SPCR HRT inequalities

Menopause symptoms, including hot flushes, anxiety, mood swings and poor disturbed sleep, can be severe in some women, substantially impacting on their quality of life. The menopause also causes an increased risk of osteoporosis (bone thinning) and fractures. Hormone replacement therapy (HRT) can protect against osteoporosis, is effective in easing symptoms of menopause and has been used by many women to improve their quality of life.

However, HRT comes with some risks of serious health conditions, particularly breast cancer and blood clots. Awareness of this has led to fewer women taking HRT, which may mean women with problematic menopausal symptoms are not taking HRT and are missing out on potential health benefits, including reduced risk of osteoporosis. We also know that women from GP practices in low-income areas are least likely to be taking HRT.

The research team at the University of Oxford are currently doing some work to understand more about the characteristics of women who are taking HRT and those who are not. We are doing this using anonymised data from medical records to identify which women are taking different types of HRT and how HRT use varies in women living in different parts of the UK, or in women of different ethnicities, levels of income or other characteristics.

The work that we are already doing will not tell us about the numbers of women who develop poor health outcomes such as breast cancer, blood clots or osteoporosis. To get this information, we need to link the data that we already have with their hospital records and cancer diagnosis. This would allow us to look at how these outcomes differ by whether women are taking HRT, but also whether women of different ethnic groups have similar risks, and whether the risk is the same for women living in affluent and deprived areas of the UK.

This study aims to understand more about cases of breast cancer, osteoporosis and blood clots in women who are prescribed and those not prescribed HRT. It will look in particular at whether women of different ethnicities are equally likely to develop these conditions, and whether there are differences by levels of deprivation and whether women are living with other health conditions, such as sickle cell disease, diabetes, obesity and cardiovascular disease. We will do this by using health data we already have on the QResearch dataset and linking the data with hospital records and cancer registries.

We will work with patient representatives throughout the study to make sure our work is relevant and that we share the results with the right groups of people. We will make infographic pictures to make our results easy to understand and share these with women’s groups and through social media.

This project is an extension to an existing QResearch project which describes prescribing of hormone replacement therapy and identification of factors associated with more or less HRT prescribing. The existing GP dataset will be used in this new project.

Prof Julia Hippisley-Cox (University of Oxford)

Professor Carol Coupland (University of Oxford)

Ms Lynn Tatnell

Ms Wema Mtika (University of Oxford)