Menopause care for diverse communities: a qualitative study of GP clinician experiences

BACKGROUND: In the UK, there is increasing public awareness of menopause. However, there remain inequalities in its treatment, with lower hormone replacement therapy (HRT) prescribing in areas of social deprivation. Little is known about how healthcare professionals (HCPs) view and understand this inequality. AIM: To explore barriers to, and facilitators of, the provision of menopause care in diverse communities. DESIGN AND SETTING: Qualitative, semi-structured interviews were conducted with HCPs across central England. METHOD: The authors purposively sampled 15 HCPs working in patient-facing roles in areas of high deprivation. An interview schedule was developed, and 11 individual interviews and one focus group were conducted between January and March 2024. The data were subject to team-based iterative thematic analysis. RESULTS: Data were categorised into three key themes: the context of contemporary primary care, delivering menopause care, and limitations of the current approach to menopause care. HCPs reported that awareness of menopause and requests for HRT were increasing, but cultural and ethnic differences were perceived as affecting whether women sought menopause care and/or HRT from their GP. HCPs believed women had high expectations of HRT and felt that discussions around realistic expectations were important. They also emphasised: the difficulty of remaining up to date on menopause care; there being limited time, resources, and ability to refer to specialists; the impact of patients' requests for testosterone; the need for targeted, culturally sensitive patient outreach initiatives and education; and the need for dedicated training for HCPs. CONCLUSION: HCPs believed that differences in levels of menopause care across diverse populations that experienced health inequalities reflected differing demands from communities, as well as a lack of time and funding to provide targeted community-based education on menopause and its treatment. Future work to improve menopause care should include additional research as well as culturally sensitive and targeted health education for patients and HCPs.