Equity in Menopause Care
Menopause is often discussed as a universal biological transition. In practice, it is anything but universal. Who is believed, who is treated early and who gains access to specialist care is shaped as much by systems, culture and confidence as it is by hormones.
Across health systems, menopause inequity does not show up loudly. It appears quietly, in delayed diagnoses, inconsistent prescribing, postcode lotteries and women being told to “wait it out” when evidence says otherwise. These gaps matter most for women whose voices have historically been marginalised.
Recent policy and clinical developments have brought these inequities into sharper focus.
In England, menopause has now been confirmed as a priority condition within the forthcoming NHS Online Hospital, enabling women to be referred digitally for specialist menopause care via the NHS App. This shift has the potential to reduce regional disparities, long waiting times and barriers faced by women with disabilities, caring responsibilities or limited mobility.
Digital access, done well, could become a powerful leveller. But equity is not created by technology alone. Without consistent clinical standards, robust escalation pathways and culturally competent care, digital systems risk reproducing the same inequities in a new format.
At the same time, new global clinical evidence from The Menopause Society (USA) has highlighted a stark and long-standing disparity that resonates strongly in the UK. Women with Premature Ovarian Insufficiency (POI) are routinely under treated with hormone therapy, despite this being recognised as replacement care, not optional symptom relief.
For women experiencing menopause under the age of 40, withholding hormone therapy is not a neutral decision. It significantly increases long-term risks to cardiovascular health, bone density and cognitive wellbeing. Yet outdated risk narratives, fear following misinterpretation of historical studies and uneven clinician training continue to influence prescribing decisions. This is not an evidence gap. It is a systems failure.
Taken together, these developments expose a deeper truth. Menopause inequity emerges when care depends on age, postcode, cultural literacy, confidence to self-advocate or the individual clinician encountered on the day.
This reality has particular consequences for Black and marginalised women, who are more likely to experience delayed diagnosis, symptom dismissal and fragmented care, especially where menopause intersects with disability, autoimmune conditions, cancer treatment or surgical menopause. Misinformation and low health literacy further widen these gaps.
Equity in menopause care therefore requires a shift in how systems think and act:
Recognising that early, premature and medically induced menopause require distinct clinical pathways
Reframing hormone therapy as preventive healthcare, not lifestyle intervention
Designing NHS pathways that reflect real women’s lives, not idealised access models
Actively countering misinformation that disproportionately harms younger women and marginalised communities
The recent POI guidance from The Menopause Society also strengthens international momentum to move away from fear-based prescribing. This aligns with broader changes in the United States following reform of hormone therapy warning labels, which acknowledged that earlier risk framing discouraged appropriate treatment. While UK regulation differs, global evidence continues to shape clinical confidence and policy discourse.
For leaders, employers and policymakers, this moment matters. Workplace menopause policies and health equity strategies must go beyond awareness and accommodation. They must engage with clinical evidence, access disparities and the lived realities of women navigating menopause alongside work, leadership and care responsibilities.
Menopause equity is not a side issue. It is a leadership issue, a workforce sustainability issue and a public health issue.
As policy, practice and evidence evolve, the critical question is no longer whether menopause care needs reform, but who benefits first and who continues to wait. Equity must be designed in, measured and held to account.
If this perspective resonated, take a moment to engage with it. Like the post to signal that menopause equity matters in leadership and healthcare conversations. Comment to share where you are seeing progress or persistent gaps in access and understanding.
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