After more than three decades working in women’s health, I’ve seen many changes, improvements in contraception, better conversations around sexual health, and a growing openness about issues that were once rarely discussed. But when it comes to menopause care, one thing remains stubbornly unchanged: where you live, who you see, and what you can afford still shape the care you receive far more than they should.
For something that affects every woman who lives long enough, menopause care in the UK is still an uneven playing field. And from where I’m standing in primary care, that inequality is playing out every single day.
Women don’t walk into clinics saying, “I think I’m perimenopausal.” They come in exhausted not sleeping, anxious, low in mood, struggling to concentrate, worried something is seriously wrong.
Some have already seen other clinicians. Some have been given antidepressants. Some have been told their blood tests are “normal.” Many feel they are not being heard.
And too often, what happens next depends entirely on who they happen to see.
I work alongside excellent GPs who are confident and proactive in menopause care. But I’ve also seen the uncertainty — and that’s not a criticism; it’s a reflection of how little menopause was prioritised in training for many years.
The result is inconsistency.
One woman may be offered HRT early and appropriately whilst another is told to “wait and see”. Another is advised she is too young and another is steered towards treatments that don’t address the root cause
Same symptoms. Different outcomes.
That inconsistency chips away at trust and delays care that could genuinely improve quality of life.
Access to specialist menopause services is hugely variable. Some areas have established clinics; others have waiting lists that stretch for months, or no service at all.
In practice, what I see is this, women who can afford it go privately and women who can’t, wait.
And while they’re waiting, they’re not just “a bit uncomfortable.” They’re struggling to function — at work, at home, in their relationships, and in themselves.
Not every woman can take time off work easily to attend appointments. Not every woman feels confident pushing for answers. Not every woman has access to clear, reliable information.
Some are dealing with language barriers.
Some come from cultures where menopause simply isn’t talked about.
Some are juggling caring responsibilities, work, and their own health with very little support.
These are often the women who fall through the gaps.
Even now, I regularly meet women who are frightened of HRT — not because of current evidence, but because of things they’ve heard years ago.
I hear:
And sometimes, those messages haven’t just come from the media — they’ve come from healthcare encounters.
We’ve made progress, but we’re still undoing the impact of outdated information.
Primary care is stretched. We all know that.
But menopause doesn’t fit neatly into a ten-minute appointment. It’s complex, often layered with other health concerns, and it takes time to unpick properly.
Without that time:
It’s not about lack of care — it’s about a system that doesn’t always allow that care to be delivered in the way it should be.
This is where I feel strongly that primary care nurses can, and should, play a much bigger role.
We are already doing the work that overlaps with menopause every day:
We are used to looking at the whole person, not just a single symptom.
And importantly, we often have something that’s in short supply, time to listen.
When nurses are supported to take on menopause care, the difference can be significant.
We can:
We can also offer something women repeatedly say they need:
being heard and taken seriously.
In practical terms, even small changes can make a difference:
This doesn’t just improve care — it reduces pressure elsewhere in the system.
Nurses often have strong relationships within their communities. We may see women who don’t routinely seek GP appointments but attend for smears, chronic disease reviews, or other care.
That creates opportunities to:
For some women, that interaction can be the turning point.
Nurses can’t fill this gap without investment.
We need:
With the right structure in place, this is a realistic and sustainable way to improve access.
If we are serious about levelling the playing field, we need to look at the system as a whole:
Menopause is not new. But the way we respond to it still needs to catch up.
No woman should feel dismissed, confused, or left to struggle because of where she lives or who she happens to see.
From my perspective as a nurse, the solution isn’t out of reach. We already have a skilled, experienced workforce in primary care that understands women’s health and is well placed to make a difference.
What’s needed now is the recognition, training, and structure to allow that to happen.
Because menopause care shouldn’t be a matter of luck — it should be something every woman can rely on.
Alexandra Fryer – Menopause Nurse
If this reflects what you’re seeing in your own practice, building confidence in menopause care is more important than ever. For those looking to develop their knowledge further, we offer a 1-day Managing Menopause in Primary Care course, led by our menopause nurse trainer Alexandra Fryer. The session focuses on practical, real-world care — recognising symptoms, using HRT appropriately, and supporting women holistically in everyday primary care.
📅 Next session: Wednesday 22nd April 2026
To find out more or book your place, see the details below or get in touch with us to discuss organising menopause training for your team.
Our ‘Managing Menopause in Primary Care’ course provides registered health care professionals with the essential knowledge and skills needed to effectively support women going through menopause in primary care settings.
If you weren’t able to join the live session, you can still catch up. In this session, Alexandra shares practical insights from clinical practice in a relaxed Q&A format, covering common challenges, decision-making, and how menopause care is delivered day to day.
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