Not one size fits all: Accessing menopause care in the NHS

Today, we’re speaking to Claire Mann, a Research Fellow who is based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate Professor based at the University of Birmingham.Title of paper: Accessing Equitable Menopause Care in the Contemporary NHS – Women’s ExperiencesAvailable at: https://doi.org/10.3399/BJGP.2024.0781Menopause awareness has increased in recent years, as well as HRT use, however, this has not been experienced equally. Cultural influences such as stigma, preferences for non-medical approaches, perceptions of ailments appropriate for healthcare, lack of representation, work against women seeking help. GPs should not assume all women who would benefit from HRT will advocate for it. They ought to initiate discussions about potential HRT, as well as other approaches, with all presenting women who may benefit.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.240 - 00:01:12.020Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the bjgp. Thanks for taking the time today to listen to this podcast.In today's episode, we're talking to Claire Mann, a research fellow who's based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate professor based at the University of Birmingham.We're here to discuss the recent paper published here in the BJGP titled Accessing Equitable Menopause Care in the Contemporary NHS Women's Experiences. Thanks, Claire and Sarah, for joining me here today to talk about this work.This study focuses particularly on the women's experience of menopause and accessing general practice and primary care. But I'll point out just before we begin that you've also published a linked paper looking at the clinician perspective.So anyone who's interested in that angle should look up your other paper. But back to this one. Sarah, I wonder if I could start with you first.I wonder if you could just talk us through the focus of the paper here and the kind of disparities that different women might face in accessing menopause care in the UK.Speaker B00:01:13.620 - 00:02:57.750Essentially, this work came about because in 2020, we published a piece of work in the BJGP that looked at prescribing a practice level of hrt.And what we found was that actually, if you were a patient at one of the most deprived practices in England, you were about a third less likely to be prescribed HRT than if you were in the most affluent. What we didn't have at that point in time was data at an individual level, just at a practice level.But it was important that work was done because that really pushed that forwards. But what we didn't understand was what was going on underneath that. So.So we asked the nihr, we wrote a grant for something called Research for Patient Benefit and said, look, we want to explore exactly why there is this disparity, because our feeling as researchers was that it wasn't straightforward and that there was a lot going on, both from the woman's perspective and the healthcare professional's perspective. And we really wanted to know exactly how that was all adding up to this gap in prescribing.What we did was we spoke to 40 women, but we were incredibly mindful that we wanted to speak to women that were less likely on paper to be prescribed hrt. So we tried to speak to women that were from more socially economically deprived areas and also black and South Asian women.So this project really was. Was underlying that. That gap.Speaker A00:02:57.910 - 00:03:31.880Yeah.And I guess, as you said, based on that previous research, you really wanted to get this deeper understanding of what was shaping menopause and HRT management and prescribing patterns.And I think just to sort of move on to what you found, really, I thought that one of the initial things that really stood out to me was the women that you spoke to talked about the menopause and how menopause care has changed over generations and how that impacts how women seek help. And I wonder if you could just start by talking us through this and what the women you spoke to told you.Speaker C00:03:31.880 - 00:05:16.160It's a really interesting study because obviously the time is right to be talking about menopause. It's going through this phenomenal change.And a lot of the women that we spoke to reflected on how that change had impacted their lives and how different their experiences might have been from the. The previous generation. A lot of women talked about when it came to menopause, they wanted to know about their mum and their mum's experiences.That's often a first port of call.But actually what a lot, particularly of the black and Asian women were telling us was that they were experiencing a different life to their own mum, that there were different pressures now, particularly in terms of being career driven, juggling intergenerational family and feeling the pressure of modern life, whilst also trying to manage their own experiences.So the current generation really are quite unique in as far as they've got a whole load of challenges and a whole load of stress that perhaps generations before them haven't had.So when they're having conversations in the family, it's a little bit mismatched because Mum might be saying, well, that's not what my experience was like.But the younger generation is perhaps thinking, well, yeah, because mom didn't, perhaps didn't work full time or, you know, didn't exist in the Western world in the same way as we do now.So it, I think that comes to play for a lot of women, particularly around career development and the fact that so many women in their middle lives now are still working full time and juggling family responsibilities, and that presents an additional stress to then also prioritizing your own health. And that's something that women found difficult to do amongst all those pressures as well, I think, was something they told us.Speaker A00:05:16.810 - 00:05:25.210Yeah. And in some communities it seemed as though there's still quite a lot of stigma around discussing the menopause openly. What did they talk about here?Speaker C00:05:25.610 - 00:06:46.450Yeah, I think obviously menopause is a hot topic and it's being spoken about in lots of ways, but that doesn't mean it's not still taboo for lots of women.Many of the women that we spoke to still hadn't had those conversations within their families because it was still something that was considered perhaps shameful and that they were expected to just deal with. Some of the black women spoke about the stoicism and being expected to be brave and have a high pain threshold.And some of the Asian women spoke about families and fertility and the patriarchy and the way that things are perceived and said that for them, actually having those menopause conversations within their homes was not as easy as it might be perceived. And so having that peer support from within the family, within the communities hasn't developed as strongly yet.It is starting to come through so that women are enabling each other with their own experiences. And where that does happen, it's really powerful.I think the women told us that, you know, peer support is really valuable, family support is really valuable, but it is still a topic that women feel stigmatized and embarrassed sometimes to talk about, particularly if it's not something that they've been open to discussing as they've been brought up through their, through their families.Speaker A00:06:47.180 - 00:07:11.340Yeah, it's really interesting because when we think about maybe the kind of information sources that women might have, so family or community or peer support would really play into that.And I wonder if they talked about that tension from how menopause or seeking help for the menopause might be perceived in the community and how that affected their help seeking behavior to their gps at all.Speaker B00:07:11.900 - 00:09:02.730So I think, I think that's exactly right.Women spoke about how not only how menopause was, as Claire said, talked about or not talked about in their own communities, but actually how any information around menopause in this country, how often they felt they didn't feel represented.And actually if they didn't feel represented, that might be through what was said or an image of what a woman going through menopause might look like or on an advertisement, actually. They just didn't feel a connection there. And therefore they felt, well, this isn't about me.And that was a barrier really for them not going forward to get help.But really interestingly, lots of women spoke about the fact that actually when they'd got to a stage when they felt that they did need help, some of them considered how they might be in sometimes racially stereotyped during that consultation.That was something that for me as a researcher, I thought, crikey, the fact that women had actually...