Last week, the British Menopause Society issued an update on the current availability of Hormone Replacement Therapy (HRT) products. Manufacturing and supply issues mean that many women in the UK are struggling to get their HRT medication, or even prescriptions for alternative treatments. This article looks at what’s behind the HRT shortage. It can also be used by Members of the Senedd and their staff to signpost their constituents to advice and support.
Around a million women in the UK use HRT to relieve the symptoms of the menopause
The Royal College of Obstetricians and Gynaecologists (RCOG), the British Menopause Society (BMS) and the Faculty of Sexual and Reproductive Healthcare (FSRH) issued a joint statement more than 2 years ago highlighting concerns that some women across the UK were unable to obtain their prescriptions due to shortages of HRT products. A failure to deal with shortages, coupled with the impact of COVID-related global supply problems means that many women are extremely concerned about not being able to get access to this vital medication.
Many women experience menopausal symptoms that affect their quality of life and long term physical health. HRT is the most effective form of treatment. HRT treats menopausal symptoms including hot flushes, night sweats, vaginal dryness, joint pains and aches, fatigue and low mood. It’s also reported that HRT can help reduce recurrent urine infections, improve sex function and reduce the risk of osteoporosis.
HRT is used to replace the oestrogen hormones which stop being produced by the ovaries when a woman enters the menopause. Some types also contain the hormone progestogen. There are different methods of taking HRT, including tablets, skin patches, gels and vaginal creams, or rings. But like all medication, once a patient has been prescribed one type of medication, it’s not straightforward to switch to another if supplies dwindle. There are also debates about the efficacy of the different types of HRT which mean that patients may be reluctant to accept other medication options.
There is little explanation for the shortages beyond manufacturing and supplier issues, although an increased uptake due to awareness of the benefits of HRT may be partially responsible
The Chair of the British Menopause Society has previously said “It remains unclear why there is a shortage of the treatments in the first place, or when the normal supply of the products might resume”.
The Pharmaceutical company Janssen, who manufacturer Evorel HRT treatment, have said they’ve seen "an unusual increase in demand for HRT over recent months across a number of countries, including the UK".
Some supplies will have been affected by the ongoing challenges brought on by the COVID-19 pandemic. Women have also faced difficulties obtaining clinical appointments and accessing pharmaceutical services, which is likely to have added further to this situation.
But the Labour MP Carolyn Harris, who co-chairs the UK Menopause Taskforce says ‘bad planning’ is behind the HRT drug shortages. She has said the shortage of HRT shows women’s health is not a priority for government;
The trouble with the menopause is for far too long women have not been listened to, women have been ignored, they've been prescribed and diagnosed with other conditions and the menopause wasn't even considered…For a menopausal woman this HRT is as important as insulin is to a diabetic.
The shortages were raised last week in the House of Commons by Caroline Nokes, the Conservative MP and chair of the Women and Equalities Committee. 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 and to work competently.”
The MP told the Mail on Sunday; “You can’t help but feel that, if this was a drug used exclusively by men, they’d have sent in the army to beef up production by now.”
Menopause is no longer a shameful word but HRT medication is not catching up with demand
Women are talking more about the menopause and therefore finding out that help is available. High profile celebrities, like Davina McCall have campaigned for better care, and political leaders including Scotland’s First Minister Nicola Sturgeon, have talked frankly about their experiences of the menopause. Helping many women to realise that they no longer have to suffer in silence. This could explain some of the rise in demand for HRT.
Recent figures suggest the number of HRT prescriptions in the UK has more than doubled in the past five years.
Women who were previously put off taking HRT because of ‘scare stories’ about the treatment may also now be coming forward. In 2015, the National Institute for Health and Care Excellence (NICE) published guidance which said that HRT is effective and is very safe; discrediting previous claims about the risks of the treatment.
The guidance means that GPs have been encouraged more to prescribe HRT to women experiencing menopause systems. We’re also starting to see women challenging things a bit more, with women asking for HRT from GPs and calling for more support in the workplace.
The Welsh Government has yet to issue a statement on the supply of HRT medicines in Wales
Earlier this year, the Welsh Health Minister Eluned Morgan MS told the Senedd’s Health and Social Care Committee that women’s health is a priority for her. The Minister has committed to publishing a women’s health quality statement later this year and is a member of the UK Taskforce.
But despite continuing reports of an overall shortage of treatments, which is likely to be causing anxiety for many women in Wales who depend on this treatment, the Welsh Government has said very little about the issue. Is the Minister working with the UK Government to ensure women in Wales get reliable and equitable access to these critical medicines in the immediate and longer term?
The UK Government’s Health Secretary Sajid Javid announced last week that he would appoint a new HRT tsar to tackle the HRT supply crisis. On 28 April, he announced that Madelaine McTernan (the head of the UK’s vaccine taskforce) will lead the new HRT taskforce. This focus on HRT may mean other recommendations that have been called for to address national shortages of HRT (such as law change around prescribing), as well as calls for yearly prescriptions for HRT may also be expedited.
Help and advice is available for women who are struggling with menopausal symptoms and/or who are having difficulty getting supplies of their HRT
According to the British Menopause Society, more than 75% of women experience menopausal symptoms, and a quarter of such women describe their symptoms as severe. There are many resources available for women who may be experiencing menopausal symptoms. Links for such information are included below:
- The British Menopause Society
- Menopause matters
- Manage my menopause
- Newson Health
- Royal College of Obstetricians and Gynaecologists’ menopause hub.
The British Menopause Society is also keeping their website updated on what treatments are available based on information from the manufacturers. They say that supplies of alternative HRT products are available and women affected should discuss alternatives with their GP.
Article by Sarah Hatherley, Senedd Research, Welsh Parliament
