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Barriers and bridges in menopause hormonal therapy

J Pak Med Assoc. 2020 May;70(5):937-938.

BhartiKalra TejalLathia )SanjayKalra . )Narendra Malhotra 


In this communication, we attempt to simplify the barriers to menopause hormone therapy (MHT) by suggesting bridges over them. We also create an alliterative rubric to assist in clinical assessment of menopause and the rational prescription of menopausal hormonal therapy (MHT). This will ensure comprehensive management of menopause.

Keywords: Menopause, hormonal therapy, barriers.


Menopausal care is a rarely discussed aspect of women’s health. The multiple biomedical and psychosocial domains of menopause are well-known. A wide variety of nonpharmacological nutraceutical endocrine and nonendocrine interventions are also available to manage menopause. Menopausal hormonal therapy can be a boon for the severe vasomotor symptoms in a woman if chosen with care and consideration. In spite of this, menopausal care remains suboptimal. This is especially true in South Asia, where a complex interplay of barriers hamper access and adherence to menopausal care. An understanding of these barriers help plan bridges to overcome them.

Barriers to MHT

Menopausal hormonal therapy (MHT) is not utilized as often as it should be. Lack of adequate knowledge at the level of heath care providers (HCP) (gynaecologists, physicians, family medicine specialists, endocrinologists) is one of the key reasons for underutilization of MHT.The Women’s health Initiative (WHI) study, in which MHT was initiated in late menopause (up to 10 years after onset of menopause), showed an increase risk of adverse cardiovascular events.1 This study had an impact not only in reduction of utilization of MHT but funding for MHT research was also affected. Since then this study has been revisited and in women without a uterus (those in the 50- to 59-year-old group) there was a generally favourable balance of benefits and risks while receiving conjugated oestrogens alone, and a trend toward reduced mortality.2 The Endocrine Society have introduced clinical practice guidelines which deem MHT safe in appropriate settings.3 Fear of side effects with MHT is often the main reason for avoidance of MHT from the patients’ perspective. Awareness and education of all stakeholders is the key to improving quality of care for menopausal women.

Bridges over barriers: (Table-1)