New Zealand’s chronic shortage of oestrogen patches has left women scrambling to get the HRT they need to manage menopausal symptoms. By Nicky Pellegrino.
Question: “I spent two weeks without oestrogen patches in January and just went to pick up my repeat prescription but the pharmacy was completely out of stock again … I’ve given up on my local pharmacies as there are very sporadic supplies and I’m driving for an hour and a half to fill my HRT prescription … I’m worried about the future if this doesn’t get sorted … I’ve been told there’s absolutely none available … My sister in Australia is sending me her oestrogen gel because I’m desperate.”
Answer: These were just some of the responses via the Menopause Over Martinis online forum when founder Sarah Connor asked New Zealand women to share their recent experiences of accessing hormone replacement therapy (HRT). The consensus was that oestrogen skin patches are in very short supply, no matter which part of the country you happen to live in.
Anna Fenton, an endo‑ crinologist in Christchurch, says her clinic started getting calls from women reporting a problem back in 2020, at the outset of the Covid-19 pandemic, and supplies seem to have ebbed and flowed since then.
The pandemic isn’t the only reason demand for the Pharmac-funded patch, Estradot, continues to outstrip supply. Rising numbers of midlife women have been asking for HRT to ease the symptoms of the menopause transition – such as hot flushes, aching joints, brain fog and mood swings.
Demand for HRT in New Zealand has more than doubled in the past five years, and there has been a sharp increase in prescriptions for patches in the past two. This may be partly due to what has been dubbed “the Davina McCall effect”. The UK television presenter’s documentary Sex, Myths and the Menopause has been widely viewed. But there has also been an increase in media articles, podcasts and books about menopause and more women are realising that hormone therapy is an option to relieve their symptoms, if they can get hold of it.
Pharmac has already broadened funding to a couple of alternative patch brands but Fenton says there have been problems.
“One of the brands is causing a lot of skin irritation, so that obviously limits the use,” she says. “There have also been issues with stickability – when women use them, they fall off.”
![Anna Fenton advises women to shop around and target pharmacies in parts of town with older or younger populations and so less demand for HRT. Photo / Getty Images](https://www.nzherald.co.nz/resizer/v2/PSP66ASVNFHBVNI7RNHLNEOT3Q.jpg?auth=622b6c3c1da531e81f1f1eeeaa22035c62185e37e9e683949b992692aa31d7a4&width=16&height=11&quality=70&smart=true)
Pharmacies around the country are receiving only a small allocation each week. If skin patches aren’t available then oral oestrogen is suitable for some women, but not for everyone as it can increase the risk of blood clots. For that reason, Fenton advises older women to stay with a patch. She says those who are under 60 and healthy – so not suffering from obesity, high blood pressure, diabetes or migraines – can take the hormone in tablet form.
Lower-dose Estradot patches are likely to be out of stock for some time, but a supply of 100mcg patches is on its way. Fenton says it is fine to cut those down so they deliver a lower dose. “Sometimes the advice is that they can’t be chopped up but that’s incorrect. We know they can be.”
She also advises women to shop around and, if possible, target pharmacies in parts of town with older or younger populations and so less demand for HRT.
Estradot manufacturer Novartis has confirmed that, despite increasing production three-fold since 2019, it has been struggling to manufacture enough oestrogen patches to meet the demand and there has been a global shortage.
“But the advantage other countries have is they have got more options,” says Fenton. “If there is no Estradot, then they have got more other brands of patches and different versions of oestrogen gel. Here, we are really limited, and I think that has been a real issue. We have maybe 5-10% of the total range of options.”
Pharmac is looking to see if there are other oestrogen products it can secure and fund. In the meantime, Fenton says she has heard of some women being advised that their best option is to come off HRT for a while. But that means their symptoms are likely to return and some will experience withdrawal bleeding.
“The poor pharmacists must be also having a difficult time,” says Fenton. “The ones I’ve talked to, close to where I work, say they have women clamouring for supplies.”
Nicky Pellegrino is the author of a book on menopause, Don’t Sweat It.