The four-year HRT shortage is dragging on and people around the country are struggling to access the transdermal oestrogen patches their doctors have prescribed.
Hawke’s Bay GP Samantha Newman is leading efforts to demonstrate how great an impact this is having on the health of midlife women.
Hormone therapies to treat the symptoms of perimenopause aren’t a “nice-to-have” or a lifestyle choice, emphasises Newman. Her concern prompted her to conduct an online survey, which has captured the experiences of oestrogen-patch users.
“I was hearing from multiple patients and people in my community that the shortage was affecting them and I got a bit angry, which wasn’t constructive,” she explains. “I realised we needed some research about the impact of hormone therapy and what the current shortage actually means for HRT users.”
More than 2300 people took part in the survey during a two-week period. The resulting data confirms that the HRT shortage is critical. Of the respondents, 95% had experienced difficulties accessing it in the past 12 months.
Almost all participants had worsening symptoms due to the shortage, including a negative impact on emotional health (84%) and a negative impact on physical health (45%).
Meanwhile, almost half the respondents reported a negative impact on their ability to work, and 18% needed to take time off.
The survey also illustrated how hormone therapies have the potential to ease a wide range of symptoms beyond hot flushes. Better sleep was the benefit most respondents named – 988 said it helped with insomnia. Anxiety, brain fog, joint paint, fatigue and migraines were also improved. Some experienced an upswing in libido and fewer mood swings since taking HRT.
“This doesn’t mean that everyone needs hormones,” stresses Newman. “Not everyone will benefit. But we have to acknowledge that it really matters.”
When the global HRT shortage began in 2020, it was partly attributed to a sharp increase in demand. That demand has continued to soar. Pharmac reports that in the 2020/2021 financial year, New Zealanders used about 1.7 million transdermal oestrogen patches. By the 2023/2024 financial year that had increased to about 4.04 million patches.
Pharmac has responded to low supplies of the funded brand, Estradot, by sourcing alternative brands of patches. It is also exploring other HRT products and currently assessing an oestrogen gel, Estragel, which, if approved for funding, will be available from November. However, Pharmac predicts that the HRT shortage will continue into next year.
Newman believes HRT options should be widened further. In other countries, women can access newer products like the Lenzetto oestrogen spray, hormone pellet therapy, (an implant under the skin that releases hormones) or vaginal delivery systems such as Estring.
“We’ve got none of those things and because of that, no one knows what they are or is confident to prescribe them, which leads to another barrier for people trying to access HRT,” says Newman.
Her survey shows that when seeking stocks of patches, women are visiting multiple pharmacies, and for those who live rurally that can require a lot of travel. Plus, there is a financial impact. More than 50% need to spend additional money on prescriptions.
Māori were facing significant challenges, checking more pharmacies, incurring more costs and experiencing a greater impact on symptoms than non-Māori. Some women were resorting to DIY solutions which included lowering doses or borrowing from others.
“Overall, respondents were angry,” says Newman. “Many expressed anger that this shortage wasn’t predicted and responded to sooner. A common theme was that this neglect wouldn’t happen with a medicine that primarily treats men.”
She hopes the survey will be a springboard to further research and what Newman would really like to see is New Zealand appoint a leader to move hormonal healthcare forward.
“In a way, the shortage has been a very effective public health experiment to prove that it really matters,” she says.
