Women experiencing symptoms of the menopause say they have been left to "suffer in silence" due to a disparity in spending on drugs across England, experts warn.
Analysis of NHS prescription data shows some local health areas spend three times the amount per woman on Hormonal Replacement Therapy (HRT) than others.
Experts said the treatment options offered by some local health boards were "very limited".
READ MORE: Women unable to access the help they need with menopause
HRT replaces hormones that are at a lower level as the menopause approaches. Not every patient will need or want HRT, and clinicians advise against it in some circumstances - including for patients with a history of certain types of cancer or blood clots.
The BBC's Shared Data Unit analysed how much Clinical Commissioning Groups (CCGs) spent on common HRT treatments between April 2021 and June 2022.
Analysis showed the highest rate of spending was West Suffolk where £14.10 was spent per woman aged 45 to 60. That compared to £5.56 spent in Leicester City.
In the North East, County Durham had the highest rate of spending where £11.74 was spent, which was closely followed by Northumberland and North Tyneside who both spent £11.10.
Sunderland spent the least in the region at £10.10, followed by South Tyneside at £10.25, and Newcastle Gateshead with £10.91.
Experts said the decision-making of local health boards had contributed to a postcode lottery and that some women were not being offered the full range of options because their local health board did not fund them.
Diane Danzebrink, of the Menopause Support charity, said GPs' “hands were tied”.
“Often we will hear from women who are being prescribed oral tablets as a first line, and they're not being offered options,” said Ms Danzebrink.
“Sometimes that is because those options are purely not available on their local CCG formulary. So that sort of ties the hands of their doctors to be able to offer them choices. But we do definitely see that it seems to be in some parts of the country rather than others.”
Other reasons cited for the disparity include cultural differences. Menopause expert and GP specialising in women’s health Dr Anne Connolly said different ethnic groups could “experience symptoms differently or manage them differently”, while Ms Danzebrink added that cultural barriers such as language could cause problems for some groups of women.
The NHS said it had increased training for clinicians.
An NHS spokesperson said: “The NHS has a Menopause Pathway Improvement Programme, which includes increased learning for clinicians in how they can best support menopausal women, and working with clinical colleges and menopause organisations to improve awareness and understanding.
“A new Menopause Optimal Pathway will also guide clinicians and help women in the workplace during peri-menopause, menopause and post-menopause.”
A Department of Health and Social Care spokesperson said: “We have put women’s health at the top of the agenda by publishing a Women’s Health Strategy for England, appointing the first-ever Women’s Health Ambassador, and taking action to increase supply and reduce the cost of Hormone Replacement Therapy.
“We have accepted the recommendations of the HRT taskforce, including the continued use of Serious Shortage Protocols when appropriate to manage shortages, and NHS England continues to work on gathering data on maintaining and updating local formularies in England.
“The UK-wide menopause taskforce is seeking to end the taboos surrounding the menopause and considering the role workplace policies can play in supporting menopausal women, and the Government’s Health and Wellbeing Fund is helping expand and develop projects which support women experiencing the menopause to remain in the workplace.”
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