HRT supply: what are the problems and how are they addressed?


Women are confronted with a lack of supply of hormone replacement therapy (HRT) given the increasing demand for such treatments.

Here, the PA news agency takes a look at the problems:

– What is HRT?

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

HRT can help relieve most menopause symptoms, including hot flashes, night sweats, mood swings, vaginal dryness, and decreased sex drive.

– What is the current supply situation?

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

The Department of Health (DH) said demand for HRT has increased dramatically, with a 38% increase in the number of prescription items over the past seven years.

– What is the reason for such an increase in demand?

The DH said there was greater awareness of menopause and more confidence among GPs in prescribing HRT.

– What was the consequence of this higher demand?

Acute shortages have reportedly prompted women to share prescriptions, with some reportedly having suicidal thoughts from the debilitating menopausal symptoms they suffer without the drug.

The DH said while most of the 70 HRT products available in the UK remain readily available, a number of factors including increasing demand have led to shortages of a limited number of products, including estrogel.

– What is the government do about it?

At the end of April, the Government announced that Vaccine Taskforce Director-General Madelaine McTernan had been appointed to lead a new HRT Supply Taskforce.

Her role will be to find ways to support the HRT supply chain and address shortages some women are facing on a limited number of products, the DH said.

Minister of Health Sajid Javid said Ms McTernan will “use her outstanding skills and expertise to build on the success of the immunization task force and strengthen the supply of essential medicines to women across the country.”

The DH also said it would issue Serious Deficiency Protocols (SSPs) to limit the dispensing of three high-demand products to ensure women have access to the HRT they need.

These are Oestrogel Pumppack 750 µg/activation gel, Ovestin 1 mg cream and Premique low dose 0.3 mg/1.5 mg modified-release tablets.

The SSPs expire on July 29 and aim to enable pharmacists to supply the three indicated HRT products according to protocol rather than written prescription without having to obtain prescriber approval.

The DH said this will “even out” the distribution of in-demand products like estrogel.

– What is the HRT task force responsible for?

The government said the taskforce will work with HRT suppliers to ensure there is a good understanding of supply shortages and what is being done 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 spending data to improve understanding of supply, demand and the root causes of congestion.

The taskforce is also expected to work with professional bodies such as the Royal College of GPs, the Royal College of Obstetricians and Gynecologists and the Pharmaceutical Services Negotiating Committee to help pharmacists and prescribers ensure they are adequately responding to the increased respond to demand.

– What about prescription fees?

The DH said it was taking action to increase access to HRT and reduce costs by allowing women to pay a one-off fee, equivalent to two single prescription charges, currently £18.70, for all their HRT recipes for a year.

Known as a prepayment certificate, it aims to give women monthly access to HRT, reducing supply pressure while keeping the cost of HRT down. This system will be implemented from April 2023.

– Is that soon enough?

Not according to RPS, who described the schedule as “disappointing”.

Thorrun Govind, Chair of the RPS in England, said: “The delay in taking this step will frustrate many who are already paying for monthly HRT prescriptions and will further exacerbate the health inequalities that women across the country are already experiencing.”

She said HRT prescriptions are “essential” but also “a financial drain during a cost of living crisis” as she called for prescription fees for such treatment to be scrapped entirely in England. HRT supply: what are the problems and how are they addressed?

Bobby Allyn

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