Author’s note: Please note, I have decided to use the word ‘women’ for simplicity within this research, whilst recognising that menopause can affect anyone assigned female at birth, regardless of how they identify.
My name is Kat Frere-Smith, and I am a third-year National Institute for Health and Care Research (NIHR) Applied Research Collaboration Kent, Surrey and Sussex (ARC KSS) funded PhD student from the University of Kent. My current research investigates the barriers women face to accessing appropriate information and support around menopause. As part of Menopause Awareness Month that took place in October, I have written this article for Inspire the Mind (ITM). Menopause marks the end of the menstrual cycle, when the ovaries stop producing as many hormones, and it is actually a point in time 12 months after the last period. This can either occur naturally or because of surgery, radiation or chemotherapy. Women can experience symptoms related to the hormonal changes ahead of menopause, whilst they are peri-menopausal, and post-menopause.
I set out to hear from some of the more under-resourced and under-researched populations in the South East of England (including those living in poverty and from minority demographics), in areas where health inequalities are prevalent.
Discussing the big news recently
Have you noticed that there has been a shift over the last few years, with menopause becoming more commonly spoken about on social media and on the TV? Celebrities, like Davina McCall, sharing their menopause journeys has certainly contributed. In many ways this has been a good thing, breaking down the taboo around the subject. However, as the discussion has grown so has the risk of misinformation, sometimes leaving women feeling unsure of what to do if they experience symptoms.
This month Dr Louise Newson, the self-branded ‘Menopause Doctor’ and founder of the Newson Clinic, published a 66-page report called 'Women's Experiences of Perimenopause and Menopause'. The report emphasises the need for women to be able to access safe, effective, evidence-based treatments. It talks about historic gender bias in medical training and clinicians misdiagnosing menopause symptoms - prescribing antidepressants, painkillers and sleeping tablets when perhaps what might be needed is a hormonal treatment. It looks at the potential impact of menopause on workforce productivity, highlighting that a fifth of all NHS employees and a quarter of GP employees are women of menopausal age. It raises lots of important points.
In the same month, however, the BBC aired a Panorama documentary called ‘The Menopause Industry Uncovered’, which focused on Dr Newson’s private menopause clinic and featured stories from several women who felt the clinic had put their health at risk by prescribing them higher than licensed levels of hormone replacement treatments (HRT). In response, many news articles were published, with some suggesting the Panorama episode was a ‘headline-grabbing shock story’ that could stop women taking HRT and that the real scandal around HRT has been overlooked.
The frenzy of debate generated by the Panorama programme illustrates the challenges women frequently face when it comes to the menopause. It is too often the case that many are left confused about who to trust and what to listen to when it comes to accessing support and advice.
Dr Newson’s report was based on a survey of nearly 6000 respondents, 96% of whom were white, 43% stated they had already seen a menopause specialist and 79% of them were already on HRT. Getting this number of respondents to a survey on the menopause in the UK is unprecedented, and it certainly offers further insight into women’s experiences. However, the survey’s lack of representativeness highlights the challenges we have in trying to understand the experiences of the women in our diverse communities across the UK.
A lack of diversity, inclusion and representation
A noteworthy response to the Panorama documentary came from the team at @blackwomeninmenopause who wrote that they were unimpressed by its lack of diversity, inclusion and representation. They shared that 'Moving forward, we must widen the paths and provide equitable support to ensure that all - regardless of background, race, ethnicity, gender identity, disability or financial means - have the tools and guidance' to access menopause care.
In 2023, the British Menopause Society published the report 'Menopause in ethnic minority women', which drew attention to the limited research evidence of menopause experiences in British ethnic minority women and highlighted the need for more research to understand the impact of race and ethnic differences on women’s menopause. The 2022 Fawcett Report showed that black and other ethnic minority women were more likely to experience delays in diagnosis and treatment than their white counterparts. This year’s Health of the Nation Report in Relation to HRT told us that Black and Asian women are far less likely to be prescribed HRT than white women. Researchers at the University of Warwick and the University of Oxford are currently undertaking some valuable work around bridging the gap in menopause care for minority ethnic women.
What are the other barriers women face to accessing information and support?
This lack of diversity and inclusivity in menopause research and care is mirrored in varying levels of awareness and knowledge of menopause and access to support. Financial strain has been identified as the variable most strongly and consistently related to menopausal symptoms; women facing substantial financial limitations lack access to health care and related resources.
Those with a chronic disease and those who are obese/overweight also tend to suffer from more severe symptoms. Meanwhile, we see a longer duration and increased severity of symptoms in women with a lower socioeconomic status, and women with low educational levels tend to be more severely affected by menopause.
We know that those who are less educated and with lower family incomes have less knowledge of the menopause and HRT, and are less likely to access any educational material on HRT. In addition to this, the evidence tells us that GP practices in the most deprived areas prescribe HRT at a rate 29% lower than those in the most affluent areas.
We know that women want to be listened to and given the facts to help them feel informed about treatment options. The majority of menopause-specific research to date has focused on symptoms and there has been less focus on women’s menopause-specific knowledge (their health literacy) or their perceptions of health care, support and treatment options available to them.
And so what? What’s next?
While there has been some research published into the association between menopause awareness, help seeking and demography (such as those cited above), my review of the academic literature has highlighted gaps in the evidence base, particularly when it comes to the experiences of women from low-income backgrounds.
As a result, I set out to collect additional data about women’s understanding of menopause, its symptoms and treatment options, specifically from women from low-income backgrounds. So far, we have collected qualitative data (research that focuses on non-numerical information) through 5 focus groups. These were organised after extensive engagement work, through community organisations with pre-existing relationships with the participants recruited.
My aim is to ensure that the insights generated from the research inform future communication and education strategies directed at women in under-resourced and under-researched communities, and my hope is that the work will contribute to a better understanding of how to provide opportunities to support women from all backgrounds at this stage of their life.
Get in touch
If anyone is interested in finding out more about the research, has any interesting links to share with me, or would like to get in touch for any other reason, please email me at
To read this article on the Inspire The Mind (ITM) website click here.
