Menopause GAP: exploring inequalities in menopause care in GenerAl Practice using qualitative methodology

Problem

In the UK 11 million women are 45 or over. Decreasing oestrogen levels during the menopause lead to 85% of women experiencing symptoms. Women experiencing symptoms have significantly lower quality of life, higher work impairment and higher use of health care services. Many women do not receive the care needed; the Women’s Health Strategy survey showed only 9% felt they had been offered sufficient information about the menopause. Hormone replacement therapy (HRT), is an effective treatment for menopause symptoms. However, women from lower socioeconomic status backgrounds, Black women and those from South Asian ethnicities, although more likely to experience severe symptoms, are much less likely to be prescribed HRT. There is a need for strategies to tackle the mismatch between women’s needs and the care they receive.We explored how women from lesser heard communities’ experience menopause, obtain information and access support. We also aimed to examine issues faced in primary care settings and the roles GPs can play in providing menopause care for all.

Approach

We are conducting in-depth narrative interviews and focus groups with an ethnically diverse group of approximately 40 women who have recent experience of menopausal symptoms, recruited through community organisations or general practices in deprived areas. We have purposively sampled to ensure that participants’ demographics include women living in areas of deprivation and Black and South Asian women. We are conducting focus groups with approximately 15 GPs and practice nurses working in deprived areas. Results will be presented as part of a workshop with women to co-design an information resource for women.PPIEThe views of 114 women were used to design the research. PPI contributors changed research plans to be more inclusive, including using community leaders a modulators of focus groups. We have had ongoing collaborative iterative engagements throughout this project which will continue into the dissemination phase.

Findings

During early analysis we have identified key areas which may influence women’s access to menopause care. The interview data shows how attitudes towards discussing menopause symptoms and menopause care can shape how women seek support. The study also compares women’s experiences of consultations with GPs and GPs’ views about how they can best support women going through menopause.

Consequences

In the short term we will raise the profile of menopause care and women’s unmet needs. We will also raise awareness of the challenges associated with improving menopause care provision in general practice, and through disseminating information to health service policymakers and managers we will aim to inform potential strategies for addressing these. We will use the findings to co-produce a resource for women experiencing menopause symptoms.