A BMJ Medicine cohort study of nearly 2 million women aged 40–60 in UK primary care suggests that hormone replacement therapy (HRT) prescribing varies by ethnicity, deprivation, and region. Published in September 2025 and drawing on a decade of electronic health records from the QResearch database, the study found that only about 19% of women in this age group received two or more HRT prescriptions; and that uptake differed markedly across population groups. The finding matters because it points to a familiar problem in general practice and women’s health: access to menopause care is not always experienced equally. For clinicians, commissioners, and practice teams, this is useful appraisal material. It shifts the conversation away from whether HRT matters and toward a harder question: who is able to access evidence-based menopause care consistently, and who is not?

Key Takeaway

Across a cohort of 1.98 million women, fewer than one in five received sustained HRT prescriptions over a 10-year period. Patterns of prescribing were not evenly distributed: differences linked to ethnicity, deprivation, and geographical region raise concern that menopause care may still be shaped by structural inequality as much as by clinical need; even eight years after NICE menopause guidance was published in 2015.

Why This Matters for UK General Practice

• Menopause care is now a major primary care workload area, with growing public awareness and patient expectation.
• Variation in HRT prescribing may reflect barriers in access, consultation quality, continuity, clinician confidence, or service design.
• If prescribing patterns differ systematically by deprivation or ethnicity, practices may need to look beyond individual consultations and examine population-level equity.

Questions for Reflection

• Are menopause consultations equally accessible across different patient groups in primary care?
• Could continuity, appointment access, or local prescribing culture be influencing who receives HRT?
• What would an equity-focused review of menopause care look like in a GP practice or PCN?

Bottom Line

This BMJ Medicine paper is a reminder that good menopause care is not only about having effective treatments. It is also about making sure access to those treatments is fair, timely, and consistent across the population.

Source: Hirst JA, Mtika WM, Coupland C, Dixon S, Hippisley-Cox J, Hillman S. Inequalities in hormone replacement therapy prescribing in UK primary care: population based cohort study. BMJ Medicine 2025;4:e001349. DOI: 10.1136/bmjmed-2025-001349