GPs with mainly white patients are significantly more likely to prescribe hormone replacement therapy (HRT) to women than those in areas with a high proportion of ethnic minority patients, i can reveal.
New research has laid bare the health inequalities experienced by women of different ethnicities going through the menopause, with doctors blaming a range of factors, including the education of GPs and cultural barriers.
Roughly two million women across the UK take HRT to help alleviate symptoms associated with the menopause, however many women have struggled to access the treatment due to shortages or other barriers.
Now i can reveal how ethnicity also plays a role in access to the menopause treatment on the NHS in England.
Analysis of NHS prescriptions for HRT in England in the final three months of 2022 shows that GPs with the highest proportion of white patients spend more than four times as much on HRT as those in areas with the highest proportion of patients from ethnic minorities.
The research, conducted by data intelligence firm GPrX and shared with i, uses 2021 Census data that shows the ethnic profile of neighbourhoods and compares this to the prescribing patterns of the GPs in those areas.
Overall, it found GPs with the highest proportion of patients from ethnic minorities spent an average of £1,324 on HRT per thousand female patients aged 45 to 60, while those with the highest proportion of white patients spent £5,459 – more than four times as much.
The research comes after i revealed last month that women living in the most deprived parts of England are far less likely to be prescribed HRT than those in the least deprived areas, with GPs in wealthy areas spending three times as much on the hormone treatment.
Ethnicity data can often overlap with data on deprivation, as more deprived parts of England also tend to be more ethnically diverse.
However, the new analysis shows there is still a disparity in how HRT is prescribed to women of different ethnicities based within areas with a similar deprivation profile.
Looking just at practices with patients from the least deprived parts of England, GPs with the highest proportion of patients from ethnic minorities spent £3,702 per thousand female patients aged 45 to 60, while those with the highest proportion of white patients spent £6,549 – or 77 per cent more.
And in practices with patients from the most deprived neighbourhoods, GPs with the highest proportion of patients from ethnic minorities spent just £1,102 per thousand female patients aged 45 to 60, while those with the highest proportion of white patients spent £3,355 – over three times as much.
GPs who specialise in the menopause told i there are multiple reasons for the disparity in prescription rates, including cultural differences, failures to reach different communities and a lack of education among doctors on how different ethnicities experience the menopause.
Dr Radhika Vohra, a GP with a specialist interest in women’s health and the menopause, said: “Different ethnic groups cope differently and they present differently and what we have is a model of menopause care that’s based on a typical Caucasian presentation in a western world.”
While research on this topic is limited, Dr Vohra said there is evidence that women of different ethnicities experience different menopausal symptoms.
“Women from Asian or South Asian backgrounds are much more likely to experience body aches, vaginal difficulties, dryness and palpitations and women from African-Caribbean backgrounds are much more likely to get joint pains and muscle weakness,” she said, adding that many doctors are focussed primarily on hot flushes when it comes to prescribing treatment for the menopause.
Research published by The Fawcett Society in 2020 found 45 per cent of women from black, asian or minority ethnic backgrounds said it took “many” appointments for their GP to realise they were experiencing the menopause, compared to 30 per cent of white women.
Dr Nadira Awal, a GP who also runs a menopause clinic, said cultural differences can prevent women from some backgrounds from seeking support with the menopause.
“It’s quite a taboo subject, particularly in the Asian community. It’s a cultural thing. You don’t moan about your symptoms, you don’t complain,” she said.
“We don’t talk about sex. We don’t talk about periods. We don’t talk about the menopause and hormones. We just get on with life.
“We’re seeing the younger generation talk about it more, but our elders were not and they just put up with it,” said Dr Awal, who is Muslim and gives presentations on the menopause at local mosques.
She said there can also be a language barrier with some patients and that some cultures don’t even have a word for menopause.
Dr Vohra agreed that there is “a variation in different health beliefs among women from different backgrounds and cultures”. She has done translations on materials into Punjabi and said there is no word for ovaries, for example.
“There’s definitely a lack of knowledge around the risks and benefits of HRT and there is a huge reluctance to approach hormones, which is where we’ve got a lot of work to do,” she added.
Prescriptions for HRT have grown dramatically over the past few years, as menopause and the benefits of the treatment have become more widely discussed in the media.
However, Dr Awal said the imagery around HRT and the menopause means women from ethnic minorities can be less likely to associate themselves with the treatment and ask their GP for it.
“Type in menopause into Google and the images you get is just a middle-aged caucasian woman with a fan. You don’t get Afro-caribbean women and you don’t get asian women at all,” she said.
Nina Kuypers, founder of the platform Black Women in Menopause, agreed that the increased knowledge around the menopause is failing to reach all communities.
“When you don’t see people that look like you – not just black people, South Asian and East Asian – you think it only happens to a particular type of person. It’s normally middle-aged, a certain social class, with grey hair,” she said.
Ms Kuypers was inspired to start Black Women in Menopause as she felt there was a “lack of cultural knowledge” within existing support groups for menopausal women, including on things such how products effect women with different skin and hair types.
She said the reasons why black women are less likely to be on HRT than white women are “complex” and include factors such as historical distrust, a lack of research on how the treatment impacts different ethnicities and accessibility.
Labour MP Carolyn Harris, who co-chairs the Government’s Menopause Taskforce, said: “There is an obvious and vital need here to find better ways of reaching women from minority ethnic groups.
“While we are slowly changing the narrative and tackling the longstanding taboos more widely, in cultures where there isn’t even a word for the menopause, this clearly isn’t breaking through enough.
“We cannot allow menopause to be a something that only white middle class women are able to access treatment for. I know there are some wonderful grassroots campaigners who are working really hard to change this and I will also be doing whatever I can to help to level the playing field for all menopausal women.”
A Department of Health and Social Care spokesperson said: “We recognise the menopause can be a challenging time for women, which is why we have put women’s health at the top of the agenda as part of the first-ever Women’s Health Strategy for England.
“As part of this, the government is implementing a bespoke HRT pre-payment certificate to reduce the cost of HRT prescriptions for menopausal women from April 2023.
“The decision to prescribe any treatment is a clinical one and should be based on the patient’s medical needs. It is therefore for the responsible GP or healthcare professional to decide on the most clinically appropriate medication and the most suitable method of supplying it.”