Bridging the gaps – A comprehensive plan for RA and menopause care

13 March 2025

RA affects three times more women than men. In late 2023, we worked with healthcare professionals around the country to create and distribute to women with RA a survey of their experiences of perimenopause (the early stages, when symptoms start but before periods stop) and menopause.

Female patient in consultation with female nurse.

Many people with RA report changes in their symptoms during times of hormonal change (such as pregnancy and menopause). We wanted to understand the experiences of women with RA and to highlight any gaps in care and improve information for both patients and professionals.

We had a brilliant response rate to this survey and the following results are based on nearly 800 patient experiences with menopause and RA.

The results
(taken from the paper published by the study team “Menopause Matters: Results of a National Survey of Rheumatoid Arthritis Patients in the UK”, published in Musculoskeletal Care in December 2024)
 
– 80% responded that their arthritis was worse during the menopause, with 10% being much worse.
– 47% had taken hormone replacement therapy (HRT). Of these, 80% had experienced an improvement in their menopausal symptoms and 30% had a moderate or large improvement in their arthritis symptoms.
– 84% of participants felt that rheumatology teams should receive more education and training about the menopause in relation to RA.
– A standout statistic was that 93% of respondents had had no medical discussion about the menopause. For those who did, this was most frequently with their GP in relation to HRT and osteoporosis.
Analysis of the comments revealed several themes, too:
– Discussion about the menopause only occurred if the patient raised it.
– There was conflicting advice about HRT.
– There is overlap and confusion of symptoms between RA and the menopause.
– Participants expressed a perceived link between menopause and onset or deterioration of their arthritis.
– This study was long overdue.
Conclusions
The study concluded that:
– Patients saw a strong connection between menopause and either the beginning or worsening of their RA symptoms, often with confusion over what was the RA and what was the menopause.
– Patients would like more discussion with their healthcare team about the menopause and its impact on people with RA.
– Patients are receiving conflicting advice about hormone replacement therapy (HRT).
– More research is necessary regarding menopause and RA.
Bar chart graph, showing that 92.2% of patients reported that menopause is not discussed or considered when discussing RA treatments with healthcare professionals.

Understanding the gaps in care and addressing them

RA and menopause share some of the same issues when we consider delivery of healthcare services. Lack of good education, resources for self-management and care pathways means that patients can be hit by a ‘double whammy’ when trying to source support and help for their symptoms. There is still much work to be done to address the issues and I hope we see more research done in this area of women’s health.

At NRAS we are going to start by developing some dedicated patient resources to support people with RA who are either perimenopausal or menopausal. In collaboration with experts in RA and menopause, we intend to develop some ‘tools’ that both patients and professionals can use to open the conversation about menopause and create a more holistic plan for dealing with symptoms. Examples would include a booklet, website content, social media content and an NRAS Live event.

Collaboration

We are currently talking to both UK and global menopause specialists to identify those experts who can support us in production of these specialist resources. Once the project team is convened, we will create a project plan that our Fundraising team can use when applying for suitable grants and trusts that will help us fund this important work.

A healthier future

By doing this work we hope to significantly improve the quality of care for people with RA and those experiencing perimenopause or menopause. Our commitment to innovation and service delivery will ensure that our members receive the comprehensive, compassionate care they deserve.

Together, we can bridge these gaps and pave the way for a healthier future.

Acknowledgements

I’d like to take this opportunity to thank the study team, who work in rheumatology in the UK: Sharon Petford; Sandra Robinson; Julie Begum; Ailsa Bosworth; Clare Jacklin; Sally Matthews; and David Walker. I would also like to say that we’re looking forward to working with you on outcomes of this work.

If you have any feedback or additional insights, please feel free to share them with us! You can get in touch via nras.org.uk/information-support/contact-us