Around a million UK women are currently struggling to get hold of hormone replacement therapy (HRT). A shortage, specific to the UK, of an oestrogen gel and other forms of HRT are causing some women to miss work in order to hunt for the drug.
Some women are even being forced out of work altogether, according to campaigners, while others have been forced to by the drugs on the black market. And the shortages have other knock-on effects to health and to the NHS, too.
So why is there a shortage, and what can we do about it? What even is HRT?
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What is HRT?
HRT stands for hormone replacement therapy. It comes in many forms, such as patches, gels, or tablets, but all are designed to relieve symptoms of the menopause by replacing the hormones that naturally fall to a lower level.
Those symptoms can include: hot flushes, night sweats, mood swings, vaginal dryness, and reduced sex drive. These symptoms can pass naturally after a few years without treatment, but they can be so severe that many women request HRT to prevent them.
Around one million women in the UK are on HRT.
Why is there a shortage?
HRT is in short supply in the UK right now. This was initially caused by a shortage of one form of HRT named Oestrogel, an oestrogen-only gel produced by Besins Healthcare.
Besins claims the shortage is actually due to increased demand. It says the shortage is specific to the UK and that it will be short-lived, since it is currently working to increase production.
In the meantime, however, many women who were previously using Oestrogel have turned to other forms of HRT - causing a shortage of those, too. Some women have reported driving to dozens of pharmacies to try and find stock of the drug.
What can be done?
While stocks remain low, the British Menopause Society has advised women "to consider equivalent alternative HRT preparations. This could include Sandrena gel (0.5mg or 1mg) or Lenzetto spray preparations."
The society continues: "Prescribers should consider using equivalent preparations to those that their patients are currently using. If an exact match is not possible, prescribers can seek guidance available on the BMS website to clarify equivalent doses.
"Consideration could also be given to prescribing oestrogen and progestogen separately to make the closest match or to find a suitable alternative. Different brands for the same medication may vary in appearance or excipients. However, they would provide equivalent amounts of hormones when used in similar doses."
The Royal Pharmaceutical Society says the government should relax the laws around prescriptions to help solve the crisis. At present, pharmacists cannot alter or substitute prescriptions, forcing them to bounce patients back to their GPs in the event of stock shortages.
The current rules mean pharmacists cannot even supply two 1mg tablets if the prescription was specifically for one 2mg tablet. The RPS says pharmacists should be given greater powers to use their judgement in such scenarios.
RPS president Prof Claire Anderson told BBC News: "Difficulties in accessing HRT unfairly impacts women, affects their mental health, and worsens health inequalities. This is an area that not only impacts our patients but also the health and care workforce.
"The government should now go further and end unfair prescription charges for patients in England altogether. Pharmacists spend many hours dealing with medicines shortages when we'd rather be talking to patients about their care.
"One solution would be to enable pharmacists to make minor changes to a prescription when something is out of stock. This is faster for patients and more efficient for the NHS."
What has the government said?
Minister for women's health Maria Caulfield said: "There are over 70 HRT products available in the UK, most of which remain in good supply, however we are aware of some issues with women being unable to access certain products. We will be appointing a new HRT supply chairperson, and convening an urgent meeting of suppliers to look at ways we can work together to improve supply."
Last October, the government promised to dramatically cut the cost of repeat HRT prescriptions, which some blame for the increased interest and demand for the drugs. However, those savings will not come in until April 2023, a year later than campaigners hoped.
In response, Carolyn Harris, a Labour MP who has been a leading campaigner on HRT, told the Times: “I feel very betrayed and angry on behalf of the 13 million women in this country who are menopausal. The government made us a promise but have failed to deliver on it. They are denying us the basic human right of living a normal life.
“Women are crying out for HRT. They are driving up the motorway to meet up with other women to swap it in service station car parks.”
She added: “The government was totally unprepared for the rise in demand for HRT, which is down to the campaigning of people like Davina McCall. It shows they are not serious about women’s health.”
Caroline Nokes, the Conservative MP and chair of the Commons' women and equalities committee, says she has resorted to rationing her own HRT medication. She 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.”
Anyone interested in starting HRT should contact their GP. More information and support is available on the NHS website.
