Patchy HRT supply upsets patients

Shortages in supplies of a commonly used hormone replacement therapy (HRT) medication have left women ‘‘outraged and angry’’, a pharmacist says.

Estradot, a medication supplied through a patch on the skin, has had supply issues for more than two years. An alternative brand of patches brought in to help ease supply in July, Climara, has since run out.

Globally, the shortages have been blamed on ‘‘extraordinary’’ increases in demand for hormone replacement therapy.

Switching to another brand, Estraderm, has caused some women to break out in itchy hives, develop localised allergic rashes and experience more hot flushes, according to women posting on an online menopause support group.

Christchurch woman Rachelle

Crosbie has been lucky enough to avoid having to switch brands so far – if her 100-microgram dosage wasn’t available, her pharmacist made it up by combining 75mcg and 25mcg patches.

‘‘He’s aware that different brands may not work as well for his customers,’’ Crosbie said. ‘‘I’m stable on Estradot. I don’t want to risk that changing since I’m in surgical menopause, which can be harder.’’

A Nelson pharmacist said women were ‘‘outraged’’ and ‘‘angry’’ when they discovered that their usual prescribed patches were not in stock.

HRT was a very commonly prescribed medication, she said. ‘‘It’s right up there with blood pressure pills.’’

Menopause podcaster Penny Ashton said while Pharmac wasn’t in a position to do much about the shortage, it would be ‘‘very hard’’ for some women whose symptoms included ‘‘terrible’’ panic attacks and insomnia. ‘‘For some people, the

thought of going back to that would be terrifying.’’

Ashton said it was expensive to see menopause specialists, if you

could even get an appointment as some had long waiting lists. ‘‘So to go through all of that and then to suddenly not be able to get it [HRT] I can see would be quite stressful for people.’’

GP and menopause doctor Dr Linda Dear said Estraderm was okay for some women, but in her experience the patches were baggy, they did not stick as well as Estradot, and a lot more had allergic reactions to the adhesive used.

Dear said she told her patients whose patches were loose or falling off to change them every two days rather than twice a week, to ensure they were ‘‘getting a nice stable dose’’.

Pharmac only funded twiceweekly patches, she said, so pharmacists would supply more than that amount, but women would have to pay to be able to change them more frequently.

While the issue was a global one, the problem in New Zealand was that there wasn’t much else to choose from, she said.

There was no other non-oral estrogen available, such as gels or sprays, and not every dosage of every brand was funded, a situation Dear described as ‘‘hit-and-miss’’.

‘‘The more non-pill options we get here, the better. We need to move beyond patches really.’’

Health professionals and advocates who talked with Stuff were, however, sympathetic to Pharmac, acknowledging that not every drug could be funded and that the shortage was a global issue.

Pharmac’s chief medical officer Dr David Hughes said there had been several disruptions to supply of Estradot since August 2020.

There was currently limited stock of the Estradot brand available because of global constraints, he said, but Pharmac was continuing to engage with the supplier about future stock availability.

Stock of Estradiol TDP Mylan was available and Pharmac had secured alternative brands for this and other strengths to ensure that people have continued access to funded treatment.

‘‘Globally, suppliers are reporting extraordinary increases in demand for HRT. In addition, disruptions in distribution have occurred due to global and local supply chain issues caused by Covid-19.

‘‘We know it can be tough, with everyone facing disruptions due to the supply chain. It’s especially difficult when it is unexpected.

‘‘We want to reassure New Zealanders that we are working as hard as possible to ensure everyone has access to the medicines and devices they need to support their health and wellbeing.’’

Pharmac created a supply issues page specifically for Oestradiol patches (Estradot) and updated this as more information was made available to them, Dr Hughes said.

‘‘The more non-pill options we get here, the better.’’

Dr Linda Dear, GP and menopause doctor