Menopause is everywhere. But is everyone being heard?
Menopause awareness is growing, but inequities in access, symptom burden and clinician confidence may leave some women unheard.
As a GP trainee researching inequalities in menopause care, I welcome this growing interest. Yet, I keep returning to one question: who is actually benefiting?
Rising awareness does not guarantee equal access. A 2025 study from England, which looked at almost two million women, found that 23% of white women had at least two HRT prescriptions, as compared to 4% of women in the Black African ethnic group. Prescribing was lowest in the most deprived areas. My research, which followed women after their first recorded consultation for hot flushes/night sweats, found similar differences.
In clinic, I have witnessed many women visibly relax upon being told their symptoms may be related to the menopause. In some cases, all a woman may need is for someone to listen to her, and for her to be given an explanation. Not all women want or need HRT, and prescribing figures alone cannot tell us what women may have been offered and/or refused. The evidence shows profound differences between the various ethnic groups in access to HRT, and to me, this is concerning. I also wonder about the percentage of women who never reach the consultation room at all.
Symptom burden often persists in women who are not prescribed treatment. A US cross-sectional study of nearly 69,000 women in 2024 showed that Black women had more severe hot flushes and night sweats compared to women of other ethnic groups, even after accounting for socioeconomic status. A recent systematic review found that Black women have almost 2 times the odds of developing severe hot flushes and night sweats when compared to White women. These findings may not be directly related to the UK but may suggest that lower levels of prescribing do not necessarily indicate lower levels of need.
There are also barriers to healthcare itself. A 2022 survey in the UK of 173 General Practitioners found that 52% believed their training had not prepared them to adequately advise and treat menopausal women. I would be interested to learn how often informed choices are offered to women when healthcare professionals do not feel adequately trained and prepared to advise on menopause.
I see this as a multi-dimensional problem and therefore, also see this as requiring a multi-faceted approach. Women need accessible information that is culturally relevant. Healthcare professionals need further education to allow them to tailor their practice to address individual preferences. Finally, health care services also need to understand the constraints women face and how this may impact their help-seeking behaviour.
Menopause has never received more attention. The question now is whether that attention is reaching the women who are less likely to be heard.
References
Hirst JA, Mtika WM, Coupland C, Dixon S, Hippisley-Cox J, Hillman S. Inequalities in hormone replacement therapy prescribing in UK primary care: population based cohort study. BMJ Medicine. 2025;4(1):e001349.
Issa A, Hathaway E, Hillman S. Exploring disparities in HRT access in UK Primary Care at symptom presentation [ePoster 35]. Post Reproductive Health. 2026;32(3):199. doi:10.1080/20533691.2026.2715923.
Kochersberger A, Coakley A, Millheiser L, Morris JR, Manneh C, Jackson A, et al. The association of race, ethnicity, and socioeconomic status on the severity of menopause symptoms: a study of 68,864 women. Menopause. 2024;31(6):476–483.
Hoang J, Halliday K, Allen D, Mtika WM, Tranter E, Glover G, et al. Factors Associated With Menopause Symptoms: A Systematic Review and Meta-Analysis. 2026.
Dintakurti N, Kalyanasundaram S, Jha P, Talaulikar V. An online survey and interview of GPs in the UK for assessing their satisfaction regarding the medical training curriculum and NICE guidelines for the management of menopause. Post Reproductive Health. 2022;28(3):137–41.