HRT supply: What are the issues and how are they being addressed?

Women are having to deal with a shortage in hormone replacement therapy (HRT) supplies amid rising demand for such treatment.

The medication, which contains the hormone oestrogen, helps alleviate the symptoms of menopause in women when their hormone levels decline, which is a natural part of ageing.

However, some women experience severe symptoms of menopause that make it extremely difficult to work or carry out everyday tasks. A new survey of more than 4,000 women shows that one in 10 UK women who have worked during menopause have left a job because of their symptoms.

HRT is therefore crucial for tens of thousands of women to continue working and living their lives as normal.

Here is everything you need to know about HRT and the supply problems that are affecting women:

What is HRT?

The NHS says HRT is a treatment to relieve symptoms by replacing hormones that are at a lower level as women approach the menopause.

HRT can help relieve most menopausal symptoms, including hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive.

What is the current situation with supply?

The Royal Pharmaceutical Society (RPS) said prescriptions for HRT have more than doubled in England over the past five years, from 238,000 in January 2017 to almost 538,000 in December 2021.

The Department of Health and Social Care (DHSC) said demand for HRT has dramatically risen, with a 38 per cent increase in the number of prescription items over the last seven years.

What is the reason for such an increase in demand?

DHSC said there is greater awareness around the menopause and more confidence among GPs in prescribing HRT.

What has been the consequence of this higher demand?

Acute shortages have reportedly caused women to share prescriptions, with some said to be made suicidal by the debilitating menopause symptoms they suffer without the medication.

DHSC said while most of the 70 HRT products available in the UK remain in good supply, a range of factors including an increase in demand has led to shortages of a limited number of products including Oestrogel.

What is the government doing about it?

At the end of April, the government announced that Vaccine Taskforce director general Madelaine McTernan had been appointed to spearhead a new HRT Supply Taskforce.

Her role will involve identifying ways to support the HRT supply chain and address shortages some women face on a limited number of products, DHSC said.

Health secretary Sajid Javid said McTernan will “use her excellent skills and expertise to build on the success of the Vaccine Taskforce to bolster supply of vital medicines to women across the country”.

DHSC also said it was issuing serious shortage protocols (SSPs) to limit the dispensing of three products in high demand to ensure women are able to access the HRT they need.

These are the Oestrogel pump-pack 750mcg/actuation gel, Ovestin 1mg cream, and Premique low dose 0.3mg/1.5mg modified release tablets.

The SSPs are set to expire on 29 July and are aimed at allowing community pharmacists to supply the three specified HRT products according to the protocol rather than the written prescription, without needing to seek authorisation from the prescriber.

The DH said this will “even out” distribution of in-demand products such as Oestrogel.

What is the HRT taskforce responsible for?

The government said the taskforce will engage with HRT suppliers to ensure there is a good understanding of supply constraints and what is being or can be done to address them in the short and long term.

It will also work with the NHS Business Services Authority to secure access to real-time HRT dispensing data in order to improve understanding of supply, demand and what is driving shortages.

The taskforce will also be expected to engage with professional bodies including the Royal College of GPs, Royal College of Obstetricians and Gynaecologists and the Pharmaceutical Services Negotiating Committee to support pharmacists and prescribers to ensure they respond appropriately to increased demand.

What about prescription charges?

DHSC said it is taking action to increase access and reduce the cost of HRT by allowing women to pay a one-off charge equivalent to two single prescription charges, currently £18.70, for all their HRT prescriptions for a year.

Known as a prepayment certificate, it is intended to mean women can access HRT on a month-by-month basis, easing pressure on supply, while keeping the cost of HRT low. This system will be implemented from April 2023.

Is this soon enough?

Not according to the RPS, which described the timeline as “disappointing”.

Thorrun Govind, chair of the RPS in England, said: “Delaying this move will frustrate many who already pay for monthly HRT prescriptions and will further drive health inequalities already experienced by women across the country.”

She said HRT prescriptions are “essential” but also “a financial drain during a cost-of-living crisis” as she called for prescription charges for such treatment to be scrapped entirely in England.