Doctors should not simply put women on HRT for the menopause, says the NHS’s clinical director for women’s health

Dr Sue Mann, NHS National Clinical Director for Women’s Health

Doctors should not simply put women on hormone replacement therapy during the menopause, according to the NHS’s chief women’s health doctor, who says it is not a one-size-fits-all solution to health problems.

The number of prescriptions for hormone replacement therapy (HRT) has increased significantly in recent years, thanks to several high-profile awareness campaigns and government measures in response to the shortage of HRT medications.

Women say the drug helps with 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, says this has created the impression that “everyone” should have the treatment.

She said that women going through the menopause feel like they are ‘missing out’ if they are not prescribed the drugs, which are currently used by around 2.3 million women in England.

And symptoms can be part of a “complex, difficult life” that “may not be solved with medication.”

“It’s a time in life when there’s a lot going on,” she told The Times. “To be very linear about it and say, ‘Oh, we’ll just give you some HRT’… I don’t think that’s very empowering for women.”

She said HRT could be “brilliant” in relieving some of the physical symptoms associated with the menopause, but it should not be automatically prescribed to women experiencing problems such as anxiety.

“I think we’re very restrictive,” she added. “I’ve seen a lot of people respond well, but that’s not all.”

The number of prescriptions for hormone replacement therapy (HRT) has increased dramatically in recent years due to several high-profile awareness campaigns and government actions in response to a shortage of HRT medications.

Instead, HRT should be seen as ‘a suite of options’, with women advised about other treatments, such as talking therapies, if necessary.

Menopause, which usually occurs between the ages of 45 and 55, is the time when hormone levels drop and menstruation stops.

HRT delivers oestrogen and progestogen via tablets, patches or gels.

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

The nationwide shortage of hormone replacement therapies prompted a 2022 campaign by the Daily Mail calling for more women to be made aware of the symptoms and treatment options.

Less than a month after the campaign launched, the government announced a Severe Shortages Protocol, making it easier for pharmacists to substitute HRT treatments if certain medications are out of stock.

The number of HRT prescriptions for menopausal women has increased dramatically in recent years, with 11 million items dispensed in 2022/23 to help manage symptoms.

The Medicines and Healthcare Products Regulatory Agency (MHRA) has also decided to make a particular form of HRT available without a prescription. This is a first in the UK. A scheme that saves menopausal women more than £200 a year came into effect last year.

Earlier this year, several experts argued that menopause is not a disease and that it is “over-medicalized.”

In high-income countries, including the UK, menopause is often viewed as a medical problem or hormone deficiency with long-term health risks “that are best managed with hormone replacement therapy”, the researchers said.

Yet “most women worldwide experience menopause without needing medical treatments,” experts including those from King’s College London say.

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

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

‘The reality is much more complex and varied. Some women report neutral experiences, while others emphasize positive aspects, such as no longer menstruating and no longer having menstrual pain.’