HRT – and patience – in short supply

Despite the number of prescriptions for HRT in England doubling in the last five years to more than 500,000 a month, stocks are running scarce, and the country is experiencing an acute shortage of these products, which are used to treat symptoms of menopause.  

Every year, millions of women go through menopause as their oestrogen levels wane, with many experiencing symptoms that can range from mild to severe, where symptoms can include: low mood, anxiety, hot flushes and insomnia.  

An estimated 1 million women in Britain are on HRT. The recent shortage has rendered women unable to sleep and work, with some even reporting suicidal thoughts in the absence of treatment. The shortages of the products have led to some women buying them on the black market, driving for hours to visit numerous pharmacists, or even asking friends to buy medicines abroad for them. 

According to a poll conducted in the UK last year, 99 per cent of women felt their perimenopausal or menopausal symptoms had led to a negative impact on their careers, with more than a third describing the impact as significant. Experts are now warning this shortage may lead to more women being absent from work.  

Speaking in the Commons on the matter last week, Caroline Nokes, chair of the women and equalities committee, called for an urgent debate on the issue to ensure women “can get the supplies that we need.” She said pharmacies in her constituency had completely run out of HRT, “which leaves women of a certain age..without access to the oestrogen gel, which enables us to sleep or work competently.” Here’s what you need to know about the current HRT shortage. 

What is hormone replacement therapy? 

Hormone replacement therapy or “HRT” was first introduced in the 1940’s to relieve symptoms of menopause such as hot flushes, night sweats, mood swings, anxiety, and lack of libido by replacing the hormones that are at a lower level. The average age a woman starts menopause is 51 – however, symptoms commonly affect women from the age of 45.  

HRT helps alleviate a host of these symptoms during this time, and according to the NHS, it typically involves both oestrogen and progesterone, with some forms only involving the former. Oestrogen-only HRT is usually only recommended if you have had your womb removed during a hysterectomy.  HRT products come in a myriad of forms under numerous brands, from the pill and patch, which are the most popular treatments, to a range of oestrogen creams, gels and sprays. 

What are the pros and cons of HRT? 

While most experts agree that HRT is a “good and safe treatment” there are “some small potential risks.” In the 1970s, HRT’s reputation as a long-regarded “wonder drug” was besmirched by an influential 2002 report that showed it could, in some cases, increase the risk of heart disease, strokes, blood clots and breast cancer. The story led to a 50 per cent decline in HRT prescriptions.  

Subsequent studies have shown that taking combined oestrogen-progesterone HRT could increase the risk of breast cancer. A study in Finland also found evidence of a link between HRT and a 9 to 17 per cent increased risk of Alzheimer’s.  Whereas the purported benefits of HRT not only alleviate symptoms of menopause but include a protection against the thinning of bones.

According to the American College of Obstectricans and Gyneocolgoists (ACOG), HRT can also combat vaginal dryness, reduce the risk of colon cancer, and reduce the risk of hip and spine fractures in postmenopausal women. Haitham Homada, a consultant gynaecologist who heads up the menopause unit at King’s College Hospital London and is a member of the British Menopause Society’s medical advisory council, tells the Daily Mail that the health risks of HRT are actually “very small when put into context.”

What’s behind the supply problems? 

The shortages of HRT products have been blamed on manufacturing and supply issues, where a combination of a shortage of Oestrogel (the main HRT product which is manufactured abroad) and a rise in demand has led to the current shortage.  Oestrogel manufacturer Besins Healthcare said it has experienced “exceptionally high demand” for Oestrogel in recent months. According to the British Menopause Society (BMS)  

Besins has indicated it is receiving deliveries of the product on a regular basis, but has acknowledged that the current supply is sometimes insufficient to meet the skyrocketing demand.  Pescriptions for HRT has more than doubled in the last five years, going up from 238,000 in 2017 to 538,000 monthly prescriptions last December as the pendulum of public opinion has swung back in HRT’s favour, with research confirming it safer than what many thought.  

As it stands, women are ordering a repeat prescription of their HRT only to be then told that their pharmacy – local or online – cannot obtain it from any of their wholesalers and to go back to the prescriber (GP) for an alternative. The British Menopause Society said yesterday that women who cannot get Oestrogel should consider “equivalent alternative HRT preparations”, including 0.5mg or 1mg of Sandrena gel or Lenzetto spray preparations. 

Claire Anderson, the president of the Royal Pharmaceutical Society, has called for prescribing rules to be altered so that pharmacists don’t need to go to their GP’s if there are no stocks of a drug listed on the prescription, but an equivalent is available. In turn, this would make it “faster for patients and more efficient,” Anderson stated.   

What is being done to tackle this shortage? 

The health secretary Sajid Javid told the Mail on Sunday that he planned to tackle the problem by appointing a new HRT tsar/tsaress with the role modelled on that of Kate Bingham, who triumphantly led the government’s Covid vaccine task force.   Javid said: “I know just how much women rely on HRT and that some have been struggling to get certain medicines. I’m determined to do all I can to make sure that supplies are meeting hugely rising demand and there is equitable access […] It’s also clear to me that we need to apply some of the lessons from the vaccine taskforce to this challenge, so we will soon be recruiting for an HRT supply chairperson.”

 Maria Caulfield MP has said she has held meetings with trade associations that deal with HRT suppliers. “They’re confident they’ll get supplies back to the demand levels that we need but we don’t want to leave any stone unturned so we’re bringing in a lead on HRT supply so if there’s anything the government can do to help suppliers we’re in a position to do so,” she said. 

According to Ms Caulfield, Manufacturers have told the government that the supply of Oestrogel should be back to normal “roughly around June.”