ccessing equitable menopause care in the contemporary NHS: a qualitative study of women's experiences

BACKGROUND: Women from lower socioeconomic status and minority ethnic backgrounds have earlier onset and more complex menopause symptoms. Hormone replacement therapy (HRT) has grown in popularity in recent years, however there are stark disparities in those who access HRT. Rates of use in deprived areas and for Black and Asian women are significantly lower than that of White women and those in more affluent areas. AIM: To explore women's experiences of menopause and accessing primary care, as well as how perceptions and approaches may be shaped by cultural norms, to gain deeper understanding of factors shaping approaches to managing menopause and HRT prescribing patterns. DESIGN & SETTING: Qualitative study with women recruited from general practice and community networks. METHOD: In-depth semi-structured interviews and focus groups with women experiencing menopause (n = 40) were conducted between October 2023 and March 2024. Purposive sampling allowed a breadth of experiences and thematic analysis was conducted. RESULTS: Three themes were developed in relation to women's experiences of accessing menopause care: 1) 'Contemporary contexts' shaped women's experiences; managing menopause alongside high workloads and caring responsibilities posed challenges perceived as distinct from previous generations; and there was heightened awareness, reduced stigma, and mixed views regarding HRT; 2) 'How menopause care is experienced' demonstrated how consultations about menopause were emotionally charged, many felt they would have to advocate for HRT (if they wanted it), and some felt frustrated with the lack of options available; and 3) 'Cultural and economic background influences on menopause help seeking' included how some women from Black or Asian backgrounds did not discuss menopause within their communities. Mistrust of medical institutions and treatments, as well as lack of representation, was problematic for Black and Asian participants. Some women worried about stereotyping during consultations. CONCLUSION: The findings outline how menopause may be particularly disruptive to modern women, demonstrate how women are often dissatisfied with the options available, and highlight key areas, such as communication about HRT benefits and/or risks, which could be improved in primary care settings.