The Guardian - UK (2022-04-30)

Saturday 30 April 2022 The Guardian •

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▲ Politicians and celebrities including Mariella Frostrup and Davina McCall protest against prescription charges for HRT in 2021 PHOTOGRAPH: STEVE PARSONS/PA

Hannah Devlin

Science correspondent

A

cute HRT

shortages have

left some women

taking extreme

measures to access

medication, with

some reportedly travelling

hundreds of miles , borrowing

from friends or even turning to

the black market. So what advice

do experts have for those trying

to manage menopause symptoms

without their usual medicine?

Haitham Hamoda, clinical lead

for the menopause service at

King’s College hospital and chair

of the British Menopause Society,

says that, while the onus should

not be on patients to deal with the

crisis, there are some practical

steps that can be taken.

“There’s been a lot of reports of

people going to the black market

which gives a bit of a sensational

aspect to this,” he says.

Instead, Hamoda recommends

that, if necessary, women switch

to diff erent HRT preparations

designed to deliver the same

hormone concentrations. The

British Menopause Society has

published an equivalence guide

for GPs and specialist doctors that

indicates the closest alternatives

for drugs that are in short supply,

such as Oestrogel , an oestrogen-

only form of HRT made by Besins

Healthcare UK and FemSeven

Sequi patches.

“There might be some variation

in absorption, you might get a

little bit more or less, but it’s not

going to be a huge diff erence,” he

says. “In the interim that’s what I’d

encourage people to do.”

To avoid a back-and-forth

between GP surgery and pharmacy,

patients can ask GPs to check

availability with pharmacies in

advance – and similarly most

community pharmacies will be able

to contact GPs to ask whether they

can dispense an alternative drug,

rather than sending the patient

back for another consultation.

Prof Claire Anderson, president

of the Royal Pharmaceutical

Society , is calling for the law to be

changed so that pharmacists can

make such minor changes without

further consultation with doctors.

Anderson urge s women not to

swap medication with friends, as

the MP Caroline Nokes described

herself as doing this week. “People

shouldn’t be using other people’s

medicines. Your medicine is

individually prescribed for you

to changing hormone levels,

including hot fl ushes, night

sweats, vaginal dryness and

mood swings. Some also take

HRT to protect bone health.

However, Anderson points out,

products have diff erent benefi t-

risk profi les, with combined

HRT (containing oestrogen and

progestogen) linked to a slight

increase in breast cancer risk

and HRT tablets, but not gels

and patches, linked to a slight

increase in blood clots.

Prof Waljit Dhillo, an

endocrinologist at Imperial

College London , advises patients

to try to stay on the same

treatment if possible as it can

take six weeks for symptoms to

stabilise after beginning a new

form of HRT. “The problem is

people are stabilised on one

preparation, switching to another

preparation ... it’s not just like

switching bread,” he says.

However, he adds, if shortages

are expected to last beyond

six weeks, it is probably worth

switching to another drug.

Dhillo says that, while some

people fi nd alternative remedies

helpful, the clinical evidence

that such treatments are eff ective

is “not very good” and so they

should not be treated as a

replacement for HRT.

Previous research has also

shown that lifestyle changes such

as cutting down caff eine and

alcohol and exercising regularly

can help manage menopause

symptoms. “Exercise is a good

thing to do but it’s not going to be

as eff ective,” says Dhillo.

Experts’ view Switch, don’t share:

how to cope if you can’t get HRT

and you should never ever share

medicines. I would really strongly

discourage that.”

HRT boosts levels of hormones

that decrease as women approach

the menopause, in particular

oestrogen. This helps reduce a

wide range of symptoms linked

▲ If gels are scarce experts urge users

to seek alternative HRT preparations

GPs told to tell

patients with

arthritis to opt

for exercise

over painkillers

PA Media

Arthritis suff erers are to be advised to

lose weight and exercise more, rather

than rely on painkillers to manage

their condition.

NHS guidance from the National

Institute for Health and Care Excel-

lence (Nice) says people who are

overweight should be told their pain

can be reduced if they slim down.

Aerobic exercise such as walking,

as well as strength training, can ease

symptoms and improve quality of

life. Exercise programmes may ini-

tially make the pain worse, but this

should settle down, guidance for GPs

and health professionals suggests.

The draft guidelines recommend

off ering patients non-steroidal anti-

infl ammatory drugs (NSAIDs) but not

paracetamol, glucosamine or strong

opioids. Nice said there was a risk of

addiction with strong opioids, while

evidence suggests little or no benefi t

for some medicines.

In the guidance, doctors are told

to diagnose osteoarthritis – the most

common form of arthritis – without

further investigation in people aged

45 or over who have activity-related

joint pain. Patients should either have

no morning joint-related stiff ness,

or stiff ness that lasts no longer than

30 minutes.

P atients can be off ered tailored

exercise programmes , with the

explanation that “doing regular and

consistent exercise, even though this

may initially cause discomfort, will

be benefi cial for their joints”.

Overweight people will be told

“any amount of weight loss is likely

to be benefi cial, but losing 10% of

their body weight is likely to be better

than 5%”.

Dr Paul Chrisp , director of guide-

lines at Nice, said: “ There is evidence

which shows muscle-strengthening

and aerobic exercise can have an

impact on not just managing the con-

dition but also providing people with

an improved quality of life.

“Beginning that journey can be

uncomfortable for some people at

fi rst, and they should be supported

and provided with enough informa-

tion to help them to manage their

condition over a long period of time .”

In the UK, more than 10 million

people have arthritis or other joint

conditions , with the knees, hips and

small hand joints most often aff ected.

Tracey Loftis , head of policy at the

charity Versus Arthritis, said: “ Our

own research into the support given

to people with osteoarthritis showed

that far too many do not have their

conditions regularly reviewed ... and

even fewer had the opportunity to

access physical activity support.

“ The lack of alternatives means

that, in many cases, people are stuck

on painkillers that are not helping

them to live a life free from pain. ”

2018 2019 2020 2021 2022

The prescription of hormone

replacement therapies has

increased over the past five years

Total items across all practices in England.

Annual % change

200,000

300,000

400,000

500,000

Source: openprescribing.net