Beat the HRT shortage without the black market

More and more women are choosing hormone replacement therapy (HRT) to ease their menopausal symptoms.

It is estimated that around 10% use it, but the number is growing, with the most recent monthly figures showing more than 500,000 prescriptions issued in the UK, up from 238,000 prescriptions five years ago. .

But while it may be good news that more and more women are coming forward for help when they may have previously suffered in silence, it has also created a problem – HRT deficiency.

Last week, there were claims that this has resulted in some women turning to the black market to source their HRT products, paying £50 for a product that is no more than the £9.35 NHS prescription fee .

Others have resorted to ‘barter and exchange bottles’ via social media.

More and more women are choosing hormone replacement therapy (HRT) to ease their menopausal symptoms [File photo]

HRT, in the form of estrogen and progestogen hormones, comes in a variety of products including tablets, gels, creams, patches, and sprays, available under different brand names and combinations. These two hormones can be taken together, such as in a pill or taken individually.

Haitham Hamoda, clinical team leader for menopause services at King’s College Hospital in London, and president of the British Menopause Society (BMS), says some products have been in short supply lately.

He said: “A shortage of certain types of HRT became an issue in late 2018 in the UK, when a manufacturer had problems sourcing ingredients for a combined HRT tablet Elleste and the manufacturer. FemSeven estrogen patch has changed production. its product line, and the product was later sold to another company’.

In these cases, it can be easy to switch to another brand with a similar profile.

However, the main problem is due to the supply of Evorel estrogen-only and combination patches in 2019 and 2020, in part due to increased demand worldwide.

“In the first six months of 2019, its manufacturer sold the same amount as the whole of 2018.

‘As Evorel had 40 per cent of the UK market at the time, this became a problem as it was so familiar and widely used.

‘Also, the combination Evorel patches, which contain both estrogen and progesterone, are the only combination patches on the market.

HRT, in the form of the hormones estrogen and progestogen, comes in a variety of products including tablets, gels, creams, patches, and sprays, available under different brand names and combinations.

‘Deficiency has a domino effect; when patients switch to other brands, such as the Estradot patch (the NHS has a fixed supply quota), this also leads to shortages of these other products. However, as of June 2020, we have had no problems with these patches. ‘

However, there is now a shortage (but on a ‘much smaller scale’) of Oestrogel, an estrogen gel.

Over the past five years, Oestrogel’s monthly prescription volume has increased eightfold, with more than 30,000 items delivered in December.

Manufacturer Besins Healthcare warned in January that stocks had become ‘drained’ because of high demand.

Increased demand for Oestrogel, as well as Evorel, has led to more women coming to the treatment, and the fact that the gel and patch is considered ‘safer’ than the combined pill.

This is partly because estrogen-only products are often ‘body-identical’ (created with hormones derived from plants rather than made in a lab), but also because they are not used orally.

“The best way to deliver estrogen is through the skin, most commonly through a patch or gel,” says Dr Mike Savvas, a consultant in gynecology and menopause at King’s College Hospital.

‘By mouth, it increases the risk of blood clots and stroke as the hormone travels to the liver, where it can affect the production of a protein called clotting factor. Applying it through the skin avoids this problem. ‘

Experts say women who cannot afford their usual HRT products should seek advice from their doctors instead of going to the black market.

Dr Edward Morris, president of the Royal College of Obstetricians and Gynecologists, said: “HRT is essential for many women to ensure they remain healthy with a high quality of life and we understand that deficiency in some type of HRT can cause grief.

‘We know the shortage situation has improved, but we also know that some women are still having difficulty accessing certain treatments.

‘We encourage those women to seek support from a healthcare professional, rather than buying it on Facebook, as they will be able to help them find the best alternative treatment.’

Mr Hamoda agreed and added: ‘There’s certainly no need to go back to the black market, where there’s no guarantee you’ll get anything.

‘For example, Oestrogel can be replaced with another estrogen-only product, such as Sandrena gel, or a patch such as Estradot, Evorel, Estradrm or Progynova, or Lenzetto spray, which provides an equivalent amount of estrogen and has the same effect by delivering it through the skin. ‘

Some women say menopausal symptoms return when they switch pills, and Mr Hamoda admits ‘it can take some trial and error to get the right HRT product for each woman’.

However, some of the problems women face in accessing HRT may be due to some physicians being unfamiliar with the HRT product lines, suggests Mr. Hamoda.

‘Every GP in the country will have patients with menopause problems, however, there is huge variation in access to advice and expertise.

He said: ‘If your doctor is not familiar with the other preparations available, that can affect the advice women give – and some healthcare professionals may not realize that they can be changed to another product safely.

‘In this situation you could take advice from the British Menopause Society about alternatives and give it to your doctor.’

thebms.org.uk

Source: | This article originally belonged to Dailymail.co.uk