Why is there an HRT shortage and what can you do to get it?

Lots of countries have experienced shortages of Hormone Replacement Therapy (HRT) in recent years, and the United Kingdom is no exception. Around April 2022, pharmacies were reporting supply shortages of HRT products, particularly Oestrogel (Oestrogen gel) and FemSeven Sequi skin patches. This left many menopausal people without vital medication to tackle menopause symptoms such as hot flushes, night sweats, brain fog, difficulty sleeping, and vaginal dryness.

Considering how widely the effects of the shortage were publicised, with celebrities like Davina McCall working to raise awareness of the issue, further supply chain problems and drug restrictions announced in May 2023 have been frustrating for the millions of people who rely on HRT products for their quality of life.

In this article, we'll explain what's behind these shortages, what to expect going forward, and how to maximise your chances getting HRT so you can begin to ease symptoms of menopause once again.  

What's behind HRT product shortages?

Pharmaceutical companies who produce HRT medication, such as Besins Healthcare, have said that the 2022 shortage was predominantly due to an increase in demand, with suppliers simply unable to keep pace. Data published by NHS England revealed that the demand for HRT prescriptions more than doubled between 2017 and 2022.

HRT shortage 2023

The 2023 shortage of popular HRT product Utrogestran, which comes in 100mg capsules of micronised progesterone, is ongoing. As of June, Utrogestran manufacturer Besins Healthcare is working to boost production rates, but unfortunately there remains a gap between supply and rising demand. As things stand, people in the UK can only receive a two-month supply for the drug so that more people can access it. Other popular HRT products currently having supply issues include: 

Estradiol (Oestradial) patch shortage

Unfortunately, the ingredients required to manufacture estradiol patches are in short supply and high demand, making it increasingly difficult for pharmacies to stock the product. Although the Department of Health and Social Care have not yet recalled the HRT Supply Taskforce, a team assembled by Sajid Javid and headed by Madelaine Mcternan which effectively tackled the 2022 shortage, they have issued alternative products (https://www.chemistanddruggist.co.uk/CD136895/DH-issues-new-estradiol-patch-SSP-as-HRT-tablets-also-out-of-stock-until-June) to help meet high demands.  

Progesterone shortage, May 2023

Utrogestan 100 milligram shortage - In May, the Government issued a "serious shortage protocol"  (SSP) for utrogestan, a drug facing one of the most acute shortages among HRT products. The DHSC have limited the distribution of utrogestan by pharmacies to a two-month supply to ensure the vast majority of people who rely on utrogestan continue to have access to it.

If you do rely on the utrogestan 100 milligram drug and are concerned about pharmacy supplies, try not to worry! The British Menopause Society have assured HRT users that alternative products are available, and have published guidance on where to get them.  Alternative progesterone options include:

• Norethisterone 5mg tablets - to be taken daily
• Bijuve  (this will require a change to oral HRT)

Please speak to your pharmacist, GP, or your Fertifa Patient Advisor if you would like more information about alternative progesterone products.

Overall increase in HRT product supplies in 2023

On a more positive note, since the then Health and Social Care Secretary Sajid Javid set up an HRT Supply Taskforce (headed by Madelaine McTernan) in 2022, supply issues have been improving quickly. While 2022 saw a 'serious shortage protocol' (also known as 'SSP') placed on 22 HRT products, and substitutes like estradiol patches and estriol cream put in place, only 2 remain in place as of June 2023.

What should you do if you're struggling to get HRT products?

With supply issues seemingly on their way down, getting hold of your usual product and tackling those menopausal symptoms shouldn't be as difficult as it was in 2022. Here's some advice on what to do if you're a menopausal person affect by HRT supplies:

• Continue to take the medication as prescribed. Avoid prolonging your HRT supply by missing days to make it "last longer". Ensuring there's a continued supply of progesterone is necessary to protect the womb lining. 
• Avoid taking smaller doses. Smaller doses won't protect your womb lining as intended.
• Speak to your doctor about alternative medication. If pharmacies are experiencing a shortage of your prescribed, usual product, consult your doctor to discuss alternative products. Some examples of potentially suitable alternatives include:
• Provera or Norethisterone. Synthetic progesterones are used for a range of purposes including contraception and menstrual bleeding.
• Bijuvean. This is an oral HRT that combines oestrogen and progesterone. 
• Mirena. This is a contraceptive device that administers progesterone into the womb to protect its lining. 
• Vagifem. This is vaginal oestrogen, a prescription medicine that contains oestradiol (an oestrogen hormone) in a vaginal insert.
• ‍Transdermal patches. This is a patch that attaches to your skin and contains medication. The drug from the patch is absorbed into your body over a period of time.
  

Remember, most doctors need at least 2 working days to process a new prescription of an alternative product, so the earlier you book an appointment the better. If you urgently need to get hold of Utrogestan or any other HRT product your pharmacy is out of, consider widening your search. Even if it requires travelling a little further, it will be worthwhile if it resolves the issue.

At Fertifa, we believe every person should have access to HRT products to help ease symptoms of menopause and challenge gender-based health inequalities.

If you are worried about being able to get your supply of HRT, and the impact it may have on your menopausal symptoms, speak to a healthcare professional, menopause specialist, or your Fertifa Patient Advisor, who are all there to walk you through your options. If you're a Fertifa patient, our in-house doctors and nurses can prescribe you HRT if that's what's best for you.