Exploring the availability and acceptability of hormone replacement therapy in LMICs using insights of pharmacists (MARIE Sri Lanka WP2a)

Vindya Pathiraja; Om Kurmi; Teck-Hock Toh; George Uchenna Eleje; Fred Tweneboah-Koduah; Bernard Mbwele; Paula Briggs; Kathleen Riach; Sharron Hinchliff; Kristina Potocnik; Vikram Talaulikar; Lucky Saraswat; Jian Qing Shi; Sohier Elneil; Nihal Al-Riyami; Yassine Bouchareb; Ashish Shetty; Cristina Benetti-Pinto; Helen Felicity Kemp; Jude Siong; David Chibuike Ikwuka; Tharanga Mudalige; Lanka Dasanayake; Peter Phiri; Nirmala Rathnayake; Gayathri Delanerolle

doi:10.1038/s41598-025-18083-x

Exploring the availability and acceptability of hormone replacement therapy in LMICs using insights of pharmacists (MARIE Sri Lanka WP2a)

Vindya Pathiraja
, Om Kurmi
, Teck-Hock Toh
, George Uchenna Eleje
, Fred Tweneboah-Koduah
, Bernard Mbwele
, Paula Briggs
, Kathleen Riach
, Sharron Hinchliff
, Kristina Potocnik
, Vikram Talaulikar
, Lucky Saraswat
, Jian Qing Shi
, Sohier Elneil
, Nihal Al-Riyami
, Yassine Bouchareb
, Ashish Shetty
, Cristina Benetti-Pinto
, Helen Felicity Kemp
, Jude Siong

David Chibuike Ikwuka, Tharanga Mudalige, Lanka Dasanayake, Peter Phiri, Nirmala Rathnayake, Gayathri Delanerolle

University of Ruhuna
University of Birmingham
Sibu Hospital
Nnamdi Azikiwe University
Narh-Bita Hospital
University of Dar Es Salaam
Liverpool Women's NHS Foundation Trust
University of Glasgow
University of Sheffield
University of Edinburgh
University College London Hospitals NHS Foundation Trust
University College London
University of Aberdeen
Southern University of Science and Technology
Sultan Qaboos University
University of Campinas
Trauma Healing Together
University of Rwanda
Hampshire and Isle of Wight Healthcare NHS Foundation Trust
University of Southampton

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

7 Citations (Scopus)

6 Downloads (Pure)

Abstract

Hormone Replacement Therapy (HRT) remains underutilised and under-researched in low- and middle-income countries (LMICs), despite its potential to alleviate menopausal symptoms. This study explored pharmacists' perspectives on the use, cost, and availability of HRT across six LMICs. A cross-sectional survey was conducted from January 1 to March 31, 2025, as part of the Global Menopause Project. Pharmacists working in community, hospital, and private sector settings in Malaysia, Sri Lanka, Nepal, Nigeria, Ghana, and Tanzania were recruited. Participants completed an anonymous online questionnaire. The questionnaire was piloted prior to dissemination, assessed HRT availability, pricing, and perceived barriers to use. A total of 331 pharmacists responded: Ghana (18·4%), Sri Lanka (17·5%), Tanzania (16·9%), Nepal (16·6%), Malaysia (15·4%), and Nigeria (15·1%). The respondents were almost equally distributed between sexes (50·8% were female), and most were aged 26-35 years (49·0%). The majority worked in private community pharmacies (41·7%) or government hospitals (32·6%), and 57·4% were based in urban areas. From the sample, 68·9% of pharmacists reported that HRTs were available for dispensing in their respective countries (highest proportion was reported in Nepal, 92·7% and lowest in Nigeria, 42%). HRT costs varied widely, with Sri Lanka reporting the highest prices and Malaysia the lowest. Key barriers identified included low health literacy, economic constraints, and limited healthcare access. Significant disparities exist in HRT access, availability and affordability across LMICs, with urban-rural gaps further compounding inequities. Pharmacists' insights underscore the urgent need for inclusive, equitable strategies in menopausal care and women's health policy in resource-limited settings.

Original language	English
Article number	37944
Number of pages	10
Journal	Scientific Reports
Volume	15
Issue number	1
DOIs	https://doi.org/10.1038/s41598-025-18083-x
Publication status	Published - 30 Oct 2025

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 Fund.

Funders
National Institute for Health and Care Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Availability
Hormone Replacement Therapy
Pharmacists
Acceptability
Low- And Middle-income Countries
Humans
Cross-Sectional Studies
Menopause
Developing Countries
Adult
Middle Aged
Health Services Accessibility
Tanzania
Malaysia
Nepal
Sri Lanka
Female
Male
Surveys and Questionnaires

Access to Document

10.1038/s41598-025-18083-xLicence: CC BY-NC-ND

Kurmi2025VoRFinal published version, 1.37 MBLicence: CC BY-NC-ND

https://europepmc.org/articles/PMC12575872?pdf=renderLicence: CC BY-NC-ND

Cite this

Pathiraja, V., Kurmi, O., Toh, T.-H., Eleje, G. U., Tweneboah-Koduah, F., Mbwele, B., Briggs, P., Riach, K., Hinchliff, S., Potocnik, K., Talaulikar, V., Saraswat, L., Shi, J. Q., Elneil, S., Al-Riyami, N., Bouchareb, Y., Shetty, A., Benetti-Pinto, C., Kemp, H. F., ... Delanerolle, G. (2025). Exploring the availability and acceptability of hormone replacement therapy in LMICs using insights of pharmacists (MARIE Sri Lanka WP2a). Scientific Reports, 15(1), Article 37944. https://doi.org/10.1038/s41598-025-18083-x

Pathiraja, V, Kurmi, O, Toh, T-H, Eleje, GU, Tweneboah-Koduah, F, Mbwele, B, Briggs, P, Riach, K, Hinchliff, S, Potocnik, K, Talaulikar, V, Saraswat, L, Shi, JQ, Elneil, S, Al-Riyami, N, Bouchareb, Y, Shetty, A, Benetti-Pinto, C, Kemp, HF, Siong, J, Ikwuka, DC, Mudalige, T, Dasanayake, L, Phiri, P, Rathnayake, N & Delanerolle, G 2025, 'Exploring the availability and acceptability of hormone replacement therapy in LMICs using insights of pharmacists (MARIE Sri Lanka WP2a)', Scientific Reports, vol. 15, no. 1, 37944. https://doi.org/10.1038/s41598-025-18083-x

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abstract = "Hormone Replacement Therapy (HRT) remains underutilised and under-researched in low- and middle-income countries (LMICs), despite its potential to alleviate menopausal symptoms. This study explored pharmacists' perspectives on the use, cost, and availability of HRT across six LMICs. A cross-sectional survey was conducted from January 1 to March 31, 2025, as part of the Global Menopause Project. Pharmacists working in community, hospital, and private sector settings in Malaysia, Sri Lanka, Nepal, Nigeria, Ghana, and Tanzania were recruited. Participants completed an anonymous online questionnaire. The questionnaire was piloted prior to dissemination, assessed HRT availability, pricing, and perceived barriers to use. A total of 331 pharmacists responded: Ghana (18·4\%), Sri Lanka (17·5\%), Tanzania (16·9\%), Nepal (16·6\%), Malaysia (15·4\%), and Nigeria (15·1\%). The respondents were almost equally distributed between sexes (50·8\% were female), and most were aged 26-35 years (49·0\%). The majority worked in private community pharmacies (41·7\%) or government hospitals (32·6\%), and 57·4\% were based in urban areas. From the sample, 68·9\% of pharmacists reported that HRTs were available for dispensing in their respective countries (highest proportion was reported in Nepal, 92·7\% and lowest in Nigeria, 42\%). HRT costs varied widely, with Sri Lanka reporting the highest prices and Malaysia the lowest. Key barriers identified included low health literacy, economic constraints, and limited healthcare access. Significant disparities exist in HRT access, availability and affordability across LMICs, with urban-rural gaps further compounding inequities. Pharmacists' insights underscore the urgent need for inclusive, equitable strategies in menopausal care and women's health policy in resource-limited settings.",

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KW - Health Services Accessibility

KW - Tanzania

KW - Malaysia

KW - Nepal

KW - Sri Lanka

KW - Female

KW - Male

KW - Surveys and Questionnaires

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DO - 10.1038/s41598-025-18083-x

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SN - 2045-2322

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JO - Scientific Reports

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ER -

Exploring the availability and acceptability of hormone replacement therapy in LMICs using insights of pharmacists (MARIE Sri Lanka WP2a)

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

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Cite this