The research, published in BJOG: An International Journal of Obstetrics & Gynaecology, brought together evidence from 53 studies conducted across more than 20 countries to explore who is most and least likely to use HRT. Drawing on data from hundreds of thousands of women over several decades, the study is the largest review of its kind and offers a global snapshot of menopause care.
What emerges is a clear pattern of inequality. Across countries and healthcare systems, HRT use varied widely, but certain groups of women were consistently less likely to receive treatment. Ethnicity stood out as one of the strongest factors. On average, Black women were around half as likely to use HRT as White women, while women from other non-White ethnic backgrounds also had substantially lower uptake. These gaps persisted even when data from different regions were combined, suggesting that structural barriers – rather than individual choice alone – may be shaping access to menopause care.
Health conditions also played an important role. Women living with obesity, diabetes, or a history of stroke or venous thromboembolism were significantly less likely to use HRT. While caution is appropriate for some medical conditions, the authors note that modern clinical guidance recommends alternative HRT formulations for higher-risk groups. The findings therefore raise concerns that some women who could benefit from treatment may not be receiving it.
Dr Jenny Hirst, Senior Research Fellow in the Department and senior author of the study, said:
'Menopause affects everyone differently, but our findings show that who gets access to treatment is not equal. Too often, women’s background or health status appears to influence whether they are offered or take up HRT, rather than their symptoms and individual needs.'
Read the full story on the Nuffield Department of Primary Care Health Science website.