World Menopause Day: HRT shortages in parts of England leaves women to ‘suffer in silence’

Women are facing a ‘postcode lottery’ in accessing Hormonal Replacement Therapy (HRT) medication and menopause treatment in England, with some waiting as long as 18 months for NHS treatment, campaigners warn.

A third of all specialist NHS menopause clinics in England are in London and Surrey, analysis shows. The Menopause Support charity said it was a “disgrace” that in 2022 millions of women were being left to “suffer in silence” because they could not access NHS care for the menopause.

Analysis of NHS prescription data by the BBC’s Shared Data Unit out today (18 October) to mark World Menopause Day found wide geographical disparities in spending on HRT drugs across Clinical Commissioning Groups (CCGs) in England between April 2021 and June 2022. West Suffolk CCG spent more per woman (aged 45 to 60) than any other CCG in the country with £14.10 per head, almost three times greater than Leicester City CCG which spent only £5.56 per woman.

HRT replaces hormones that are at a lower level as a woman approaches the menopause.  Not every woman will need or want HRT, and clinicians advise against it in some circumstances - including for patients with a history of certain types of cancer or blood clots.

Additional analysis by the BBC found there were more privately run menopause clinics in England than NHS ones with 59% of CCG areas having no NHS clinics at all. The Department of Health and Social Care said it will consider a recent Women and Equalities Committee target to provide at least one NHS menopause clinic or specialist in every CCG by 2024. CCGs have recently been replaced by Integrated Care Boards (ICBs), which in some circumstances group multiple former CCGs into one larger area.

‘An 18 month wait for menopause treatment’

Diane Danzebrink, founder of the Menopause Support charity, said that because of limited NHS provision women were either having to wait over a year for treatment or pay hundreds of pounds for prescriptions of HRT by going private.

“What we’ve certainly seen more recently is that the lists as far as NHS menopause clinics are concerned have just got longer and longer,” Ms Danzebrink said.

“Unfortunately, there are still some areas that have absolutely no provision. But where there is provision, because of what happened with the pandemic, we now see that those waiting lists are really significant. Some waiting lists at NHS menopause clinics are 18 months. We’re used to them being three to six months, but people can’t wait 18 months.

“The provision isn’t there in terms of quantity, but even where it is there it’s forcing more and more people to seek private menopause care. And that can be very costly. You’re often talking about several hundred pounds, and that can go up sharply with private prescriptions.

“There are going to be millions of women across the country who could never consider the idea of private menopause care and are being left to suffer in silence. In 2022, that’s a disgrace.”

‘Local NHS provision needed for women’

Dr Paula Briggs, who delivers both NHS and private care and is chair elect of the British Menopause Society (BMS), stressed that menopause care should “ideally” be delivered in the community, preferably in women’s health hubs.

“What we need is more baseline education for more GPs,” she said. “The BMS is working very closely with NHS England to produce balanced, peer reviewed, easy to access patient information, and a campaign for all medical professionals to ‘think menopause’.

“If you’ve got a patient in front of you, who is the average age of the perimenopause [the time around which a woman enters menopause], and they’re describing menopausal symptoms like heavy menstrual bleeding and hot flushes and night sweats, instead of thinking ‘could this person have hyperthyroidism’, think menopause because that’s the most likely thing. And I think that potentially will have a huge, positive impact on the number of women being diagnosed early.”

Where are the UK’s menopause clinics?

Patients who seek out treatment for menopause symptoms can be referred to specialist NHS clinics for further care. But further BBC analysis of British Menopause Society data shows 59% of CCG areas in England have no NHS clinics, including all of Devon and Cornwall and large areas in the North. The data also showed almost a third of existing NHS clinics are either in London or Surrey.

Elsewhere in the UK NHS provision is also patchy. In Wales there are nine NHS clinics and three private clinics - with none at all in two of the country’s seven health board areas: Powys Teaching Health Board and Swansea Bay University Health Board. Scotland has 14 NHS clinics and five private clinics, spread across 11 of 32 local authority areas. Northern Ireland has one NHS clinic compared to two private, all located in Belfast or South Eastern Health and Social Care Trusts. You can use the interactive map below to see if there is a NHS or private specialist clinic near you.

‘Improve awareness and understanding’

The NHS said it had increased training for clinicians. A spokesperson said: “The NHS has a Menopause Pathway Improvement Programme, which includes increased learning for clinicians in how they can best support menopausal women, and working with clinical colleges and menopause organisations to improve awareness and understanding.

“A new Menopause Optimal Pathway will also guide clinicians and help women in the workplace during perimenopause, menopause and post-menopause.”

‘Women’s health at the top of the agenda’

A Department of Health and Social Care spokesperson said:  “We have put women’s health at the top of the agenda by publishing a Women’s Health Strategy for England, appointing the first-ever Women’s Health Ambassador, and taking action to increase supply and reduce the cost of HRT.

“We have accepted the recommendations of the HRT taskforce, including the continued use of Serious Shortage Protocols when appropriate to manage shortages, and NHS England continues to work on gathering data on maintaining and updating local formularies in England.

“The UK-wide menopause taskforce is seeking to end the taboos surrounding the menopause and considering the role workplace policies can play in supporting menopausal women, and the government’s Health and Wellbeing Fund is helping expand and develop projects which support women experiencing the menopause to remain in the workplace.”