Background: Menopause symptoms of arthralgia, myalgia, widespread pain, stiffness, and fatigue may mimic or exacerbate symptoms of rheumatic disease. The musculoskeletal syndrome of menopause is often misdiagnosed as fibromyalgia or arthritis, and therefore, menopause must be recognised to avoid misdiagnosis and inappropriate treatment. Hormone replacement therapy (HRT) can improve musculoskeletal symptoms, fatigue, and quality of life, and is generally safe and effective. Furthermore, menopause carries long-term cardiovascular and bone health risks, which are particularly important for patients with rheumatic disease who are already at increased risk of these comorbidities. Incorporating a women’s health perspective into routine patient care may improve outcomes in this population.

Objectives: To evaluate the recognition of menopause and HRT use in rheumatology consultations at our trust, and to assess whether clinician, consultation or patient-related characteristics influenced this.

Methods: We conducted a retrospective service evaluation across rheumatology departments at NHS University Hospitals of Liverpool Group. One hundred female patients aged 45-55 years were identified from clinic lists during April-May 2025. Data on demographics, diagnoses, menopause status, and HRT use were obtained from hospital and primary care electronic patient records (EPR). Associations between clinician, consultation, patient-related characteristics and recognition of menopause were analysed using Pearson’s chi-square tests, Fisher’s exact tests or logistic regression.

Results: The cohort included 100 female patients (mean age 50.8 years, range 45–55). Seventy-six per cent were White British, 4% Asian/Asian British, 1% other White background, 1% Black/Black British, and 18% of unknown ethnicity. The most common diagnoses were rheumatoid arthritis (16%), psoriatic arthritis (10%), systemic lupus erythematosus (8%), Sjogren’s syndrome (8%) and vasculitis (7%). Fourteen patients were under investigation or had no rheumatology diagnosis made.

Consultations comprised 25 new patient and 75 follow-up visits. Menopause status was discussed/recorded in 23% of consultations overall (36% of new patients; 19% of follow-ups). Thirty-nine patients had menopause or HRT use coded in their primary care record; only 11 (28%) had this information reflected in rheumatology clinic letters or EPR notes. Of 29 patients prescribed HRT in primary care, 17 (59%) had it recorded in their rheumatology clinic medication lists. No consultation documented discussion of HRT risks or benefits.

There was no significant association between clinician gender (p = 0.45), clinician role/grade (p = 0.73), or clinic type (general rheumatology clinic vs specialist clinic) (p = 0.49) and the likelihood of menopause status being discussed/recorded. A trend suggested menopause status was more likely to be discussed at new patient appointments than follow-ups (p=0.07). There was also no association between patient ethnicity (p = 0.44) or Index of Multiple Deprivation (IMD) (OR 1.05, 95% CI 0.88–1.25, p = 0.58) and the likelihood of menopause status being discussed/recorded; however, the analysis may be underpowered to detect small effects.

Conclusions: We observed low rates of recognition of the menopause in our service evaluation, regardless of clinician or patient characteristics. HRT use was inconsistently recorded in rheumatology records, and no consultation documented discussion of HRT risks and benefits. These findings highlight the need for education on women’s health within rheumatology services. A planned multi-centre service evaluation will aim to expand on these results and inform strategies to improve care for menopausal women attending rheumatology clinics.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: None declared.