Breaking down barriers for prescribing and using hormone therapy for the treatment of menopausal symptoms: an experts’ perspective

ABSTRACT

Introduction

Around 80% of women suffer menopause-related symptoms that affect their daily activities and quality of life. Menopausal hormone therapy (MHT) has proven to be beneficial in relieving these symptoms. Nevertheless, only 20/30% of symptomatic women seek treatment. This has resulted in neglect of a generation of healthcare professionals’ (HCPs) education in menopausal medicine and a reduction in the prescription of MHT in menopausal women for over two decades.

Areas covered

The aim of this article was to identify the main barriers that HCPs face for prescribing MHT and menopausal women for using it. Six European experts in menopause agreed on the profiles of women that benefit from MHT and proposed strategies to break down these barriers.

Expert opinion

The most important barrier for HCPs was deficient knowledge of the true evidence-based information, with inadequate training regarding the efficacy and safety of personalized MHT and the real benefit/risk ratio in the treatment of symptomatic women. For patients, fear of developing breast cancer was identified as the single most important barrier. Breaking down barriers is possible, by providing appropriate training and education to HCPs and women. This should result in fully informed, evidence based, shared treatment decisions by women and their physicians.

KEYWORDS:

• Barriers: fear of breast cancer
• inadequate menopausal education
• menopausal hormone therapy
• menopausal women
• hormone therapy use misperceptions

Article highlights

• The most important barrier for HCPs was a deficient knowledge of the true evidence base, with inadequate training of HCPs regarding the efficacy and safety of a personalized MHT and the real benefit/risk ratio in the treatment of young, otherwise healthy symptomatic menopausal women.

• Other barriers identified were the overestimated risk of breast cancer, misleading information about safety, lack of knowledge about the risks of not treating symptomatic women, lack of interest in women’s health, and available time for menopausal consultations.

• For women, fear of breast cancer was identified as the single most important barrier, followed by a lack of knowledge and misperceptions about MHT use. Misleading information from the media and the community and poor social opinion on hormones, especially related to safety and quality of life, and possible side effects were identified as the important barriers for women using MHT.

• This lack of understanding has resulted in a failure to discuss treatment options with women and has led to unnecessary suffering of untreated symptomatic women and to an exposure to higher risk of long-term metabolic consequences.

• Breaking down these barriers is possible, by providing appropriate training and education to HCPs, including gynecologists and GPs, and to women. This should result in fully informed, evidence based, shared treatment decisions by women and their physicians.

• In addition, other stakeholders such as the media, national or international menopausal societies, pharmaceutical companies, and decision makers should be involved in breaking these barriers with a global approach.

Acknowledgments

Writing assistance for this article was provided by Content Ed Net (Madrid, Spain) with funding from Viatris.

Declaration of interest

S Rozenberg has received travel and consultancy fees from Viatris, Abbott, Bayer, Eurogenerics, Gedeon Richter, Takeda, Theramex, UCB, and Will-Pharma. N Panay declares speaker’s bureau for Abbott, Bayer, Besins, Gedeon Richter, Kora, Meda, MSD, Mylan, Novo Nordisk, SeCur, Shionogi, Theramex and Viatris, and advisory committee for Abbott, Bayer, Besins, Kora, Meda, Mithra, MSD, Mylan-Viatris, Novo, SeCur, Theramex, Shionogi and Viatris. A Cano declares honoraria for educational activities from Theramex, Abbott, Viatris, Shionogi and Italfarmaco, they are a member of the advisory board of Theramex, Viatris, Astellas and Italfarmaco, and past President of the European Menopause and Andropause Society. S Gray has received honoraria for speaking/education from Bayer, Consilient, Gedeon Richter, Theramex and Viatris and advisory fees from Bayer, Consilient, Exeltis, NovoNordisk, Shionogi, Theramex and Viatris. She is an executive director of the Primary Care Women’s Health Forum. K Schaudig has received honoraria for lectures or participation in advisory boards as well as reimbursement for travel expenses and research funding by the following companies: Astellas, Bayer-Jenapharm, Bésins, Exeltis, Gedeon Richter, Hexal, Viatris, Novo Nordisk and Theramex. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This article was funded by Viatris