Getting HRT:
Understanding Your Options and Knowing How Long to Stay On It!
Menopause Is Not the Problem. Being Denied Care Is.
Menopause is already a profound physiological and psychological transition. Hormones shift, sleep fractures, cognition feels unreliable, emotions intensify, joints ache, confidence wobbles. Yet for Black and South Asian women, menopause is rarely permitted to exist as a legitimate medical event. It is filtered instead through disbelief, misinterpretation and systemic minimisation.
The data now confirms what women have been saying quietly for years. Analysis of prescription records covering 1.85 million women in the UK shows that while 23.3 percent of white women are prescribed Hormone Replacement Therapy, only around 5 to 5.2 percent of Black women and 6 to 6.2 percent of Asian women receive the same treatment.
A separate ten-year Oxford study found that Black African and Chinese women were 79 to 82 percent less likely to receive HRT at all.
These gaps persist even after age and health conditions are accounted for. This matters, because it tells us something uncomfortable but essential. It is not about preference, resilience or biology but about systemic under-prescribing by GPs and Clinicians.
How Menopause Gets Erased in Black and South Asian Bodies
Many Black and South Asian women arrive at menopause already carrying years of responsibility families, careers, communities and leadership roles. When symptoms surface, they are rarely met with curiosity. Instead, they are reframed as stress, blood pressure, anxiety, lifestyle or emotional fragility.
Research shows that Black and Asian women are four to five times less likely to be prescribed HRT than white women, even when presenting with the same symptom profiles. That gap is not explained by biology. It is explained by how symptoms are interpreted through racialised and cultural lenses.
When a woman is told she is “too young”, that women in her community “do not usually need HRT” or that she should simply push through, that is not clinical judgement. This is bias dressed up as caution. The result, it delays care at a stage of life where early, informed intervention can make a measurable difference to long-term health.
Understanding HRT Options Without Fear or Half-Truths
One of the quiet injustices in menopause care is how poorly information is shared with women of colour. Conversations are often rushed, risk-heavy and stripped of context, leaving women anxious, confused or discouraged from seeking support altogether.
Modern menopause care recognises that HRT is not one single treatment. Some regimens use synthetic or animal-derived hormones that are well studied but may carry higher breast or cardiovascular risk depending on formulation. Others use hormones that are chemically identical to those produced by the body, such as estradiol and micronised progesterone.
Large studies now show that transdermal oestrogen, delivered through the skin via patches or gel, is associated with lower clotting and cardiovascular risk than oral oestrogen. When paired with micronised progesterone rather than certain synthetic progestins, the overall safety profile improves further. These distinctions matter, yet they are not always explained clearly, particularly to Black and South Asian women, who are often warned about risk without being given the full picture.
How Long Can You Stay on HRT?
Is this the question that too many women are rarely given an honest answer to.
We know the most persistent myth in menopause care is the idea that women must stop HRT after three to five years. That guidance originates from older studies using hormone combinations that are not the same as those commonly prescribed today.
Current evidence tells a different story. Leading menopause organisations now state clearly that there is no universal time limit for HRT use. The guiding principle is simple but powerful. Continue treatment for as long as the benefits outweigh the risks, with regular review.
Starting HRT within ten years of menopause or before the age of sixty has been associated with improved cardiovascular and overall health outcomes, including reduced coronary heart disease and mortality in key analyses. While regulatory language still refers to using the lowest effective dose for the shortest duration necessary, this is not a fixed cut-off. It is an individualised decision.
If a woman’s symptoms persist and her quality of life is improved, there is no medical requirement to stop simply because time has passed.
What Happens When Women Are Not Taken Seriously
Multiple UK datasets now show that inequitable access to menopause care is not accidental. Clinicians frequently lack cultural competence and misinterpret how symptoms are expressed across different ethnic groups. Over time, this discourages women from returning for help at all.
For many women, clarity becomes a survival strategy. Naming symptoms precisely. Naming impact on work, sleep and emotional wellbeing. Naming menopause itself. Asking explicitly for evidence-based options. Requesting review rather than dismissal.
When refusal happens, asking for it to be documented and requesting referral to a menopause-trained clinician or Women’s Health Hub is not confrontation, it is navigation within a system that does not default to listening.
Risk, Context and the Reality for Women
Black and South Asian women are often warned about HRT risks without being offered nuance. Yet risk is not static. It changes with timing, formulation, delivery method and individual health history.
Transdermal oestrogen combined with micronised progesterone has been shown to carry lower thrombotic risk and a more favourable cardiovascular profile for many women. Without this context, women are left to make decisions based on fear rather than evidence or worse, are denied choice altogether.
Keeping a symptom diary, centring menopause as the primary issue and insisting on full explanations are not acts of resistance. They are acts of self-preservation.
Reclaiming Your Menopause Journey
The truth is this. Black and South Asian women have been navigating menopause with fewer resources, less support and more barriers than almost any other group. Women have been underserved by healthcare, silenced by cultural stigma and left out of research and public messaging for far too long.
But by understanding your rights, learning the safest treatment options, recognising the systemic inequalities at play and supporting one another in safe, empowering spaces, women will begin to rewrite the story of what menopause looks like for them. You deserve:
Clear information.
Respectful, evidence‑based care.
Choices, not dismissals and most importantly
To move through this transition with dignity, confidence and sisterhood.
Every time women speak up, they make it easier for another woman to be heard, seen and supported. Together, they are breaking the silence and building a future where all women receive the menopause care they deserve.
If this post has resonated with you, offered clarity or strengthened your understanding of menopause and treatment options, I invite you to share your reflections in the comments and circulate this information within your professional and community networks. By doing so, you help extend vital knowledge to others who may benefit from greater awareness and support during their own menopause journey.
