I remember the first Great HRT Shortage. The menopause removes hormones, HRT replaces them – up to a point. Twice a week for the last six years, I have applied two oestrogen patches – Estradot, manufactured by Novartis – to my abdomen. Every night, I take 100mg of micronised progesterone. This is meant to stabilise the upheaval that the menopause causes, which has included, so far, profound depression, panic, anxiety, weeping, tinnitus, peeling skin, posterior-tibial tendonitis and bloating, increased clumsiness, impaired memory and brain fog. Upheaval? I’m a different woman now.
I know that HRT is not a lifestyle choice but a lifesaver. Women in England and Wales between the ages of 50 and 55, or prime menopause age, had the highest rates of suicide in 2021, and if you have ever sat in your car sobbing, or wondered how it was possible to feel so bleak and numb and still be living, then you will understand that awful figure.
So two years ago, when my Estradot patches suddenly became impossible to find, I did everything I could to source them. Independent pharmacies use different wholesalers from bigger chains, so I phoned every independent pharmacy in a 20-mile radius. No Estradot, anywhere. With rising panic, I found myself – after another tipoff – driving 60 miles to a tiny pharmacy in a Manchester suburb to collect a paper bag filled with Evorel. It’s another brand of oestrogen patch that I don’t get on with, but it was better than nothing. That paper bag felt like contraband and salvation.
That shortage abated, and I returned to the assumption that when I needed HRT, I could get it. Then a week ago, when I went to collect my prescription, the pharmacist looked pained and said: “I keep trying to order it and I can’t get it.”
This isn’t supposed to be happening again. Officially, it’s not happening again. The British Menopause Society keeps a list of HRT products that are in short supply. Estradot is not on the list. I wrote to Novartis, its manufacturer, and it said it had no supply issues. I wrote to Alliance Healthcare, the biggest of the wholesalers my pharmacy uses, to ask whether it was the cause of the shortage. Not us, it said. It’s not in our interest to limit supply. I checked the latest list of serious shortage protocols (SSPs) published by the government. There are plenty of HRT products on there (Sandrena oestrogen gel; Estraderm patches) but not Estradot, not since April 2022.
I turned to menopause forums. There, the truth of this unofficial shortage is in the countless stories of women desperate for Estradot, Evorel and many other products. They are spending hours phoning pharmacies. They are spending money buying privately (if you can pay £100 for something that should cost £9.35 in England and is free in Wales, Scotland and Northern Ireland, there is no shortage). They are begging friends for a few patches or some gel, not that anyone has any spare when we are only allowed a three-month supply.
Never mind. Didn’t I read that the government had appointed an HRT tsar? She would know what to do. I looked her up. Madelaine McTernan was appointed in April to fix the HRT supply. In August, she said her work was done – although SSPs remained in place – and went back to overseeing the Covid vaccine programme.
Finally, a friendly wholesaler told me that Novartis had installed quotas for pharmacies. My pharmacist can only order four boxes of 100mcg patches a month. That’s just my prescription, and he has half a dozen HRT users on his books. I had got to the pharmacy at 10am on the first day of the month and he had already run out.
HRT prescriptions have doubled in the past five years, now that menopause and the benefits of HRT are better publicised and accepted. Great. But you’d think that greater demand would be good news for a profit-making pharmaceutical industry rather than causing an unexplained shortage that is being officially denied. When I approached the company again, Novartis sent an official statement. “Our patients and customers are our number one priority, and we aim to ensure a fair and equitable access to our medicines, both in the public and private market; for patients in need, no matter where they are and what their background.” A spokesperson added: “Novartis has increased production capacity to deal with a nine-fold increase over six years for transdermal patches.”
A Department of Health spokesperson told me: “We have put women’s health at the top of the agenda by publishing a women’s health strategy for England, appointing the first ever women’s health ambassador, and taking action to increase supply and reduce the cost of hormone replacement therapy. The National Institute for Health and Care Excellence is working on new menopause guidelines due in 2024.” Until then, official advice for anyone struggling to get a prescription filled is to contact your GP or pharmacist.
I am glad that the menopause is finally getting attention. But, for now, all those grand commitments are only aspirational. The highly publicised pre-payment system allowing women to pay one charge a year for HRT (unlike now, where I pay £9.35 for each element of my prescription, every three months, even though it is one regime) was widely thought to be imminent within months of it being announced in October 2021. It is now supposed to happen in April next year. Good. But still, we’ll be able to pay only one charge for medicine we can’t get.
Why does this matter when everything is cracking? Because women of menopausal age are the glue that keeps the cracks together, and HRT is the glue that keeps us together. We are the carers, the shoppers, the house-workers, the family taxi services, the ones keeping other heads above water. We deserve better than promises as empty as my last box of Estradot.
Rose George is the author of Nine Pints: A journey through the miraculous, mysterious world of blood
In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email email@example.com or firstname.lastname@example.org. In the US, the National Suicide Prevention Lifeline is at 800-273-8255 or chat for support. You can also text HOME to 741741 to connect with a crisis text line counselor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org