Rupa Sharma is a GP in Birmingham. She is a strong advocate for promoting women’s health in primary care, ensuring it is a necessity rather than a luxury, and reducing health inequalities.
The moment that stays with me is not from a meeting room or a pathway document, but from conversations with women at a local community event.
These public engagement events were part of my work as a Women’s Health Lead in Sandwell, where I was involved in improving existing community menopause pathways. Moving between busy GP clinics, strategic meetings, and patient-facing events forced me to hold two realities in mind: the ideal logic of service design and the realistic, emotionally charged experiences of patients seeking care. It was in this space between policy and practice that my understanding of menopause care, and of general practice, fundamentally changed.
In parallel, I was gaining experience in menopause care delivered in secondary care for women at higher clinical risk, who account for a small proportion of overall menopause consultations. Seeing how resources, time, and specialist input were concentrated in this setting further sharpened my awareness of the contrast between what is possible for a few and what is available to the many in community practice.
Many of the women whose experiences informed our pathway work described remarkably similar journeys. Symptoms often crept in gradually: disrupted sleep, joint pain, brain fog, and mood changes that were difficult to articulate. These were rarely recognised as menopausal symptoms. Instead, women spoke about attributing them to stress, work pressures, caring responsibilities, or personal failure.
Symptoms often crept in gradually: disrupted sleep, joint pain, brain fog, and mood changes that were difficult to articulate. These were rarely recognised as menopausal symptoms.
Several women described feeling inadequate for struggling when others around them appeared to cope. Some delayed booking an appointment altogether, worried about wasting the doctor’s time with something so vague, or believing that this was simply what they were expected to endure as women.
When women did seek help, access was often inconsistent. Some described supportive, validating consultations that transformed their understanding of what was happening to their bodies. Others spoke of feeling dismissed, particularly when their symptoms did not fit a narrow clinical narrative. Being told they were too young, still having periods, or just stressed left lasting impressions.
This difference in care received was amplified for women from more deprived backgrounds, Additional barriers included difficulty getting time off work, limited continuity of care, language challenges, and digital systems that assumed a level of confidence and access many did not have.
Listening to these accounts challenged my earlier assumptions. As a GP, I had often framed the difficulty of menopause care around time pressure and clinical complexity which remain very real. But hearing patients describe the emotional toll of not being believed, of repeatedly explaining symptoms, and of carrying the burden of self-advocacy made me reflect on how easily health systems has inadvertently shifted responsibility onto those least equipped to hold it.
At the same time, conversations with GPs revealed a parallel sense of strain. Many described menopause consultations as some of the most challenging they face: symptoms that span physical and psychological domains, evolving evidence, conflicting guidance, and the weight of risk–benefit discussions around hormone replacement therapy. Several spoke about the discomfort of uncertainty — knowing that there was no single answer, yet feeling pressured to provide one. In areas with limited referral options or long waiting lists, GPs described feeling stuck between wanting to help and fearing they might cause harm.
Sitting in meetings designing menopause pathways, I became increasingly aware of how these frontline realities can be smoothed out in policy language. Referral criteria that appeared clear on paper did not always reflect the complexity of patients’ lives. Pathways assumed continuity, time, and capacity that many practices struggle to sustain. Patient stories, when shared, often carried more weight than any dataset, revealing where systems unintentionally exclude those who do not fit standard routes.
Moving between busy GP clinics, strategic meetings, and patient-facing events forced me to hold two realities in mind: the ideal logic of service design and the realistic, emotionally charged experiences of patients seeking care.
This experience changed how I practice. I now listen differently when women describe symptoms that feel “hard to pin down”. I am quicker to name menopause as a possibility, even when the picture is unclear, and more explicit in acknowledging uncertainty. I try to validate experiences before moving to management, recognising how powerful it can be simply to say, What you’re describing makes sense.I am also more honest about system limitations, framing care as an ongoing conversation rather than a one-off solution.
Most importantly, I have become more cautious about viewing menopause care purely through the lens of pathways and protocols. While these are essential, they cannot substitute for time, continuity, and trust. Patients do not experience care in flowcharts; they experience it in moments of feeling heard — or not.
Working as a Women’s Health Lead did not give me definitive answers about how best to deliver menopause care in the community, however it offered a deeper appreciation of the gap between intention and experience. If we are to improve menopause care meaningfully, patient voices must remain central not as an afterthought, but as a guide to how services are designed and delivered. For me, carrying those voices back into the consulting room has been one of the most valuable outcomes of the role.
Featured Photo by Paul Knight on Unsplash
