NHS under fire for menopause drug lottery

Women in some areas three times more likely to be prescribed HRT, analysis shows

MENOPAUSAL women are three times more likely to be offered hormone replacement therapy (HRT) in some parts of the country than others, with the NHS under fire for subjecting patients to a “health lottery”.

An analysis of NHS figures shows a clear link between affluence and access to HRT, prompting warnings that women too often have to be “sharpel-bowed and middle-class” to persuade GPS to prescribe the drugs.

Middle-class women across the South West are the most likely to access therapies, with the provision highest in Cornwall. Stark differences in the provision of HRT across the country leave the poorest areas the worst served, the analysis shows.

Experts raised concerns that draft guidelines for the NHS could exacerbate the problem. They accused the National Institute of Health and Care Excellence (Nice) of “medical gaslighting” in suggesting that symptoms such as hot flushes can be directly treated by talking therapies.

Mariella Frostrup, of Menopause Mandate, said the findings were “appalling” and showed a “socioeconomic chasm” when it comes to menopause.

She said: “Yet again, women are subject to a health lottery that can, let’s not forget, leave them depressed, struggling at work and with relationships, exhausted, and even suicidal, without a prescription for HRT.”

The NHS prescribing data shows that Cornwall and the Scilly Isles, along with Devon, Somerset, Dorset and Gloucestershire, are far more generous in access to HRT than other parts of the country.

The provision in Cornwall and the Scilly Isles for women aged 45 to 60 is three times that of north-east London, the area with the lowest rates in England.

Six out of the 10 areas with the highest prescribing rates are in South West England, with Suffolk and north-east Essex, Sussex, Herefordshire, Worcestershire and Surrey also scoring highly.

Five of the 10 areas with the lowest prescribing rates are in London, along with the Black Country, Birmingham and Solihull, Bedfordshire, Luton and Milton Keynes, West Yorkshire, and the North East and North Cumbria.

It comes as the Nice consults on controversial draft guidance which says menopausal women will be offered talking therapy to tackle hot flushes.

Nice has recommended the use of cognitive behavioural therapy (CBT) for such symptoms, saying it should be offered instead of HRT or in addition to it. Until now, GPS had been told to consider talking therapy to “alleviate low mood or anxiety” that results from the menopause. However, the new draft guidance says cognitive behavioural therapy could reduce the frequency and severity of hot flushes although it admits to “uncertainties” about the quality of evidence to support this.

The NHS prescribing data, which covers the 12 months until September 2023, shows a widening gap in provision between the richest and poorest areas, suggesting that gains getting hold of HRT are mainly among the middle classes. Ms Frostrup said she was concerned that the focus on CBT in the draft guidelines from Nice would “only exacerbate the gap”.

It comes after the Government published a Women’s Health Strategy last August, following pledges to boost access to HRT and cut the price of prescriptions.

The month before the strategy was published, the gap between the most and least deprived areas amounted to 850 units of HRT per 1,000 women aged 45 to 60. Since then it has risen to 950 units, the data shows. The 10 Integrated Care Systems with the best provision have among the highest scores for affluence, while those with

the worst have among the lowest. Tina Backhouse, of Theramex UK and Ireland, a pharmaceutical company that specialises in women’s health, said: “A lot of women have to fight really hard for HRT. It’s important that HRT isn’t seen as just a white, middle-class thing, as something you have to have sharp elbows to obtain. It is so unfair that women have to fight when they are at their lowest ebb,” she said.ms Backhouse added she feared the Nice guidance would be an extra barrier preventing women from getting help, with many GPS already proving reluctant to prescribe HRT. There’s no doubt that CBT generally will help with anyone’s anxiety, inability to get to sleep but many of us fear that this is medical gaslighting. That this is telling women their symptoms are in their mind, not their body,” she said, raising concerns about “medical misogyny”.

“It’s a lottery. When you are denying women the ability to even hold down a job and maintain their life that is cruel.”

Caroline Nokes, chairman of the women and equalities Committee, said: “Sadly, this is exactly the sort of postcode lottery we have highlighted in the Select Committee. We also know that in too many cases women have to be persistent and insistent to get HRT. I’m not against CBT per se, and know for some women it will be a real benefit. But it cannot be used to mask the scale of the problem in getting decent menopause advice and treatment.”

A spokesman for Nice said the draft guidance said that HRT should be offered to women with “troublesome vasomotor symptoms (hot flushes and night sweats)” as was the case in previous guidance, and offered an additional option that CBT could be considered.

They said: “There is some new evidence that CBT can help to reduce some symptoms and how much people are bothered by their symptoms.”

A Department of Health and Social Care spokesman said: “We have put women’s health at the top of the agenda... taking action to increase supply and reduce the cost of HRT.”