Throughout this blog I refer to the menopause affecting women. However, I recognise that people who don’t identify as women also go through the menopause.
It’s a life event many women will go through – with 47 million globally this year alone.
Yet real change is needed if we are to achieve equitable menopause care for all.
Many women are facing barriers to good menopause care that leave them feeling frustrated, unheard and for some, soldiering on with severe symptoms that affect their everyday lives.
Before we look at those barriers in more detail, let’s take a moment to remind ourselves what the menopause is. The menopause is when a woman has not menstruated for 12 consecutive months and oestrogen, progesterone and testosterone levels fall.
The average age of menopause is 51. Menopause and perimenopause (the time directly before menopause, when hormones fluctuate but a woman still menstruates) can herald dozens of potential symptoms, including vasomotor symptoms, mood changes and urogenital symptoms. Menopause-related risk factors include cardiovascular disease, osteoporosis, type 2 diabetes and dementia.
Hormone replacement therapy (HRT) is the first-line treatment for menopausal symptoms, but in 2002 the combined oestrogen and progestogen HRT arm of the Women’s Health Initiative (WHI) study was halted in light of findings of a small increased risk of breast cancer and cardiovascular disease.
The move made headlines worldwide, and between 2003 and 2007, HRT users fell from two million to under one million. Yet women in the WHI study took an older type of oral oestrogen and progestogen, and the risk was very low and not statistically significant – but the impact of those headlines was felt for decades.
As a menopause specialist, I use social media and other aspects of my work to reassure women and the general public around the safety and efficacy of HRT. While in recent years there has been a long overdue societal shift away from perceiving menopause as a ‘taboo’ issue, many women still face an uphill battle to access to evidence-based treatment.
The key barriers to treatment
The first is difficulty obtaining HRT. A 2021 survey of 5,000 women by Newson Health Research and Education found 79% had visited a GP and 7% attended more than 10 times before receiving adequate help or advice. Of those women who did eventually receive treatment, 44% of women had waited at least one year, and 12% had waited more than five years.
In terms of treatment, only 37% of women were prescribed HRT and 23% were given antidepressants. This is despite NICE menopause guidelines clearly stating that the majority of women benefit from taking HRT, and that antidepressants should not be given for low mood associated with the menopause.
And then there are the HRT shortages we have witnessed in 2022. An increase in awareness and demand has led to shortages of certain products to the extent that in April 2022, the Department of Health and Social Care established an HRT taskforce to tackle shortages.
Socio-economic status and ethnicity also present major barriers to treatment. One study found the overall prescribing rate of HRT was 29% lower in English GP practices from the most deprived areas compared with the most affluent. In addition, analysis of a large-scale panel survey carried out on behalf of the Fawcett Society of women with current menopausal symptoms found ethnic disparities in UK menopause care. Despite no ethnic differences in terms of symptoms, white British women were twice as likely to be receiving HRT for their symptoms compared to black British and British Asian women (15% for white women compared to 8% for women with a non-white/ethnic minority background).
Of course, this all must change.
More research is urgently needed into the barriers to good menopause care across all backgrounds, for trans and non-binary people and for those coping with menopause and other conditions such as HIV, cancer and mental health conditions.
Every woman, regardless of background, deserves access to high-quality menopause. This starts with access to good menopause education. The menopause needs to be discussed openly in classrooms, workplaces and in the home.
Every contact counts; all health and social care professionals need to have training in menopause symptoms and evidence-based treatment options so they can signpost help to women who may benefit from it, particularly those working with harder to reach communities.
Finally, all women deserve the time and the opportunity to sit down and discuss their symptoms, treatment options, medical history and personal preferences with a healthcare professional.
The days of menopause being seen as a ‘taboo’ subject are long gone, and these changes are needed to safeguard the health and wellbeing of women today and in the future.
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