Health Implications of Inadequate Follow-Up for Women on Hormone Replacement Therapy in Primary Care: A Questionnaire-Based Cross-Sectional Study

Background Hormone replacement therapy (HRT) is widely used to alleviate menopausal symptoms and improve quality of life. However, its long-term safety and efficacy depend on regular follow-up to monitor for adverse effects, reassess treatment goals, and ensure adherence to clinical guidelines. Evidence suggests a gap in the provision of appropriate follow-up care for women on HRT, particularly in primary care settings. Objective This questionnaire-based cross-sectional study aims to evaluate the extent of follow-up care provided to women on HRT and explore the health implications of inadequate monitoring, including symptom control, safety concerns, and patient outcomes, in a large primary care practice in East London. By identifying gaps in monitoring and the consequences of inadequate follow-up, this study seeks to develop strategies to improve follow-up for women on HRT, ensuring patient safety and optimal symptom management. Methods Patients who had been initiated on HRT between 2021 and 2024 were identified using electronic patient records (EPRs). A structured questionnaire was sent to assess symptom control, identify red-flag symptoms suggestive of malignancy, and gather insights into patients' concerns or questions regarding their treatment. Data was then collected on follow-up practices in an Excel spreadsheet and analysed. Results The review revealed that none of the patients initiated on HRT received follow-up care in accordance with the National Institute for Health and Care Excellence (NICE) guidelines and no annual reviews were conducted. Notably, 43% (N=84) of patients expressed uncertainty regarding the recommended duration of HRT use. Additionally, 25% (N=49) reported inadequate symptom management, while 1.7% (N=3) exhibited red-flag symptoms warranting further investigation. Furthermore, 2% (N=4) of patients were found to be using HRT incorrectly, highlighting the need for improved patient education and follow-up care. Conclusion These findings expose a significant gap in follow-up care for women on HRT, with serious implications for both patient safety and treatment effectiveness. In the absence of adequate monitoring, issues such as inappropriate HRT use can go undetected, potentially compromising patient safety. To address this gap, structured follow-up protocols and improved communication in primary care are needed. Ensuring that women receive the guidance and support they need will be essential in making HRT both safer and more effective.