“Every time I go to the pharmacy now I’m not sure if I am going to get what I need,” said Emilie Joyal, from Rotorua.
She was highly dependent on the medication after having her ovaries removed last year, aged 40. That meant her menopause was debilitating and she required HRT just to function day-to-day.
Joyal said the shortages meant her usual dose was not available so she got larger doses and cut the patches in half to fit her prescription - an approach which GPs said was “fiddly” but worked as a temporary solution.
Around 60,000 New Zealand women now use HRT treatments, which release estrogen into the body in a controlled way - as ovaries do before menopause. They help mitigate symptoms like hot flushes, anxiety, mood swings, dizziness, joint and muscle pain, insomnia and panic attacks.
“It is life-changing to have this,” said Joyal, who founded a support group for women with early menopause. “It is what carried me out of a very dark place, being plunged into hormone deficiency every night, when the anxiety multiples times 10 and you can’t sleep.”
HRT is also an important medication for trans patients, because it helps align their body with their gender identity.
An update by Pharmac today said supplies of Estradot - the most commonly used treatment - had run out in the 25, 50 and 75mcg doses. Some 100mcg stock had just arrived in New Zealand and would be released soon.
Supplies of 25 and 50mcg would not be restocked until July and a new shipment of Estradot 75mcg was expected later this month. For some doses, alternatives like Estraderm and Estradiol were available now.
Pharmac director of operations Lisa Williams said its supplier had advised that demand for Estradot patches continued to surpass available supply.
She said demand in New Zealand alone for HRT medications had more than doubled over the past five years, and the increase had been especially sharp over the last two years.
Pharmac data showed demand for oral doses was flat while demand for patches - which don’t carry the same risk of blood clotting - had shot up.
The increase in demand had coincided with supply chain disruptions caused by Covid-19.
New Zealand pharmacies are on allocation, meaning they are only getting a small volume of menopause treatments each week to ensure even distribution around the country.
Williams said Pharmac had secured stock of alternative brands and funded a range of brands to support ongoing access to treatment. Additional supplies of Estradiol were expected to arrive in late May.
The shortages are a global problem. There have been reports in the UK of HRT black markets, people using other patients’ medications and women driving for hours in a bid to find pharmacies which stocked their product.
While New Zealand was not alone in facing shortages, patients and advocates said this country currently had few suitable, funded alternatives to Estradot.
A support group for people with menopause is petitioning Pharmac and Medsafe to approve and fund more HRT options, including gel treatments like Sandrena and Oestrogel.
Williams said Pharmac was exploring whether there were other products which could be funded in New Zealand.
She acknowledged the stress supply issues might be causing some people and recommended they contact their doctor if they were concerned about their health or access to medicines.
Royal NZ College of GPs medical director Dr Luke Bradford said demand for HRT treatments had skyrocketed because of an increased awareness of the burden of menopause and the safety and benefits of HRT medicines.
There was a growing understanding that women did not have to “sit and put up with these symptoms”, he said.
Bradford said some pharmacists were telling GPs that sourcing HRTs at the moment was “a nightmare”. The shortages meant GPs had to constantly be in touch with pharmacists about their stock levels and had to advise patients to cut up larger patches when their usual dose was not available.
“We can’t be sure that once a patient has started on a medicine and has stabilised on it that the supply is there, which is obviously concerning for us and patients,” he said.
“For a symptomatic patient, MHT [menopausal hormone treatment] is often life-changing. It really does change their quality of life and general wellness.”
Asked about the alternatives which have been secured by Pharmac, Bradford said Estradiol had a slightly higher risk of blood clots and was not suitable for patients with migraines.
