The UK is currently experiencing an acute shortage of hormone replacement therapy (HRT) products. But what is HRT, and what is causing the shortages?
What is HRT?
HRT boosts levels of hormones that wane as women get older and approach the menopause, in particular oestrogen. By doing so, HRT helps to alleviate a host of symptoms associated with the menopause, from hot flushes to night sweats and vaginal dryness. It is estimated about 80% of women going through the menopause experience such symptoms.
According to the NHS, HRT typically involves both oestrogen and progestogen, although there are forms that involve only the former – these can be used by women who have had a hysterectomy or are using an intrauterine system.
There are various different schedules and methods for taking the hormones, and different doses can be used.
HRT can not only improve women’s quality of life but may also have other benefits, such as protecting against thinning of bones.
However, some women have health conditions that may make HRT unsuitable for them, while the therapy has also been linked to an increased risk of breast cancer – although some experts have pointed out the risk remains low and is greater for some forms of HRT than others.
How many women use HRT?
According to the National Institute for Health and Care Excellence (Nice), about a million women in the UK use treatment for the symptoms of the menopause, although access to HRT has been described as a “postcode lottery”.
In October the Department of Health and Social Care announced women in England would be able to get a year’s supply of an HRT drug for the cost of a single NHS prescription – although implementation has been delayed – while in February plans were revealed for one form of HRT to be made available over the counter in the UK.
Speaking to the Times, Labour MP Carolyn Harris, chair of the government’s menopause taskforce, said about 30,000 women use Oestrogel – an oestrogen-only form of HRT produced by Besins Healthcare UK, which is at the heart of the current shortages.
What is behind the current HRT shortage?
This is not the first time there has been a shortage of HRT. At present, however, shortages are primarily affecting Oestrogel as well as a handful of other forms of HRT including FemSeven Sequi patches.
Besins said the Oestrogel supply problem was limited to the UK and the result of increased demand for HRT.
The British Menopause Society (BMS) said: “Besins expects this to be a short-term issue and anticipates that supplies will be available to local wholesaler branches soon.”
Data from NHS England shows that prescriptions for HRT have more than doubled in over the past five years.
“Following a recent increase in campaigning and media coverage – of menopause symptoms, their impact, and the role HRT can play – demand has grown, and more doctors are prescribing it. Unfortunately, supply has not kept pace with increased demand, however,” said Dr Clare Spencer of My Menopause Centre.
However, some ministers have also cited manufacturing problems, with the supply of ingredients used by some companies disrupted by Covid and other issues.
Janet Morrison, chief executive of the Pharmaceutical Services Negotiating Committee, acknowledged the shortage.
“Demand for HRT prescriptions is currently outstripping supply following the announcement of changes to HRT prescription charges,” she said. “This can be exacerbated by prescribers issuing prescriptions for six or 12 months at a time.”
What can be done?
The BMS advises women who are experiencing difficulty in obtaining Oestrogel to consider equivalent products, such as Sandrena gel, while prescribers should also consider alternatives for their patients.
However, some experts have noted that women are often on a particular HRT regime that is right for them, making changes problematic.
Speaking to Radio 4’s Today programme on Monday, Harris said the shortage of Oestrogel was down to bad planning, and that opting for similar products had led to a rush on them, too.
She added while there was a pill alternative, this was only available in two geographical areas of the UK, meaning it is “stacked high in warehouses”.
On Sunday the health secretary, Sajid Javid, revealed he planned to create an HRT tsar to tackle the shortage.
But Harris said Javid should take on the role himself. “He could decide to loosen the regulations on the formularies and make this [pill] product available across the country,” she said.
Spencer also called for action. “What’s important now is for government to urgently work with manufacturers to increase production and ensure that we don’t have a repeat of this situation, and that the government expedites the reduction in HRT prescription fees it promised last year, which Harris has tirelessly campaigned for,” she said.
