Why do women in England’s poorest areas have lower rates of HRT prescribing?

Women in the most deprived regions of England are the least likely to be prescribed hormone replacement therapy (HRT) for menopause, latest data shows.

An NHS Business Services Authority (NHS BSA) report on inequalities in NHS prescribing of HRT, published on 5 August 2026, noted that while the number of women taking HRT has more than doubled since 2020/2021, stark regional variation remains.

In 2025/2026, 2,038,025 women aged 40 years and older were prescribed HRT — up from 781,170 in 2020/2021.

Figure: Growing numbers prescribed HRT

However, the likelihood of a woman receiving the treatment varies hugely, which depends on where she lives.

The NHS BSA data also revealed that, overall, in Core20 areas — the 20% most deprived areas of England — around 8.8 in every 100 women aged over 40 years receives HRT for menopause symptoms. In non-Core20 parts of the country, this figure rises to 14.2 in 100 women, the data showed.

Analysing the gap

When the data is granulated further to local authority (LA) level, even starker differences appear. The London borough of Newham — which is now listed as the most deprived borough in London and one of the most deprived areas in England — reported the lowest HRT prescribing rate at just 4.5 in 100 women aged over 40 years. The next lowest rate was in the London borough of Barking and Dagenham, at 4.7 in 100 women aged over 40 years, with Leicester being third lowest at 6.2 in 100 women.

Meanwhile, Brighton and Hove had the highest rate of HRT prescribing with almost one-quarter (23.4 in 100) of women aged over 40 years prescribed HRT. Waverley, Surrey, had the second highest rate at 21.7 in 100 women, while Elmbridge, also in Surrey, reported 20.8 in 100 women. Elmbridge and Waverly are two of the least deprived areas in England.

These regional variations are part of an ongoing pattern. A previous NHS BSA report, published in October 2024, highlighted that in 2023/2024, women in the most deprived areas of England were prescribed fewer HRT items (324,630 items) compared with those living in the least deprived areas (739,597 items).

Commenting on the data, a spokesperson for the British Menopause Society (BMS) says that it is “disappointing to see little improvement in equity of access to HRT”.

What is driving the disparity?

While the NHS BSA data highlight the disparity in HRT prescribing, there remain questions around why they exist.

The spokesperson for BMS adds: “There is a need for further research into why this is the case.

“It could be a combination of factors, including other medical factors contributing to an avoidance of HRT prescribing by clinicians (for example, diabetes, cardiovascular comorbidity or cancer), poorer access to appointments, and variation in decision-making and confidence, on the part of both providers and patients.

“Language barriers, cultural issues and access to evidence-based information for decision-making also play a part.”

Nuttan Tanna, pharmacist consultant in women’s health and osteoporosis/bone health at London North West University Healthcare NHS Trust, thinks that the variation is about “more than simple deprivation — it’s about much wider contexts”.

“Within north-west London, our Northwick Park specialist service supports a diverse multi-ethnic population — and these women present with different cultural and social views,” she adds.

North West University Healthcare NHS Trust is part of NHS West and North London Integrated Care System (ICS), which had the third lowest HRT prescribing rate when broken down by ICS across England. In this ICS, 9.7 of 100 women aged over 40 years were prescribed HRT in 2025/2026.

In NHS North East London — where the borough of Newham is located — 7.8 in 100 women aged over 40 years were prescribed the medication. In addition to being one of the most deprived areas, Newham is also the most ethnically diverse local authority in England.

“I accept that there is variability in GP/practice staff expertise on menopause and HRT management, but where this is good, I think that this is the reason where, even though our GPs have identified and referred the patient for menopause review, we struggle with, for example, language problems,” Tanna notes.

She also highlights a recent case where a patient did not wish to discuss symptoms with the male translator. There are also cases where “you discuss the HRT risks and benefits, and as soon as you mention the small risk for breast cancer, they decline HRT treatment”, Tanna says.

The ethnicity gap

A report from the Menopause All-Party Parliamentary Group, published in October 2025, revealed “worrying disparities in both diagnosis and treatment pathways for ethnic minority women and people experiencing menopause”, adding that “Black women are five times less likely to be prescribed HRT (5.2%) compared to White women (23.3%), whilst Asian women are four times less likely (6.2%) to be prescribed it”.

However, the report also found that barriers to menopause care rarely existed in isolation.

“Intersectionality — the overlapping and interconnected nature of social categories such as race, class, disability and sexuality — means that many women and people face multiple, compounding obstacles at the same time,” the report said.

The results of a study into inequalities in HRT prescribing in UK primary care, published in BMJ Medicine in September 2025, showed that prescribing rates for two or more prescriptions of HRT were higher in White women than in other ethnic groups, while prescription rates decreased with increasing social deprivation.

The study authors said that it was unclear from their analysis whether the women who received HRT were those with the most severe symptoms of menopause. One explanation for the lower rates of prescribing in some groups “could be lack of awareness, difficulty in describing menopause and symptoms, or not receiving care from a female practitioner for women from some ethnic groups”, the study authors wrote.

They also highlighted the importance of “understanding more about choices made by women and potential preferences for non-hormonal treatments”.

Next steps

Mahendra Patel, chair of the Royal College of Pharmacy’s English Pharmacy Advisory Council, says: “The rise in HRT prescribing is encouraging, but the difference between more and less deprived areas is striking.”

“We should be careful not to assume that lower prescribing means women are missing out on treatment, because prescribing rates alone don’t tell us whether there is unmet need,” he notes.

Patel adds that “cost may be a factor for some women, but it is unlikely to be the whole explanation”.

“Awareness, health literacy, access to services and cultural and social factors, including how menopause is discussed and understood within different ethnic and faith communities, may also influence whether women seek and receive appropriate care,” he continues.

“Understanding what is driving these variations is important so we can identify where women may need greater support.”