P040 An Audit of Menopause Assessment and Hormone Replacement Therapy Use in Rheumatology Patients

Background/Aims Menopausal symptoms, including arthralgia and fatigue, can overlap with and exacerbate symptoms of rheumatological conditions. Recognising menopause is important for symptom attribution but also as Hormone Replacement Therapy (HRT) can improve musculoskeletal symptoms and quality of life. Some rheumatological conditions, such as systemic lupus erythematous (SLE) and antiphospholipid syndrome (APLS), carry specific risks related to HRT and require individualised assessment, therefore recognition of these conditions in primary care is important. A service evaluation was undertaken to assess 1) accuracy of documentation of menopause status and HRT use in rheumatology and 2) evaluate whether rheumatology diagnoses are accurately recorded in primary care records, recognising the potential impact on HRT prescribing. Methods A retrospective review of electronic records of consecutive female patients, age 40-65, attending rheumatology clinics during 7 days in May 2025 was undertaken. Clinic letters and linked primary care summary records (ICR) were reviewed. Patients were excluded if ICR was unavailable. Data was collected to assess accuracy and concordance of menopause status, HRT use and rheumatology diagnoses between clinic letters and ICRs. Results 90 patients were included (mean age 54.8). Most common diagnoses were rheumatoid arthritis (21.1%) and fibromyalgia (14.4%). Menopause and HRT were coded in the ICR of 14/90 (15.6%) and 27/90 (30%) respectively. Of these 1/14 (7.1%) had menopause and 19/27 (70.4%) had HRT documented in clinic letter. Menopause status was documented in 10/90 (11.1%) of clinic letters. Menopause was discussed in 4/16 (25%) new patient appointments. 83/90 (92.2%) had accurate and concordant documentation of HRT (either prescribed HRT or not) in both clinic letter and ICR. 68/90 (75.6%) patients had the rheumatological diagnoses accurately coded in ICRs or had no formal diagnosis. 10/90 (11.1%) patients had APLS or SLE, of which 3/10 (30%) had a documented menopause discussion in the clinic letter. In 1/10 (10%) menopause was recorded in the ICR only, but not in the clinic letter. 9/10 (90%) had their diagnosis accurately coded in ICR, which is important for safe HRT prescribing due to increased clot risk. 4/10 (40%) were prescribed HRT on ICR. Conclusion Despite menopause being a potentially important factor influencing symptom burden in rheumatology conditions, we observed low levels of discussion of menopause in this at-risk group. This highlights an educational need within our department. However, a multicentre service evaluation is planned within the UK rheumatology community, as educational needs may be more widespread. The value of linked primary care records can also be leveraged to optimise our recording of menopause and HRT. Disclosure K. Nimmo: None. L. Townsend: None. K. Amaanulla: None. S. Skeoch: None.