Author response

The authors would like to take this opportunity to thank Dr Neaves for her letter. Although we were disappointed that you felt this article was out of date, due diligence was taken by the authors in reviewing the current guidelines available from the British Menopause Society (BMS) to frame this clinical practice article for primary care physicians (PCPs) on prescribing hormone replacement therapy (HRT), as it was recognised that individual prescribing patterns may vary.¹

In relation to the specific points raised, current BMS guidance does not state that transdermal HRT should be first line, unless there are specific contraindications, as highlighted in the article.² Oral HRT therefore remains a viable option and may even be the preferred route for some women, who may not have tolerated transdermal preparations. In addition, with a personalised and holistic approach being advocated for menopause management and HRT use, being aware of all the options, including the types of progestogen available, is vital. This is especially important considering that HRT supply remains an ongoing issue. In relation to vaginal oestrogen, while it is acknowledged that some women may require higher doses and even alternative medications for vulvo-vaginal atrophy (VVA), from the authors’ experience, first-line options such as those highlighted in the article are usually effective. It was considered that exploring VVA further was beyond the scope of this article.

Finally, addressing the numerous complexities, including the overall health benefits and availability of HRT, as you have highlighted, was equally considered beyond this article’s remit, which was ultimately to condense several of the current guidelines for PCPs to access more readily when prescribing HRT.

Competing interests

Rima Chakrabarti is a member of the British Menopause Society.