Women in deprived areas are accessing hormone replacement therapy (HRT) on the NHS at nearly half the rate of women in more affluent areas, the latest data shows.

According to analysis by The Pharmacist, just 10% of women aged 45-59 living in the 20% most deprived areas in England were given HRT on the NHS in 2023/24.

This is compared to the 18% of women aged 45-59 living in the 20% least deprived areas of England that accessed HRT on the NHS last year.

And the gap between access in the most and least deprived areas is widening, new data from the NHS Business Services Authority (NHSBSA) reveals.

Some 197,847 women aged 45-59 living in the most deprived areas of England accessed HRT items on the NHS in 2023/24, compared to 435,032 of this demographic in the least deprived areas.

A total of 1,592,922 women aged 45-59 accessed HRT items on the NHS in 2023/24, out of a total 2,692,228 patients from all ages and sexes receiving items covered by the NHS HRT pre-payment certificate (PPC). The medication defined as HRT items by this dataset may or may not be prescribed for the menopause.

'Disappointing and unacceptable'

Lourette Philips, president of the National Association of Women Pharmacists (NAWP), a network of the Pharmacists' Defence Association (PDA), called the persistent inequalities 'disappointing and unacceptable', particularly considering the government's women's health strategy.

'Every individual has the right to equal treatment and access to health services regardless of demographics,' she said.

And she suggested that increased socioeconomic stressors in more deprived areas may lead to increased need for HRT.

'The findings show that the most deprived areas may not get the same access to healthcare or there is a lack of awareness about menopause and available treatment,' added Ms Philips.

Meanwhile, Ayah Abbas, the past immediate president of NAWP, suggested that educating people about menopause 'can help solve a lot of issues and can close the gap'.

'Patients going through menopause need to be aware that they don’t need to suffer in silence and can reach out for help,' she told The Pharmacist.

'Those from deprived communities haven’t got the right language to communicate symptoms'

Community pharmacist Sukhi Basra agreed: 'Health literacy in deprived areas and an ability to articulate their symptoms to get the right care is crucial. Being empowered to explain or even recognise that they are suffering from perimenopause is vital.

'I see this all the time. Those from deprived communities haven’t got the right language to communicate their symptoms sometimes and thus don’t get understood.

'They need access to healthcare professionals they have a rapport with and can understand their needs through good relationships.'

She suggested that the 'accessible and knowledgeable' community pharmacy sector could be pivotal for helping women access care.

Access to HRT a global issue

Meanwhile, Dr Anna ​Robinson-Barella, a lecturer in clinical pharmacy at Newcastle University, noted that the International Menopause Society (IMS) had recently called 'for better collaborative efforts across the globe to make access to HRT and other menopause medicines easier and fairer for all'.

And she added that academic literature was lacking in evidence and perspectives from those who are trans or gender-diverse.

Pharmacies can help 'break the stigma'

Pharmacist Thorrun Govind added: 'People who work in pharmacies tend to be derived from the communities that they're around. So they can be part of breaking the stigma, encouraging more conversations, welcoming people to the pharmacy,' she said.

But she suggested that learning for healthcare professionals could be improved to help women access care, while a more proactive approach could help widen access to HRT.

'There's a big gap in access to HRT for ethnic minorities and those in deprived areas,' Ms Govind told The Pharmacist.

'We need to be better at going to going to these people and sharing the support that we can provide, rather than saying, "No, you need to come to us".'

She highlighted examples of healthcare professionals going to places of worship to help overcome cultural barriers around accessing care.

'A tax on women'

The data relates to items that are prescribed and dispensed by community pharmacies in England.

But Ms Govind highlighted that the numbers of women actually taking HRT as prescribed may be even lower, due to the cost or difficulty of collecting prescriptions.

'This is effectively a tax on women, which pharmacists collect on behalf of the government. We need to scrap the prescription charge [in England],' she said.

The HRT PPC was introduced in April 2023. In its first year, it was used to cover 14.5% of eligible HRT items provided to all demographics of patients in England. And by June 2024 - the most recent data available - this proportion had increased to 21%.

'Those without the agency and means to navigate the system will be left without'

Community pharmacist Ade Williams also noted the cost of prescriptions. 'We must not forget that the products are not free - so having disposable income to spend on your health becomes a barrier,' he told The Pharmacist.

Ongoing medicine shortages could also be further exacerbating health inequity 'so that those without the agency and means to navigate the system to obtain their products will be left without', he suggested.

According to the NHSBSA release, in 2023/24 a total of 57,580 HRT items were dispensed under a serious shortage protocol (SSP), compared to 7,969 in 2022/23 and 208 in 2021/22.

'To deliver comprehensive female health equity, the role and work of community pharmacy, already in these localities, not just to facilitate care but to advocate for patients, remains ever important,' Mr Williams added.

'Trends like this highlight why commissioning local pharmacy services that remove barriers to accessible care are urgently required.'

CPE: 'The introduction of new NHS services comes at a cost'

Janet Morrison, chief executive of Community Pharmacy England (CPE) said that commissioning pharmacies to provide menopause advice – including the supply of HRT through independent prescribing – was a priority in its vision for the sector's future.

But she warned that 'the introduction of new NHS services comes at a cost', and reiterated that community pharmacy funding needed to be stabilised to help pharmacies deliver even current services.

NHSE: 'We know there is more work to do'

Dr Sue Mann, NHS England clinical director for women’s health, said the rise in HRT prescriptions over recent years 'reflects the sharp increase in menopause awareness'.

'It’s encouraging that millions more women are feeling supported to talk about menopause and access the care they need,' she said.

But she acknowledged that 'there is more work to do to increase awareness and reduce inequalities in access'.

'That’s why we’re rolling out women’s health hubs to provide extra care within communities as well as tools to help women to manage their symptoms,' she said.

'HRT is an important option of a raft of treatments that can make a real difference to women going through the menopause, and it’s vital that all women have equal access to support and are fully informed about the risk and benefits of the different therapies available,' Dr Mann told The Pharmacist.