Endocrine Abstracts

The United Kingdom faces an unprecedented convergence of healthcare-related crises: an ageing population with extensive chronic healthcare needs; a crisis in social care, for which cross-party political agreement remains a distant mirage, and the inaccessibility of primary care services, as providers have prioritised meeting externally-set targets that unlock additional funding, ahead of providing accessible medical care according to clinical need. This has created a maelstrom of acute “medical” admissions that often lack dignity and sometimes even humanity, with risk factors for pain, disability, impaired QoL and hospitalisation in older age including sarcopenia, osteoporosis, cardio-metabolic syndrome, social isolation and poor mental health. The 4–5 year menopause transition heralds profound changes in physiology that accelerate biological ageing. The average woman loses 10% of bone mass and 10% of limb muscle mass; the lipid profile becomes pro-atherogenic; fasting glucose and HbA1c rise by 6%; sleep quality deteriorates and vulvovaginal atrophy precipitates sexual dysfunction or urinary urgency in 50%; 40% experience mood disorders, and divorce peaks, with most citing menopause as a contributing factor, irrespective of who initiated proceedings. HRT can mitigate most of these adverse effects and yet HRT scripts in are far below levels prior to the WHI study (2002), despite corrective messages in the media, and not helped by position statements emphasising the primary role of HRT as a treatment only for vasomotor and sexual symptoms. Even vaginal oestrogen is barely prescribed despite reducing actual or perceived UTIs. In the present UK healthcare environment (hours to get through to the surgery; weeks to secure routine appointment lasting 5 minutes that may not be with a doctor), it is unrealistic to expect women’s needs to be met via patient-with-symptoms-consults-doctor-gets-counselled-receives-treatment. The only way forward is for a positive HRT discussion to be hard-wired into NHS primary care as per screening and vaccination.