Getting older – unequally

Around 10 per cent of women use HRT, but there are big social class, regional and ethnic differences in uptake



Today the National Institute for Health and Care Excellence (NICE) has published guidance on the menopause. It covers diagnosis and the drug and lifestyle interventions that can help with symptoms. It also interprets the risks and benefits of hormone replacement therapy (HRT) in relation to cancer and cardiovascular disease.

This is something I welcome. I experienced a premature menopause brought on by radiotherapy for colorectal cancer. My GP refused me HRT for the night sweats and flushes that I was experiencing and I felt obliged to turn to private medicine. My morning routine now involves rubbing in hormone gels (oestradiol and testosterone) and progesterone pills for seven days every month. I feel the relief I have received is worth an increased risk in some cancers.

While the NICE guidance is good news, it also raises many questions. Despite the ubiquity of the menopause and the controversy about HRT, it’s staggering that it has taken so long to issue NICE guidance. Concerns about greater incidence of breast, endometrial and ovarian cancers among HRT users have been in the public domain for years, but it is only now that woman in England have any ‘official’ guidance.

I think this is reflective of attitudes towards ageing in a youth-obsessed culture. Talking about the menopause is taboo, and women’s reticence about discussing the symptoms are part of the reason that it has taken NICE so long to act.

At the beginning of this century, an estimated 20 per cent of middle-aged women took HRT. But the use of HRT dropped dramatically after 2002, after the results of the Women’s Health Initiative trials linked HRT with breast cancer. In the UK, perhaps about 10 per cent of women use HRT now, but there are big social class, regional and ethnic differences in uptake. HRT is far more likely to be used by white women in social classes A and B who live in London and the South East.

The greater use of HRT by wealthier, better educated southern women raises questions about inequalities in ageing, for both men and women. A trip from west to east on the Central Line provides visual evidence of stark class differences in the process of growing old. The men and women of east London age differently (and die younger) than those in Kensington and Chelsea. Poorer men and women have worse health in middle age and are less likely to work until state pension age. Levels of well-being among the middle-age and retired are lower in deprived areas.

These inequalities do not only affect the very poorest. Rather there is a close link between where a person is on the socio-economic ladder and health and wellbeing in middle age– the higher the rank, the better the health.

Last week, a study led by the US economist Angus Deaton illustrated the unexpectedly high death rate among white middle-aged males in that country. Despite these alarming trends, this evidence has not been highlighted until now. Again, this neglect could be interpreted as consequence of attitudes to ageing.

In both the United States and Britain the dominant political debates about growing old tend to focus on extreme old age and the cost of residential care. In policy terms, you are either young, or very old, with little debate about the experiences and needs of those in the middle.

Health inequalities and use of HRT is only one of many issues that affect the middle-aged population of Britain. These issues encompass pension investments and planning for retirement, as well as the under-employment of women in their 50s and 60s. New analysis shows that the gender pay gap is highest for women in their 50s.

These trends require our politicians to respond to the needs of the middle-aged. This will only be achieved if we talk about ageing and shift the debate about growing older – including being open about the menopause.

Jill Rutter is a contributing editor to Left Foot Forward

One Response to “Getting older – unequally”

  1. Bradley EC

    There will always be difficulties ensuring equal delivery of a complex treatment when the less educated are not capable of making intelligent decisions for themselves or even of keeping themselves informed. What amazes me in my experience with G.P’s is that it is very easy to be by-passed by simply failing to ask for an intervention. Lower class and less educated people do not get their blood pressure checked as often as the educated because they do not ask for it. That they should not need to ask is the issue.

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