Menopause care for diverse communities: a qualitative study of GP clinician experiences.

Healthcare professionals reported increasing awareness of menopause and requests for HRT among patients in deprived areas.

• 15 HCPs working in patient-facing roles in areas of high deprivation were purposively sampled across central England.
• 11 individual interviews and one focus group were conducted between January and March 2024.
• HCPs reported that awareness of menopause and requests for HRT were increasing in their patient populations.
• The increasing awareness was perceived as a broader trend reflecting growing public discourse around menopause in the UK.

Cultural and ethnic differences were perceived by HCPs as affecting whether women sought menopause care and/or HRT from their GP.

• HCPs identified cultural and ethnic background as a key factor influencing women's help-seeking behaviour for menopause symptoms.
• This finding emerged under the theme of 'delivering menopause care' in the thematic analysis.
• HCPs attributed some of the inequality in HRT prescribing to differing demands from diverse communities rather than solely to systemic barriers.
• The qualitative approach captured HCP perceptions rather than objective patient-level data on cultural attitudes.

HCPs believed women had high expectations of HRT and felt that discussions around realistic expectations were an important part of consultations.

• HCPs reported spending consultation time managing patient expectations about HRT effectiveness.
• This was identified as a component of the 'delivering menopause care' theme.
• High patient expectations were seen as a challenge particularly in the context of increased media and public attention to menopause.
• Managing expectations was framed as important to ensure appropriate and informed use of HRT.

HCPs reported difficulty remaining up to date on menopause care and expressed a need for dedicated training.

• Keeping current with evolving menopause guidance was described as challenging within the demands of contemporary primary care.
• This difficulty was categorised under the theme 'limitations of the current approach to menopause care'.
• HCPs emphasised the need for dedicated training for HCPs as part of improving menopause care.
• The challenge of remaining up to date was situated within broader pressures of limited time and resources in primary care.

Limited time, resources, and ability to refer to specialists were identified as significant barriers to providing menopause care in deprived areas.

• HCPs emphasised the constraint of limited time and resources when discussing barriers to menopause care delivery.
• Restricted ability to refer patients to specialist menopause services was highlighted as a systemic limitation.
• These constraints were captured under the themes 'context of contemporary primary care' and 'limitations of the current approach to menopause care'.
• HCPs linked lack of funding to an inability to provide targeted community-based education on menopause and its treatment.

Patient requests for testosterone were identified by HCPs as having a notable impact on menopause consultations.

• Testosterone prescribing requests were specifically highlighted as a distinct challenge within menopause care delivery.
• This emerged as a sub-theme under 'delivering menopause care' in the thematic analysis.
• The finding suggests that media-driven awareness may be influencing patient requests beyond standard HRT.
• No specific numbers or prescribing rates for testosterone were reported given the qualitative study design.

HCPs identified the need for targeted, culturally sensitive patient outreach initiatives and education to address menopause care inequalities.

• HCPs perceived that generic menopause information may not adequately reach or resonate with diverse and deprived communities.
• Culturally sensitive and targeted health education for both patients and HCPs was recommended as a future priority.
• The need for targeted outreach was framed as a response to differing community demands and barriers to help-seeking.
• This finding fell under the theme 'limitations of the current approach to menopause care'.

HCPs attributed inequalities in menopause care across diverse populations to both differing community demands and systemic resource constraints.

• HCPs did not attribute inequalities solely to systemic or structural factors but also to variation in demand across communities.
• Lack of time and funding to provide targeted community-based education was identified as a contributing systemic factor.
• This dual attribution — demand-side and supply-side — was a key finding across the thematic analysis.
• The study context included known background of lower HRT prescribing in areas of social deprivation in the UK.