Daily Mail - 29.08.2019

Page 50 Daily Mail, Thursday, August 29, 2019

50 femailMAGAZINE

Why

the

could put

women’s

As NHS stocks run critically low, more

and more women are trying alternatives

— with worrying consequences

by Jennie

Agg

W

omen are calling it the ‘great hormone

shortage of 2019’. Internet forums and

Facebook groups are ablaze as women

swap stories of traipsing from pharmacy

to pharmacy, only to go home empty-

handed, unable to fill their HRT prescriptions.

There have been reports of women bulk-buying hormone

patches while on holiday in Spain, while pharmacists closer to

home have said those worried about running out are asking for a

six-month supply, rather than their usual three months.

medical leaders — from the Royal College of obstetricians and

Gynaecologists, the Faculty of Sexual and Reproductive Health-

care and the British menopause Society — have called on the

Government to act, and there’s a petition, which is gaining

momentum, to get the matter discussed in Parliament.

As first reported in the mail earlier this month, tens of

thousands of women up and down

the country have been unable to

get their usual prescription for

HRT (hormone replacement

therapy), while many more are left

wondering if they will be able to

renew theirs.

Paula Briggs, a consultant in

sexual and reproductive health for

Southport and ormskirk Hospi-

tals nHS Trust, says: ‘There is

understandably a lot of anxiety if

patients think they’re not going to

be able to access something that

makes a big difference to them.

Patients are asking if what they’re

on is going to be in short supply.’

And now experts have raised

serious concerns that, faced with

not being able to get their usual

medication, women may be

increasingly tempted to try

aggressively marketed alternative

hormone therapies offered by

private clinics, but which medics

say are less safe.

HRT is given to relieve symp-

toms of the menopause, including

hot flushes, low mood and libido,

vaginal dryness and memory prob-

lems, which can be debilitating. It

works by replacing the hormones

that diminish as women stop

having periods.

Unless a woman has had a

hysterectomy, HRT typ-

ically involves taking

a combination of

both oestrogen

and progester-

one, and some-

times testoster-

one. medication

can be given as

a tablet, a pes-

sary, a patch or

gel applied to

the skin — or a

mirena coil, which

releases progester-

one, can be fitted in

the womb.

more than 2.5 million

prescriptions are issued for

HRT every year.

But slowly but surely, stocks of

certain products have dwindled.

Six products normally available

on the nHS — including FemSeven

Sequi and Conti patches and com-

bined pills such as Clinorette and

Cyclo-progynova — are out of

stock, according to the latest

information released by

the Department of Health.

H

AlF of all options for

oral oestrogen tablets

are currently unavail-

able. While stocks of

three strengths of commonly

prescribed oestrogen patches —

evorel, which has 40 per cent of

the market share — are due to run

out in october. Supplies of

evorel’s lowest strength patches

(25mcg) are also predicted to run

out by February 2020.

For information about which

products are in stock or not and

when out of stock products are

likely to be back, the British

menopause Society has recently

published an update on its web-

site (thebms.org.uk) as has the

Pharmaceutical Services negoti-

ating Committee (psnc.org.uk).

How, then, has this been allowed

to happen? Although matters

seem to have reached a crisis

point this month — with doctors

reporting it has become increas-

ingly difficult to prescribe oestro-

gen patches in particular, prob-

lems in the supply chain for some

HRT medications were first

reported to the Department of

Health back in December 2018.

This is something that manufac-

turers are required to do if there is

likely to be a serious interruption

to stocks. However, those on the

ground say the problem dates

back even further.

‘We’ve had shortages of different

products on and off over the past

year or two,’ says michael Savvas,

a consultant gynaecologist at

King’s College Hospital london

and member of the British

menopause Society’s

medical advisory

board. The produc-

tion of several

strengths of

elleste tablets

was ‘inter-

rupted’ accord-

ing to its manu-

facturer mylan,

which said this

was due to an

issue with

its ‘manufactur-

ing partner’.

Then, in an unre-

lated incident, the

firm behind a number of

patches had issues relating

to the quality of the glue that

sticks them to the skin.

The shortage of these products

— which have been unavailable

since the end of last year —

appears to have had knock-on

effects. When patients couldn’t

get hold of their usual drug, they

were prescribed another, and

suddenly a disproportionately

high number of people were after

the same drug, resulting in

pressure on supplies.

That’s certainly the case with

the widely prescribed evorel

patches. According to the manu-

facturer, Janssen, the current

shortage is down to ‘an unusual

increase in demand’.

many people posting online have

wondered if the threat of a no

Deal Brexit is a factor. But accord-

ing to the Pharmaceutical Serv-

ices negotiating Committee

(which acts as a go-between for

pharmacies and the nHS) this is

not thought to be the case.

Although the PnCS has

previously highlighted that the

prospect of a no Deal Brexit was

affecting supplies of other drugs,

such as the painkiller naproxen,

HRT is ‘not one that’s been picked

up as a particular concern’ accord-

ing to a spokesman.

It’s also possible, some experts

have suggested, that shortages

have been triggered at least in

part by more women asking for

HRT, as confidence grows that it

is safe. This comes in the wake of

high-profile support from celebri-

ties such as mariella Frostrup and

books such as oestrogen matters,

published last year by two doctors,

which made the case for HRT.

This is contrary to previous

reports and outdated evidence —

that has since been debunked

—suggesting it can significantly

raise the risk of breast cancer. The

nICe guidelines were changed in

2015 to encourage the prescribing

of HRT, urging that twice as

many women could benefit than

do so currently.

‘Some of the current shortage is

due to manufacturing problems,

but some of it is due to increased

demand,’ confirms louise newson,

a GP specialising in menopause

and author of the Haynes meno-

pause manual. ‘I think as messages

have filtered through about the

benefits and safety there is more

confidence around HRT and

women do feel more empowered

to ask for it.’

‘There’s definitely been an

increase in interest lately,’ adds

Dr Briggs.

‘In our area, we recently ran an

informal drop-in session for

women considering HRT and 350

turned up!’

So what can you do if you are

affected by the great

hormone shortage?

While acknowledging the sever-

ity of the current supply problems,

all of the experts Femail spoke to

for this piece were keen to reassure

women that there are still effective

HRT alternatives to their usual

brand available — although GPs

rather than menopause special-

ists may not have been updated

about which products are and

aren’t in stock.

‘Women who find they can’t get

their usual products should go

back to their prescribing doctor,

who should be able to find a good

equivalent,’ says Dr Savvas.

Haitham Hamoda, a consultant

gynaecologist at King’s College

Hospital, london, and chair of the

British menopause Society,

advised that doctors should ‘find

equivalent types by looking at the

Safety

fears

In 2000, 6 million HRT

prescriptions were

issued. But this has fallen

by two-thirds, due to

studies — since branded

overblown — linking

it to cancer

HRT

lives at

crisis

SPECIAL REPORT

WHAT’S OUT

OF STOCK

n FemSeven Conti combined

skin patches. Contain oestrogen

(estradiol hemihydrate, 1.5mg)

and progesterone

(levonorgestrel, 0.525mg). DUE

BACK IN STOCK: Feb 2020

n FemSeven Sequi skin patches.

Contain oestrogen (estradiol

hemihydrate, 1.5mg) and

progesterone (norehisterone

acetate, 1.5mg)

DUE BACK: Feb 2020

n Zumenon oral tablet.

Contains oestrogen only

(estradiol hemihydrate).

DUE BACK: Mid-September

n Bedol oral tablets, 2mg.

Contain oestrogen

only (estradiol)

DUE BACK: Not known

n Clinorette combined HRT

tablets. Contain oestrogen

(estradiol, 2mg) and

progesterone (norehisterone

acetate, 1mg)

DUE BACK: Not known

n Climanor oral tablets.

Contain progesterone

(medroxyprogesterone, 5mg).

DUE BACK: Not known

SOURCE: Department of Health

Pharmaceutical Services

Negotiating Committee