New study highlights equity gap in accessing inclusive menopause care across the UK

Researchers explored how women experience menopause care within the NHS, focusing on inequalities shaped by ethnicity, socioeconomic status and cultural norms.

21 October 2025

A pioneering study published in the British Journal of General Practice has revealed deeper understanding behind factors shaping approaches to managing menopause and HRT prescribing patterns.

The MenopauseGAP study - led by chief investigator Dr Sarah Hillman (University of Birmingham), co-applicants Dr Claire Mann (University of Warwick) and Dr Abi Eccles (University of Oxford), alongside a multidisciplinary team of researchers from the University of Warwick, University of Oxford, and University of Birmingham - proposes a range of recommendations to ensure equitable access to menopause support and hormone replacement therapy (HRT).

The qualitative study involved in-depth interviews and focus groups to allow for an in-depth exploration into a range of women’s experiences of menopause. Using a diverse sample of 40 women aged 40-60, researchers were able to examine a diverse range of women’s experiences in accessing primary care, their approaches to managing menopause, as well as their views on how social and cultural backgrounds shape clinical experiences.

The team worked closely with women who are community leaders and/or had experienced menopause symptoms. They facilitated recruitment via established networks, including support groups and organisations such as Cysters and Black Women in Menopause, who commented on findings, helped to develop recruitment materials and advised on terminology.

The study identified three overarching themes of the participants’ experiences

1. Context of care

Modern women face heightened responsibilities, including juggling careers and caregiving commitments, which can intensify the impact of menopause. While awareness has grown, participants expressed concern over the commercialisation of menopause products and confusion about credible information, and felt they would benefit from GPs being able to offer clearer guidance.

The study also revealed that concerns about the risks or side effects of taking HRT, particularly cancer, remain prevalent. While some women felt confident in their understanding of the treatment, others were fearful or confused due to outdated or unclear information; or feeling that the information was not relatable.

2. Experience of menopause care

Many women reported facing emotionally charged consultations, often feeling they had to advocate strongly for HRT or modify their behaviour to avoid being stereotyped. Satisfaction with treatment options varied, with some women offered antidepressants or other treatments instead of HRT, whilst others actively sought alternative and complementary therapies for a variety of reasons.

3. Social background influences

Cultural perceptions often discourage help-seeking; in some communities, menopause is seen as a natural process and part of life that does not warrant medical attention. Many Black and South Asian participants noted how conversations about menopause were rare or non-existent within their communities and highlighted the lack of relatable information and representation in healthcare materials, which led to disengagement or wariness.

Our findings show that initiating sensitive conversations about menopause and its management options, especially with women from underrepresented groups, can make a real difference in patient outcomes and satisfaction.
Dr Sarah Hillman, University of Birmingham.

Commenting on the study’s findings, Dr Sarah Hillman, Clinical Associate Professor of Women’s Health and Primary Care, University of Birmingham, said, “We must recognise that menopause care is not one-size-fits-all. Cultural sensitivity, representation, and clear information are key to ensuring all women receive the support they need.

“GPs should not assume that all women will advocate for themselves. Our findings show that initiating sensitive conversations about menopause and its management options, especially with women from underrepresented groups, can make a real difference in patient outcomes and satisfaction.”

Dr Abi Eccles, University of Oxford, added, “Menopause is a natural process, but for many it can be profoundly disruptive; this is often compounded by contemporary problems and expectations of modern women, such as higher workloads alongside caring responsibilities.

“Our study shows that while awareness of menopause has increased in recent years, access to care is not equitable. Having a system where it is assumed that women will advocate for access to treatment, means some do not access equitable care. Our findings show how women from South Asian and Black communities may be less likely to discuss menopause within their communities or consider menopause a problem to seek healthcare for. This appears to be reinforced by a lack of representation, some mistrust of medical institutions, as well as preferences for more holistic approaches.”

Dr Claire Mann, University of Warwick, said, “Our findings show that menopause care is not reaching all women equally, for a variety of factors. Future work to improve menopause care within the NHS should include targeted and intersectional health education for both patients and clinicians; especially for women who may want holistic treatment but can’t access this due to the limitations of current consultation frameworks.”

Nina Kuypers, PPIE and founder of Black Women in Menopause, added: “It's clear that current care provisions are failing to capture a whole range of experiences and voices of those experiencing the menopause, resulting in multiple demographics of people - especially those within Black and South Asian communities - being left behind to struggle in silence or excluded from conversations.

“We need to redefine how the menopause is being represented; everyone deserves a personalised, ‘menopause-centric medicine’ approach to their care. Moving forwards, I hope studies like the MenopauseGAP can make people aware of the diversity of menopause experiences within different ethnic groups.”

Funded by the National Institute for Health and Care Research (NIHR), the MenopauseGAP study highlights the urgency of addressing inequalities in menopause care and ensuring that all women, regardless of background, can access informed, compassionate, and culturally sensitive support.

Notes for editors

For media enquiries please contact Holly Young, Press Office, University of Birmingham, tel: +44 (0)7815 607 157.

Notes to editor:

The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, educators and more than 40,000 students from over 150 countries.
England’s first civic university, the University of Birmingham is proud to be rooted in of one of the most dynamic and diverse cities in the country. A member of the Russell Group and a founding member of the Universitas 21 global network of research universities, the University of Birmingham has been changing the way the world works for more than a century.

The MenopauseGAP

This project, The MenopauseGAP, is funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR 204354). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Led by chief investigator Dr Sarah Hillman (University of Birmingham), co-applicants Dr Claire Mann (University of Warwick), and Dr Abi Eccles (University of Oxford), alongside a multidisciplinary team of researchers from the University of Warwick, University of Oxford, and University of Birmingham - proposes a range of recommendations to ensure equitable access to menopause support and hormone replacement therapy (HRT).

It comprises of two papers, which can be accessed online via the British Journal of General Practice:

A qualitative study of GP clinician experiences

A qualitative study of Women’s experiences

About the University of Warwick

Founded in 1965, the University of Warwick is a world-leading institution known for its commitment to era-defining innovation across research and education. A connected ecosystem of staff, students and alumni, the University fosters transformative learning, interdisciplinary collaboration, and bold industry partnerships across state-of-the-art facilities in the UK and global satellite hubs. Here, spirited thinkers push boundaries, experiment, and challenge conventions to create a better world.

About the University of Oxford

Oxford University has been placed number one in the Times Higher Education World University Rankings for the ninth-year running, and number 3 in the QS World Rankings 2024. At the heart of this success are the twin pillars of our ground-breaking research and innovation and our distinctive educational offer.
Oxford is world-famous for research and teaching excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research, alongside our personalised approach to teaching, sparks imaginative and inventive insights and solutions.

About the National Institute for Health and Care Research

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

Funding high quality, timely research that benefits the NHS, public health and social care;

Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;

Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;

Attracting, training and supporting the best researchers to tackle complex health and social care challenges;

Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK international development funding from the UK government.

Featured staff

Dr Sarah Hillman
Clinical Associate Professor in Women’s Health and Primary Care
Staff profile for Sarah Hillman, Clinical Associate Professor in Women's Health & Primary Care, 125 Anniversary Fellow, School of Health Sciences, University of Birmingham
Email: s.c.hillman@bham.ac.uk