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

Abstract

Background: Historically, menopausal symptoms have been hugely under-treated and under-reported, with many women struggling to manage intrusive, bothersome symptoms which can significantly affect quality of life. In the past couple of years, awareness of the impact of the menopause has risen in the public health agenda but many women are still not receiving adequate information and support. Aim: To gain an in-depth understanding of the barriers that impact women's access to treatment and uptake of hormone replacement therapy (HRT). Design and Setting: Qualitative study with perimenopausal and menopausal women, general practitioners (GPs) and gynaecologists in the UK. Methods: Sixty-minute in-depth interviews conducted with 20 menopausal women, 30 GPs and 10 gynaecologists. Data from the interviews were analysed thematically. Results: Barriers to seeking help for menopausal symptoms include: a lack of knowledge of the full range of symptoms, stigma, embarrassment and the belief that it is part of normal ageing. Previous negative experience in accessing advice or treatment discouraged women from pursuing help. There are substantial differences in the beliefs and attitudes towards the menopause amongst GPs and often a lack of confidence in prescribing HRT. Secondary care services can consequently be overwhelmed by an explosion in uncomplicated referrals which could be effectively managed in primary care. Conclusion:There are barriers at each point in the management pathway: from women not feeling empowered to seek medical advice, to some women feeling their symptoms are dismissed by healthcare professionals (HCP); or HCPs not recognising some of the less common menopausal symptoms, not offering options for treatment, both hormonal and non-hormonal, or offering onward specialist referral for complex issues outside their expertise. There are multiple opportunities to address these gaps in knowledge, including the use of HCP education and culturally appropriate leaflets to reach a wider range of perimenopausal and menopausal women.

Knowledge, Awareness, Attitudes and Practices toward Perimenopausal Symptoms among Saudi Females

“…Therefore, there is a need to explore factors that determine active perimenopause knowledge in Middle Eastern societies. Reported barriers to seeking help for menopausal symptoms include a lack of knowledge of the symptom’s full range, stigma, embarrassment, and normalization of the menopause phenomenon [ 19 ].…”

General practitioners’ and women’s experiences of perimenopause consultations: A qualitative evidence synthesis protocol

“…A meta-ethnography was chosen as the most suitable approach to enable the development of a conceptual understanding of the experiences of perimenopausal consultations as experienced by both GPs and women in the context of general practice. Given the surge of attention given to menopause and perimenopause in the media 20,21,34 as well as primary qualitative research 25,[35][36][37] conducting this qualitative evidencesynthesis is timely. As recommended 32,38 a research team with suitable expertise and skills has been established to conduct this meta-ethnography.…”

“…It has been said that increased media attention has empowered women to discuss their experiences more openly and seek medical help, increasing requests for prescriptions for hormone replacement therapy from GPs 24 . There has been concern expressed by some GPs in the UK, that recent media attention has not only resulted in a significant increase in women seeking HRT but also younger women requesting blood tests 25 that may not be clinically useful 18 .…”