Acute HRT shortages have left some women taking extreme measures to access medication, with some reportedly travelling hundreds of miles, borrowing from friends or even turning to the hidden market. So what advice do experts have for those trying to manage menopause symptoms without their usual medicine?
Haitham Hamoda, clinical lead for the menopause service at King’s College hospital and chair of the British Menopause Society, said that, while the onus should not be on patients to deal with the crisis, there were some practical steps that could be taken.
“There’s been a lot of reports of people going online and to the black market which gives a bit of a sensational aspect to this,” he said.
Instead, Hamoda recommends that, if necessary, women can switch to different HRT preparations designed to deliver the same hormone concentrations. The British Menopause Society has published an equivalence guide for GPs and specialist doctors that indicates the closest alternatives for drugs that are in short supply, such as Oestrogel, an oestrogen-only form of HRT made by Besins Healthcare UK, and FemSeven Sequi patches.
“There might be some variation in absorption, you might get a little bit more or less, but it’s not going to be a huge difference,” he said. “In the interim that’s what I’d encourage people to do.”
To avoid a back-and-forth between GP surgery and pharmacy, a patient can ask their GP to check availability with pharmacies in advance. Similarly, most community pharmacies will be able to contact GPs to ask whether they can dispense an alternative drug, rather than sending the patient back for another consultation.
Claire Anderson, president of the Royal Pharmaceutical Society, is calling for the law to be changed so that pharmacists can make such minor changes without further consultation with doctors.
Anderson urged women not to swap medication with friends, as the MP Caroline Nokes described doing this week. “People shouldn’t be using other people’s medicines. Your medicine is individually prescribed for you and you should never ever share medicines. I would really strongly discourage that.”
HRT boosts levels of hormones that decrease as women approach the menopause, in particular oestrogen. This helps reduce a wide range of symptoms linked to changing hormone levels, including hot flushes, night sweats, vaginal dryness and mood swings. Some also take HRT to protect bone health. However, Anderson points out, different products have different benefit-risk profiles. Combined HRT (containing oestrogen and progestogen) is linked to a slight increase in breast cancer risk, while HRT tablets – but not gels or patches – are linked to a slight increase in blood clots.
Prof Waljit Dhillo, an endocrinologist at Imperial College London, said he would advise patients to try to stay on the same treatment if possible as it can take six weeks for symptoms to stabilise after beginning a new form of HRT.
“The problem is people are stabilised on one preparation, switching to another preparation … it’s not just like switching bread,” he said. However, he said, if shortages are expected to last beyond six weeks, it is probably worth patients switching to another drug.
Dhillo said that, while some people find alternative remedies helpful, the clinical evidence that such treatments are effective is “not very good” and so they should not be treated as a replacement for HRT.
Previous research has also shown that lifestyle changes such as cutting down on caffeine and alcohol and exercising regularly can help manage menopause symptoms. “Exercise is a good thing to do but it’s not going to be as effective,” said Dhillo.
