Barriers to Accessing Effective Treatment and Support for Menopausal Symptoms: A Qualitative Study Capturing the Behaviours, Beliefs and Experiences of Key Stakeholders

Figures & data

Table 1 Barriers for Women to Seek Help and Access Support

Barriers to Seeking Help	Barriers to Accessing/Accepting Treatment and Support
Lack of knowledge of the full range of menopausal symptoms beyond vasomotor symptoms and how long they might last	Limited information exchange with GPs making it more difficult to diagnose, especially when follicle stimulating hormone (FSH) investigations are “normal”
Misattribution of symptoms to another cause	Perceptions of HRT based on beliefs about risk of breast cancer
Normalisation of symptoms	Beliefs surrounding HRT versus delaying symptoms
Stigma, embarrassment, identity (not wanting to associate with everything the menopause represents) meaning symptoms are not discussed	Limited or no information supporting the decision to use HRT: how to take it, how long for, long-term safety, long-term benefits, concerns not addressed (some HRT prescriptions were not filled because concerns had not been addressed)
Cultural norms around the menopause and symptoms in different ethnic groups	Language of HRT: sometimes described as an additional treatment instead of restoring reduced hormones

Table 2 GP Barriers to Diagnosis and Offering HRT

Barriers to Diagnosis	Barriers to Offering Treatment with HRT
Beliefs/perceptions of the menopause as not an illness but a natural process; deprioritised compared with other “real” illnesses	Belief that the menopause does not require treatment
Clinical restrictions; limited consultation time	Lack of knowledge about HRT and other treatment options
Lack of knowledge/recognition of symptoms other than vasomotor	Lack of confidence in prescribing HRT
Misattribution of symptoms to another cause eg depression	Misunderstandings/misperceptions about HRT in terms of breast cancer risk and a lack of knowledge of health outcome benefits
Avoiding embarrassing/difficult conversations so women are not proactively asked about specific menopausal symptoms such as sexual dysfunction and vaginal issues	Not knowing when to refer for specialist help

Table 3 Barriers to Care and HRT from Gynaecologists

Barriers to Care by Gynaecologists	Barriers to Obtaining HRT from Gynaecologists
Explosion in primary care referrals contributes to long waiting lists and many of these women can and should be managed in primary care	Beliefs and perceptions of treatment; lifestyle management versus HRT- not all gynaecologists treat initially with HRT
Women with complex needs are not referred from primary care including patients with a history of cancer who could still receive some treatment for symptoms	Not all women are suitable for HRT; differences in benefit/risk balance for women of different ages and at different stages of menopause highlighting the need for individualised care
Markedly fewer referrals of women with lower socio-economic status and different ethnic backgrounds	The panacea for all ills; women have unrealistic expectations of HRT treatment