Doctors should not simply ‘recommend women on hormone replacement therapy’ for the menopause, says NHS clinical director for women’s health

Doctors should not simply “recommend hormone replacement therapy” to women during the menopause and it is not a “one-size-fits-all” solution to health problems, according to the NHS’s top women’s health doctor.

Prescriptions for hormone replacement therapy (HRT) have skyrocketed in recent years thanks to several high-profile awareness campaigns and government action to address shortages of HRT drugs.

Women have credited the drug with relief from hot flashes, brain fog, joint pain and mood swings.

But Dr Sue Mann, a consultant and the NHS’s first national clinical director for women’s health, said this had created a perception that “everyone should be on” the treatment.

She said menopausal women feel they are “missing out” if they are not prescribed the drugs, which are currently taken by around 2.3 million women in England.

And the symptoms may be part of a “complex and difficult life” that “a medication may not be able to solve.”

“It’s a stage of life where there’s so much going on,” she told The Times. “Being very linear and saying, ‘Oh, we’re going to give you hormone replacement therapy’ – I don’t think that’s very empowering for women.”

She said hormone replacement therapy could be “brilliant” in helping with some of the physical symptoms linked to menopause, but should not be automatically prescribed to women who experience problems such as anxiety.

“I think we’re being very reductionist,” he added. “I’ve seen a lot of people respond well to it, but it’s not like that everywhere.”

Instead, hormone replacement therapy should be considered as “a set of options,” and women should be advised about other treatments, such as talking therapies, if necessary.

Menopause, which usually occurs between the ages of 45 and 55, is when hormone levels decrease and menstrual periods stop.

Hormone replacement therapy provides estrogen and progestin through pills, patches, or gels.

Dr Mann, a consultant in reproductive health at Homerton University Hospital in London, was appointed NHS clinical director for women’s health in April.

A national shortage of hormone replacement therapy led to a Daily Mail campaign, launched in 2022, calling for more women to be aware of symptoms and treatment options.

Less than a month after the campaign was launched, the government announced a Severe Shortage Protocol, which makes it easier for pharmacists to substitute HRT treatments if certain drugs are out of stock.

The Medicines and Healthcare products Regulatory Agency (MHRA) has also taken the decision to make a particular form of hormone replacement therapy available without a prescription, in a historic UK first, and a scheme came into force last year that saves menopausal women more than £200 a year.

Earlier this year, experts argued that menopause is not a disease and is “overmedicalized.”

High-income countries, including the UK, commonly regard menopause as a medical problem or hormone deficiency disorder with long-term health risks “best managed with hormone replacement therapy,” they said.

However, around the world, “most women go through the menopause without needing medical treatment,” said the experts, including those from King’s College London.

They argued that there is a lack of data on whether health problems are caused by menopause or simply aging.

Dr Lydia Brown, from the University of Melbourne, said: ‘While it is true that some women have extremely negative experiences of the menopause and benefit from hormone therapies, that is not the whole picture.

‘The reality is much more complex and varied, some women report neutral experiences and others highlight positive aspects, such as freedom from menstruation and menstrual pain.’