Menopause and musculoskeletal health in English primary care: study protocol

Menopause is associated with a wide range of symptoms, including musculoskeletal pain, yet its contribution to musculoskeletal consultations and healthcare utilisation in primary care remains poorly quantified. The extent to which hormone replacement therapy (HRT) influences musculoskeletal-related healthcare use is uncertain.

To quantify the prevalence, incidence, and healthcare burden of musculoskeletal symptoms and conditions among women experiencing the menopause transition in English primary care, and to explore the association between HRT use and musculoskeletal-related healthcare utilisation.

Closed cohort study with nested repeat cross-sectional analyses using English national primary care electronic health records from the Clinical Practice Research Datalink Aurum, 2015-2024.

Women aged 35-60 years with consultations for musculoskeletal symptoms/conditions and/or menopause-related symptoms or HRT prescribing will be identified. Annual prevalence and incidence rates per 10 000 registered women will be estimated. Healthcare utilisation outcomes include consultation frequency, investigations, analgesic prescribing, referrals, and sickness certification. Joinpoint regression will assess temporal trends. Poisson and negative binomial regression models, accounting for practice-level clustering, will estimate adjusted rate ratios. Analyses will be stratified by ethnicity and socio-economic status. Exploratory analyses will compare outcomes among HRT users and non-users.

This study will provide national primary care estimates of menopause-related musculoskeletal burden and associated healthcare utilisation. Findings will inform clinical recognition, management strategies, and evaluation of potential inequalities in care.