Significant disparities exist in HRT access, availability and affordability across LMICs, with urban-rural gaps further compounding inequities, underscoring the urgent need for inclusive, equitable strategies in menopausal care and women's health policy in resource-limited settings.
Key Findings
Results
68.9% of pharmacists reported that HRTs were available for dispensing in their respective countries, with wide variation across the six LMICs surveyed.
Nepal reported the highest proportion of HRT availability at 92.7%.
Nigeria reported the lowest proportion of HRT availability at 42%.
Other countries surveyed included Malaysia, Sri Lanka, Tanzania, and Ghana.
The survey was conducted from January 1 to March 31, 2025, with 331 total pharmacist respondents.
Results
HRT costs varied widely across the six LMICs, with Sri Lanka reporting the highest prices and Malaysia the lowest.
The study assessed HRT pricing as part of the questionnaire covering availability, pricing, and perceived barriers to use.
Cost was identified as one of the key barriers to HRT access under the category of economic constraints.
Wide cost variation across countries highlights affordability as a major equity concern in LMICs.
Results
Key barriers to HRT use identified by pharmacists included low health literacy, economic constraints, and limited healthcare access.
These barriers were identified through an anonymous online questionnaire completed by pharmacists across six LMICs.
Urban-rural gaps were noted as further compounding inequities in HRT access and availability.
57.4% of respondents were based in urban areas, suggesting potential underrepresentation of rural perspectives.
Methods
A total of 331 pharmacists across six LMICs participated in the cross-sectional survey, with relatively balanced distribution across countries and sexes.
Country distribution: Ghana (18.4%), Sri Lanka (17.5%), Tanzania (16.9%), Nepal (16.6%), Malaysia (15.4%), and Nigeria (15.1%).
Respondents were almost equally distributed between sexes, with 50.8% female.
Most respondents were aged 26–35 years (49.0%).
The majority worked in private community pharmacies (41.7%) or government hospitals (32.6%).
57.4% were based in urban areas.
Background
HRT remains underutilised and under-researched in low- and middle-income countries despite its potential to alleviate menopausal symptoms.
The study was conducted as part of the Global Menopause Project (MARIE Sri Lanka WP2a).
Pharmacists working in community, hospital, and private sector settings were recruited across Malaysia, Sri Lanka, Nepal, Nigeria, Ghana, and Tanzania.
The questionnaire was piloted prior to dissemination and assessed HRT availability, pricing, and perceived barriers to use.
Pathiraja V, Kurmi O, Toh T, Eleje G, Tweneboah-Koduah F, Mbwele B, et al.. (2025). Exploring the availability and acceptability of hormone replacement therapy in LMICs using insights of pharmacists (MARIE Sri Lanka WP2a).. Scientific reports. https://doi.org/10.1038/s41598-025-18083-x