GPs may need to switch patients' HRT as shortages set to increase

Published: 9th August 2019

As reported on 09-08-19

Most strengths of Elleste tablets are currently unavailable and the manufacturers of Evorel patches has said that it expects shortages of this product to begin in September.

Mylan, which produces Elleste, told GPonline’s sister site MIMSthat the shortages were because its manufacturing partner was experiencing interruptions in the production of certain strengths of the drug.

Janssen, the manufacturer of Evorel, said shortages of other products have increased demand for Evorel. Evorel Conti (estradiol/norethisterone) patches and Evorel (estradiol) 100 patches are expected to be out of stock from September; Evorel Sequi (estradiol/norethisterone) and Evorel 50 and 75 patches from October; and Evorel 25 patches from March 2020.

Meanwhile, all strengths of FemSeven Conti and Sequi (estradiol/levonorgestrel) patches have been out of stock in the UK since the end of last year and are not expected to be available again until 2020. The manufacturer Theramex said this was due to a quality issue with the patches’ adhesive.

Review HRT

Dr Louise Newson, a GP with a special interest in the menopause and an executive member of the Primary Care Women’s Health Forum, said she has had to switch patients onto different treatments. However, she said the shortages provided GPs and patients with an opportunity to review their HRT and ensure they were on the most appropriate therapy.

‘The HRT shortage should be seen as an opportunity to optimise women’s HRT,’ Dr Newson said. ‘Having transdermal oestrogen, so oestrogen through the skin as a patch or gel, is the preferable route for the majority of women as there is no thromboembolic risk with using oestrogen in this way. Also, having micronised progesterone in the form of Utrogestan or a Mirena coil are the preferred types of progestogens.’

The British Menopause Society said in May that it was aware of supply issues with many HRT products but that it was ‘reassured that some are only temporary’.

At the time it advised prescribers to find equivalent types by looking at the oestrogen and progestogen component and matching it as closely as possible to another brand - for example Kliofem can be prescribed instead of Elleste Duet Conti.

Switching treatment

Where an exact match was not possible the society recommended that GPs prescribe the oestrogen and progestogen separately to make the closest match. Prescribers should also be aware that different brands of the same medication may vary in appearance or excipients, the society added.

Prescribers can find suitable alternatives using the MIMS HRT comparison table.

Mylan said it was providing the DHSC and the British Menopause Society with frequent updates on supply of Elleste. It added: ‘We offer a website for healthcare professionals, called MyWay HRT Hub & Treatment Navigator that includes a dedicated sectionshowing the latest stock constraints and alternative choices from Mylan’s HRT portfolio.’

Theramex said it was evaluating other sources of adhesive for FemSeven Sequi and FemSeven Conti. It said there was no other HRT with precisely the same composition so it was unable to suggest any alternative treatments.

The Primary Care Women’s Health Forum has produced an easy HRT prescribing guide for GPs and other prescribers, which provides advice on prescribing HRT based on current guidelines and best practice.