Research shows that white women in England are the most likely to receive HRT prescriptions

Menopausal women from Chinese and Black African backgrounds are about 80% less likely to need hormone replacement therapy than white women, according to a large-scale study.

HRT is one of the most common treatments for menopausal symptoms such as hot flashes, mood swings, poor sleep and vaginal dryness. It can also help maintain muscle strength and prevent osteoporosis.

But a 10-year study of almost 2 million women in England has found worrying inequalities in women’s access to HRT.

Academics from the University of Oxford examined HRT prescriptions issued in England to 1,978,348 women aged 40 to 60 over a ten-year period.

Findings presented Monday at the World Congress on Menopause in Melbourne showed that between 2013 and 2023, almost six times as many white women were prescribed HRT than black women, and more than twice as many women in affluent areas were offered HRT than those who lived in these areas. socially disadvantaged areas.

While previous studies have identified unequal access to HRT, the academics believe this is the first study to quantify the likelihood of getting it, adjusted for age, deprivation and ethnicity.

Over the ten years, they found that compared to their white counterparts, women from a Chinese background were 82% less likely to receive HRT, and women from a black African background were 79% less likely. Women from Pakistani, Bangladeshi and Indian backgrounds were 70%, 64% and 61% less likely to use HRT respectively.

Since 2016, National Institute for Health and Care Excellence (Nice) guidelines have recommended HRT as a possible treatment for menopausal symptoms.

But the study found that the guidance did not improve access to HRT. “(We didn’t find that) women were suddenly all getting the same care since the Nice guidelines came in, and that’s what they should be doing,” said Dr. Jennifer Hirst, a senior primary care researcher at the University of Oxford. “It should have been more of an equalizer, but that’s not what happened.”

In fact, the trend has worsened. Over the five years since 2016, women from Chinese, Black African, Indian and Pakistani backgrounds or women in the most deprived neighborhoods were even less likely to receive HRT compared to their white counterparts and women in the most affluent neighborhoods.

Nina Kuypers, founder of Black Women In Menopause, says: “Many black women tell us that when they go to the doctor they feel rejected or unheard, with their symptoms often misinterpreted or overlooked. Instead of being recognized as part of menopause, their experiences are sometimes attributed to unrelated conditions, such as diabetes or high blood pressure, which are common in the black community.

“There is also a lack of culturally competent care, with many health care professionals not trained in understanding the unique ways menopause manifests across different racial and ethnic groups. Additionally, Black women are often underrepresented in clinical trials, meaning treatment guidelines do not always reflect their specific needs. As a result, they face delays in receiving appropriate treatment for their menopausal symptoms, compounded by socioeconomic barriers that make access to specialized care even more difficult. These factors lead to long-term suffering, further misdiagnoses and a lack of trust in the healthcare system.”

Janet Lindsay, the director of the charity Wellbeing of Women, said the “huge differences” showed a “worrying trend towards a two-tiered system of menopause care”.

Menopause expert and campaigner Kate Muir, author of Everything You Need to Know About the Menopause (But Were Too Afraid to Ask), said: “This inequality is further exacerbated by the fact that black women are more likely to experience symptoms including hot flushes . The latest research shows that hot flashes can increase the risk of poor brain health later in life, making early intervention more important. Asian women have a higher risk of osteoporosis, but are much less likely to use HRT, which is recommended by the NHS to keep bone density high and reduce the risk of fractures.”

Campaigners, including Muir, believe that discussing periods and menopause during the Over 40s health check could make a big difference for all women.

MP Carolyn Harris agrees, but called on the government to go further. She said: “My mission is that every area of ​​social policy recognizes menopause as a problem, that every medical discipline includes comprehensive training for their practitioners to understand menopause, and that every woman has the opportunity to understand what menopause is and what the options are. .”

Prof. Kamila Hawthorne, president of the Royal College of GPs, said the findings were disappointing but not surprising. “Addressing health inequities is a strategic priority for the college,” she said.

Dr. Sue Mann, NHS national clinical director for women’s health, said it is crucial that all women have equal access to support and are fully informed about the risks and benefits of different menopause treatment options, including HRT.

“We know more work needs to be done to raise awareness and reduce inequalities in access, which is why we are rolling out women’s health centers to provide additional care within communities, as well as resources to help women manage their symptoms keep,” she says. said.