to one year of HRT treatment. There is no limit to the number of items you can claim with your PPC within that year; it currently costs £19.30 and you can buy it here.
If you need medicines other than HRT, you can buy a standard prepaid voucher, which is more expensive at £111.60, but if you have a number of prescriptions each year, this could offer quite a saving. You can buy standard PPC here.
Does health insurance cover menopause treatment?
Private health insurance usually does not cover menopause treatment or HRT prescriptions. Nevertheless, private health insurance with coverage for outpatient services could play a role in the initial diagnosis.
Although many women will receive a diagnosis of perimenopause and menopause from their GP, sometimes additional tests, scans and consultation with a gynecologist are required to make a diagnosis. This could be for a number of reasons, such as being under 40 or perhaps having other symptoms that are not typical. Generally speaking, if your GP doubts the diagnosis, they will probably refer you to a gynaecologist.
Health insurance with outpatient insurance will usually cover the cost of a consultation with a gynecologist
Assuming you have outpatient insurance (and your symptoms are not related to a pre-existing condition) when your GP refers you for further tests, your health insurance should cover the cost of going to private appointments.
Remember, however, that private health insurance will not cover the cost of treatment, so as soon as you are diagnosed with menopause, you will be referred back to the NHS for treatment.
Atypical symptoms and other conditions
Although menopause treatment is not covered by private health insurance, if you experience severe or atypical symptoms that you and your GP think might be something other than menopause, you should be able to use your health insurance as you would normally have it investigated.
Why is menopause treatment not covered by insurance?
Private health insurance covers acute conditions. These diseases can be resolved with treatment, such as bone fractures or hernias. Policies may also cover elective surgery, such as hip replacement.
Because perimenopause and menopause are natural biological processes and not acute conditions, they are excluded from the rules.
Does private health insurance provide any menopause support?
Although HRT treatment is not covered, some insurance providers offer menopause support. This usually includes access to mental health advice and information on managing symptoms through diet and lifestyle. Don’t forget that private healthcare plans usually include 24/7 access to a virtual GP or nurse as standard. So if you have any particular concerns, you can talk to someone sooner rather than later.
Few health insurers offer more tailored support as part of a standard health policy. For example, Vitality policies include an app that provides access to a menopause specialist for one-on-one advice. There are also links to support groups and forums where you can exchange ideas and meet (virtually) other people going through menopause.
Bupa also offers a menopause plan package with tailored advice and support for a year. However, these Bupa plans are not included in the standard policy. Instead, you’ll need to pay for the menopause package, which is currently £299 (you can buy the package whether you’re an existing customer or not).
How can I access private health care when I’m older?
Menopause is a natural part of ageing, which may cause you to think more about your overall health and the benefits of private health insurance.
Not only can policies help you access treatment quickly, depending on the level of cover you have, but they can also allow you to choose where and with whom you receive treatment. Finally, as we mentioned earlier, if you have atypical menopausal symptoms and your GP suspects it could be caused by something else, you can use your health insurance for specialist consultations and tests (assuming you have outpatient insurance).
For more information or to speak with an expert, we can connect you with a regulated broker who can explain your options and help you choose the policy that best suits your needs and budget.
