A perspective on economic barriers and disparities in access to hormone replacement therapy in LMICs (MARIE-WP2b)

Gayathri Delanerolle; Snehal Ghosh; Paula Briggs; Peter Phiri; Julie Taylor; Vindya Pathiraja; Tharanga Mudalige; Yassine Bouchareb; Heitor Cavalini; Sharron Hinchliff; Carol Atkinson; Kristina Potocnik; Lucky Saraswat; Fred Tweneboah-Koduah; Nana Afful-Mintah; Helen Felicity Kemp; George Uchenna Eleje; Divinefavour Echezona Malachy; Bernard Mbwele; Teck-Hock Toh; Jude Siong Yip-King; Daniela Angerame Yela; Gabriela Pravatta Rezende; Renan Massao Nakamura; Cristina Laguna Benetti-Pinto; Muhammad Irfan; Rabia Kareem; Jeremy van Vlymen; Ashish Shetty; Ganesh Dangal; Suman Pant; Kathleen Riach; Nirmala Rathnayake; Lanka Dasanayake; Jian Qing Shi; Om Kurmi; Saval Khanal; Sohier Elneil

doi:10.1038/s41598-026-49559-z

A perspective on economic barriers and disparities in access to hormone replacement therapy in LMICs (MARIE-WP2b)

Gayathri Delanerolle
, Snehal Ghosh
, Paula Briggs
, Peter Phiri
, Julie Taylor
, Vindya Pathiraja
, Tharanga Mudalige
, Yassine Bouchareb
, Heitor Cavalini
, Sharron Hinchliff
, Carol Atkinson
, Kristina Potocnik
, Lucky Saraswat
, Fred Tweneboah-Koduah
, Nana Afful-Mintah
, Helen Felicity Kemp
, George Uchenna Eleje
, Divinefavour Echezona Malachy
, Bernard Mbwele
, Teck-Hock Toh

Jude Siong Yip-King, Daniela Angerame Yela, Gabriela Pravatta Rezende, Renan Massao Nakamura, Cristina Laguna Benetti-Pinto, Muhammad Irfan, Rabia Kareem, Jeremy van Vlymen, Ashish Shetty, Ganesh Dangal, Suman Pant, Kathleen Riach, Nirmala Rathnayake, Lanka Dasanayake, Jian Qing Shi, Om Kurmi, Saval Khanal, Sohier Elneil

Centre for Discoveries in Life Sciences

University of Birmingham
Hampshire and Isle of Wight Healthcare NHS Foundation Trust
University of Liverpool
Liverpool Women's NHS Foundation Trust
University of Southampton
University of Ruhuna
Sultan Qaboos University
University of Sheffield
Manchester Metropolitan University
University of Edinburgh
University of Aberdeen
Narh-Bita Hospital
Ethos Clinic
Trauma Healing Together
Nnamdi Azikiwe University
University of Dar Es Salaam
Sibu Hospital
University of Campinas
Riphah International University
University College London Hospitals NHS Foundation Trust
Cleveland Clinic
Kathmandu Model Hospital
University of Glasgow
Southern University of Science and Technology
McMaster University
King's College London
University College London

Research output: Contribution to journal › Article › peer-review

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Abstract

Women globally spend a significant portion of their lives experiencing perimenopausal and menopausal symptoms, which can severely affect their quality of life. Hormone Replacement Therapy (HRT) has proven effective in alleviating symptoms such as hot flushes, sleep disturbances, and mood disorders. However, disparities in access to HRT exist, especially in low- and middle-income countries (LMICs), where socioeconomic factors and healthcare availability may limit treatment access. We aimed to explore economic barriers and disparities to access to HRT across Brazil, Ghana, Malaysia, Nepal, Nigeria and Sri Lanka. A cross-sectional exploratory study was conducted using publicly available data from national healthcare databases, pharmacies, and hospital formularies from Brazil, Ghana, Malaysia, Nepal, Nigeria, and Sri Lanka. The availability and cost of common HRT medicines, including oral and transdermal therapies, were analysed alongside of surgical procedures. Affordability was assessed by comparing the cost of a two-month HRT supply to the number of days of minimum wage work required to cover the cost. Additionally, Gross National income per capita was also collected to contextualise these findings. The availability of HRT medicines varied widely across six countries, with Brazil and Nigeria offering a broader range of options compared to Ghana and Nepal. Pricing disparities were significant, with the cost of medicines such as the Mirena Coil requiring over 21 days of minimum wage work in Brazil and more than 260 days in Nigeria for Angeliq. Affordability remained a critical issue across LMICs, with high out-of-pocket costs restricting access to essential menopausal treatments. This study reveals substantial economic barriers to accessing HRT in LMICs, driven by high costs and limited availability. Healthcare policy reforms to improve access and affordability of HRT in these regions are urgently needed. These findings can inform strategies to reduce healthcare inequalities and enhance women's health outcomes globally. [Abstract copyright: © 2026. The Author(s).]

Original language	English
Article number	19272
Number of pages	13
Journal	Scientific Reports
Volume	16
Issue number	1
Early online date	26 Apr 2026
DOIs	https://doi.org/10.1038/s41598-026-49559-z
Publication status	E-pub ahead of print - 26 Apr 2026

Bibliographical note

This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives
4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Funding

NIHR Research Capability Funding.

Funders
National Institute for Health and Care Research

Access to Document

10.1038/s41598-026-49559-zLicence: CC BY-NC-ND

Pant2026VoRFinal published version, 2.25 MBLicence: CC BY-NC-ND

Cite this

Delanerolle, G., Ghosh, S., Briggs, P., Phiri, P., Taylor, J., Pathiraja, V., Mudalige, T., Bouchareb, Y., Cavalini, H., Hinchliff, S., Atkinson, C., Potocnik, K., Saraswat, L., Tweneboah-Koduah, F., Afful-Mintah, N., Kemp, H. F., Eleje, G. U., Malachy, D. E., Mbwele, B., ... Elneil, S. (2026). A perspective on economic barriers and disparities in access to hormone replacement therapy in LMICs (MARIE-WP2b). Scientific Reports, 16(1), Article 19272. Advance online publication. https://doi.org/10.1038/s41598-026-49559-z

Delanerolle, G, Ghosh, S, Briggs, P, Phiri, P, Taylor, J, Pathiraja, V, Mudalige, T, Bouchareb, Y, Cavalini, H, Hinchliff, S, Atkinson, C, Potocnik, K, Saraswat, L, Tweneboah-Koduah, F, Afful-Mintah, N, Kemp, HF, Eleje, GU, Malachy, DE, Mbwele, B, Toh, T-H, Yip-King, JS, Yela, DA, Rezende, GP, Nakamura, RM, Benetti-Pinto, CL, Irfan, M, Kareem, R, van Vlymen, J, Shetty, A, Dangal, G, Pant, S, Riach, K, Rathnayake, N, Dasanayake, L, Shi, JQ, Kurmi, O, Khanal, S & Elneil, S 2026, 'A perspective on economic barriers and disparities in access to hormone replacement therapy in LMICs (MARIE-WP2b)', Scientific Reports, vol. 16, no. 1, 19272. https://doi.org/10.1038/s41598-026-49559-z

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abstract = "Women globally spend a significant portion of their lives experiencing perimenopausal and menopausal symptoms, which can severely affect their quality of life. Hormone Replacement Therapy (HRT) has proven effective in alleviating symptoms such as hot flushes, sleep disturbances, and mood disorders. However, disparities in access to HRT exist, especially in low- and middle-income countries (LMICs), where socioeconomic factors and healthcare availability may limit treatment access. We aimed to explore economic barriers and disparities to access to HRT across Brazil, Ghana, Malaysia, Nepal, Nigeria and Sri Lanka. A cross-sectional exploratory study was conducted using publicly available data from national healthcare databases, pharmacies, and hospital formularies from Brazil, Ghana, Malaysia, Nepal, Nigeria, and Sri Lanka. The availability and cost of common HRT medicines, including oral and transdermal therapies, were analysed alongside of surgical procedures. Affordability was assessed by comparing the cost of a two-month HRT supply to the number of days of minimum wage work required to cover the cost. Additionally, Gross National income per capita was also collected to contextualise these findings. The availability of HRT medicines varied widely across six countries, with Brazil and Nigeria offering a broader range of options compared to Ghana and Nepal. Pricing disparities were significant, with the cost of medicines such as the Mirena Coil requiring over 21 days of minimum wage work in Brazil and more than 260 days in Nigeria for Angeliq. Affordability remained a critical issue across LMICs, with high out-of-pocket costs restricting access to essential menopausal treatments. This study reveals substantial economic barriers to accessing HRT in LMICs, driven by high costs and limited availability. Healthcare policy reforms to improve access and affordability of HRT in these regions are urgently needed. These findings can inform strategies to reduce healthcare inequalities and enhance women's health outcomes globally. [Abstract copyright: {\textcopyright} 2026. The Author(s).]",

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A perspective on economic barriers and disparities in access to hormone replacement therapy in LMICs (MARIE-WP2b)

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