Lower HRT prescribing in deprived areas 'suggests large unmet need for menopause care'

Researchers from the University of Warwick found that even after taking into account cardiovascular disease outcomes and risk factors, prescribing of HRT in the most deprived fifth was still 18% lower than in practices from the least deprived fifth.

Their study, published in the BJGP, also showed that there was a significantly higher tendency to prescribe oral HRT as opposed to transdermal preparations in the more deprived practices.

The researchers say their findings highlight inequalities associated with HRT prescribing, and may reflect a large unmet need for menopause care in areas of deprivation. 

Prescribing data

The researchers used prescribing data from GP practices in England for 2018 and compared this with practice-level Index of Multiple Deprivation (IMD) scores. The rate of prescribing in each practice was defined as the number of HRT items prescribed per 1000 female patients aged 40 years and over.

Practices with less than 500 women in this group or which prescribed fewer than 50 HRT items were excluded from the study. The final data set included 6,478 practices with 14,291,989 women and 2,677,613 prescriptions for oestrogen-containing HRT.

After adjusting for the practice prevalence of smoking, obesity, hypertension, diabetes, CHD, and stroke or TIA, practices in the quintile with the lowest IMD score had an 18% lower rate of HRT prescribing compared with the least deprived practices.

The researchers say further research is needed to identify the clinician and patient factors that may explain their results. The cost of prescriptions could be one factor contributing to less prescribing of HRT in more deprived areas, they suggest.

Transdermal HRT

The study also found that proportionally more oral than transdermal HRT was prescribed in areas of higher levels of deprivation – a finding the researchers called 'interesting'.

'Cardiovascular risk (which is greater in areas of higher deprivation) is an indicator that might lead to a higher ratio of transdermal HRT prescriptions (which carries no increased risk of thromboembolism or stroke) compared with oral HRT preparations,' they said. The difference may also reflect patient choice, they added.

Lead author Dr Sarah Hillman from Warwick Medical School said: 'Our research showed that women in deprived areas are less likely to be prescribed HRT and are prescribed relatively more oral and less transdermal HRT, even though transdermal has less risks of side effects.

'The data couldn’t tell us why that is the case, only that there was a difference. That will be investigated in the next stage of the research. However, there is likely to be both clinician and patient factors involved. Access to menopause care is incredibly important. HRT is a medication that can significantly improve symptoms of the menopause.'