HRT - Why is there a shortage and which medications are affected?
Published: 28th August 2019
Why is there a HRT shortage?
There are various reasons for this.
For some types of HRT there have been manufacturing issues. There has also been a large increase in demand for HRT - as more women are realising how safe and effective HRT is at improving their symptoms and also improving their future health. Many more GPs, doctors and nurses are now prescribing HRT due to improved education and knowledge, especially since the NICE guidelines were produced in November 2015.
Which types of HRT are affected?
Some combination (estrogen and progestogen) tablets are not available due to a manufacturing problem (eg. Elleste Duet).
Combination patches (containing estrogen and a type of progestogen) are not available.
Many types of estrogen only patches are not available; some of this is due to manufacturing problems and some are due to shortages from increased demand.
Women taking estrogen as a tablet can actually use the shortage as an opportunity to review the dose and type of HRT they are taking and decide whether this needs to be changed and even improved upon. Having estrogen as a patch or gel through the skin is not associated with a risk of clot so it is the safest way of taking estrogen.
If you are having trouble sourcing HRT from your usual pharmacy, it can be worthwhile trying a different pharmacy or even an online pharmacist who may have more in stock.
Which types of HRT are available?
Estrogen as a gel is still available. Body identical progesterone is still available - this is called Utrogestan in the UK. For many women having the estrogen and progestogen separately is advantageous as it allows for more control with the dose. Women in the UK can buy NHS pre-payment certificates for their prescriptions which will reduce the monthly cost.
What is HRT?
There are many different types and doses of HRT available, so it is really important to be given the right one for you.
All types of HRT contain estrogen, which works to replace the estrogen that your ovaries no longer make after the menopause. Taking HRT can really improve your symptoms (and quality of life) and also lead to a greater improvement in your heart and bone health. The best time to start HRT is when your periods are changing and you experience symptoms (ie when you are perimenopausal).
Is HRT safe?
HRT is actually much safer than most people realise. For the vast majority of women, the benefits of HRT outweigh the risks. More information about HRT is available here - and body identical HRT here.
What type of HRT should I take?
There is now robust evidence which shows that taking body identical HRT derived from the yam (a root vegetable) is the best type of HRT for most women. I have written an Easy HRT Prescribing Guide which many GPs tell me they find really useful. Numerous women have told me they have printed this out and given it to their GPs too.
What form of HRT should I use?
There are many advantages of using the estrogen as a patch of gel instead of a tablet and having the progestogen as micronised progesterone oral capsule (Utrogestan in the UK) or having a Mirena coil.
The estrogen that I usually prescribe for women is called 17 beta-estradiol. This is a 'body identical' estrogen, so has the same molecular structure as the estrogen in our bodies before the menopause.
It is safer to have the estrogen as a patch or gel, as this is absorbed directly through our skin into our bloodstream and has less side effects and risks. These types of estrogen can be given to women who suffer with migraines and those with a higher risk of blood clot.
There is a very small risk of clot with taking estrogen as a tablet. For most women their risk of clot is low, so this increase does not put them at undue risk, but many doctors are now preferring to prescribe patches or gels.
The type of progestogen (needed for women who have their womb) I usually recommend is called 'micronised' progesterone (Utrogestan). This is a 'body identical' progestogen as it has the same molecular structure as the progesterone in our bodies. This means it is usually associated with fewer side effects than other types of progestogens. Side effects of older progestogens can include bloating, weight gain, spots and mood swings.
The additional advantage of micronised progesterone is there is no increased risk of breast cancer for the first five years of taking it. After this time the risks of breast cancer are very low and seem to be lower than the risk for a woman taking the older types of progestogen. However, even with other types of combined HRT the risk of breast cancer is extremely low. Women who are overweight or drink around a couple of glasses of wine a night actually have a greater risk of breast cancer than women taking combined HRT.
Why won't my doctor prescribe HRT?
Despite all the national and international menopause guidelines clearly stating that most women benefit from taking HRT - and the fact that the risks with taking HRT are very low - many women still find that their GPs are refusing to give them HRT.
A recent survey I undertook of nearly 2,000 women found that 66% of women have inappropriately been given or offered antidepressants. There is no evidence that antidepressants improve the low mood associated with the perimenopause and menopause.
If you have had a negative experience obtaining HRT and do not feel confident approaching your GP then this letter may help you. This has been used with success by many women who are struggling with their GP prescribing HRT.
I am hoping the shortage of HRT can be a positive experience to learn new facts about HRT and be given the right type for you.