Continuity of hormone replacement therapy in custody: Why abrupt discontinuation puts women at risk

The continuity of essential medications is a fundamental component of clinical governance within custodial healthcare. National standards, including the Royal Pharmaceutical Society (RPS) Professional Guidance on the Safe and Secure Handling of Medicines¹ and the College of Policing's 2024 Authorised Professional Practice (APP) for Custody,² emphasise the importance of maintaining prescribed treatments to prevent avoidable clinical deterioration. Yet hormone replacement therapy (HRT) frequently remains excluded from rapid medicines continuity pathways, resulting in abrupt interruption for women entering police and prison custody despite risks highlighted in the UK National Preventive Mechanism (NPM) Menopause in Detention Toolkit.³ This article examines the immediate physiological and psychological consequences of abrupt iatrogenic oestrogen withdrawal, framing endocrine withdrawal as an acute patient safety issue rather than a lifestyle concern. It integrates emerging evidence, including the UK National Preventive Mechanism (NPM) Menopause in Detention Toolkit,³ the Independent Custody Visiting Association (ICVA) Menopause Impact Report,⁴ and the growing recognition that women and clinicians require clearer evidence to support decisions regarding the continuation or discontinuation of hormone replacement therapy(Hamoda and Panay, 2024).⁵ It also incorporates peer-reviewed neuroendocrine research demonstrating the destabilising effects of abrupt oestradiol withdrawal ^6-8. The paper argues for a paradigm shift in custodial healthcare, recognising hormone replacement therapy as an essential endocrine treatment requiring timely continuity of care. It proposes practical approaches to medicines verification and rapid bridging protocols to reduce avoidable endocrine withdrawal, support accurate clinical assessment and improve patient safety.