Ongoing Hormone Replacement Therapy (HRT) Shortages In The UK
The IAPMD Board of Directors approved the following position statement on the shortage of hormone replacement therapy (HRT) in the UK. The position statement will be used to guide IAPMD’s programming and messaging as it relates to the HRT shortage.
Note: “HRT” refers to “hormone replacement therapy,” which includes prescription preparations of the reproductive hormones to replace the ones the body no longer makes after menopause.
Background:
The vast majority of women/AFAB individuals with PMDD have normal hormone levels. PMDD appears to be a negative response to the normal fluctuations in female reproductive hormone levels. Many patients with PMDD require HRT as part of hormone stabilization treatment. HRT is used (1) as an ovulation suppression treatment for PMDD, (2) as an add-back therapy during chemical menopause, and (3) as an add-back therapy during surgical menopause. In the latter two cases, add-back HRT is critical for symptom control (e.g., hot flashes, depression, anxiety, suicidal ideation) and to protect bone, brain, and heart health during menopause.
Around a million women in the UK use HRT to relieve the symptoms of menopause, and in total, about 2.5 million prescriptions of HRT are made every year in England. Doctors can prescribe HRT as patches, pills, or gels.
According to a joint statement issued August 23, 2019, by the Royal College of Obstetricians and Gynaecologists (RCOG), the British Menopause Society (BMS), and the Faculty of Sexual and Reproductive Healthcare (FSRH), many women in the UK are now unable to access their HRT products due to ongoing manufacturing and supply issues. Clinicians also report that HRT is becoming increasingly difficult to prescribe.
The crisis reportedly started in late 2018 when supply issues began in China, forcing some manufacturers to stop producing HRT patches. This shortage of some brands resulted in increased demand for other brands, which in turn became scarce. Shortages are expected to continue into 2020.
IAPMD Position - Tory Eisenlohr-Moul, PhD, Chair, IAPMD Clinical Advisory Board:
“The IAPMD is extremely concerned about the implications of this shortage on the physical and mental health of women/AFAB individuals who are struggling to get their HRT prescriptions. HRT is essential for the treatment of PMDD for many individuals and absolutely critical for bone, heart, and brain health for those in natural, chemical, or surgical menopause. If the shortage continues, it has the potential to pose significant short and long term risks to their physical and mental well-being.
Notably, the HRT shortage may have an even more detrimental effect on younger women who are in early, surgically-induced menopause following oophorectomy (removal of ovaries) as a last-line treatment for PMDD. After a woman of reproductive age undergoes removal of her ovaries, her reproductive hormone levels drop abruptly, and she enters what is called surgical menopause. While estrogen levels lower gradually during natural menopause, they plummet rapidly in surgical menopause. With a hormone sensitivity, such as PMDD, this sudden drop in estrogen can be extremely challenging and can lead to severe mental health symptoms as well as physical menopausal symptoms such as hot flashes, night sweats, and vaginal dryness that can threaten her quality of life. In addition, longer-term deprivation from estrogen can have negative --and at times irreversible-- effects on the brain, bones, skin, heart, blood vessels, and more. Therefore, access to HRT is critical in surgical menopause not only for quality of life, but to reduce physical risks and ensure long-term health.
In sum, the HRT shortage is a time-sensitive crisis that could have lasting long-term effects on the health of women."
Sandi MacDonald, IAPMD Executive Director:
“The IAPMD supports the Royal College of Obstetricians and Gynaecologist's efforts to set an urgent meeting with the Department of Health and Social Care (DHSC) in the UK to determine how the issue can be resolved. The DHSC must continue to work with suppliers of HRT to determine the reasons behind the shortage and take appropriate actions to resolve the issue and prevent it from happening again in the future.
We also acknowledge the efforts of the British Menopause Society to advise prescribers to find equivalent types of HRT by looking at the estrogen and progestogen component and matching it as closely as possible to another brand. Any patient affected should discuss alternative HRT products with their doctor.
The IAPMD also has a Surgical Menopause Advisory Committee made up of international professionals charged with improving the lives of people affected by surgical menopause (surmeno) by educating and empowering health professionals to provide high quality, evidence-based, and patient-centered services in the treatment of surgical menopause symptoms, and supporting patients negatively impacted by surgical menopause with tools and resources for education, self-assessment, symptom management, and accessing quality care.
We provide support for women/AFAB individuals who suffered from PMDD and had a hysterectomy (full or partial) with the removal of one or both ovaries in the IAPMD Facebook support group - PMDD, Oophorectomy, Hysterectomy, & Life After. This group is a place to find support and connect with others on the same journey into surgical menopause.
Since 2018, the IAPMD has been working to reduce the negative sexual and emotional impact of surgical menopause in women of reproductive age, through a grant provided by the Patty Brisben Foundation for Women's Sexual Health. Our program "Reducing Negative Impact of Surgical Menopause on Sexual Health and Emotional Well-Being," provides education, support, resources, and tools necessary for women of reproductive age facing surgical menopause before, during, and after an oophorectomy. The program will center around a new website available via iapmd.org, online educational materials, a healthcare provider directory, and a new online peer support group. This project also includes healthcare provider educational opportunities via webinars and medical conference exhibits.”
Policy Recommendations:
The IAPMD recommends individuals concerned about this issue in the UK reach out to the Royal College of Obstetricians and Gynaecologists (RCOG) and British Menopause Society (BMS).
Resources & Links:
British Menopause Society’s latest update on HRT shortages and alternative products.
Prescribers can find suitable alternatives using the MIMS HRT comparison table.
Primary Care Women’s Health Forum easy HRT prescribing guide for GPs and other prescribers, which provides advice on prescribing HRT based on current guidelines and best practice.
For confidential advice by telephone or email, contact Women’s Health Concern, the patient arm of the BMS.
RCOG’s menopause hub for more information.
IAPMD.org for information, resources and support for women/AFAB of reproductive age who suffered from PMDD and may have opted for surgically-induced menopause.
IAPMD Facebook support group PMDD, Oophorectomy, Hysterectomy & Life After.
About the IAPMD:
The International Association for Premenstrual Disorders (IAPMD) is the leading voluntary health organization which aspires to create a world where people with Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME) can survive and thrive. Our mission is to inspire hope and end suffering in those affected by Premenstrual Disorders (PMDs) through peer support, education, research, and advocacy. What began as a collective of fellow sufferers in 2013 has grown into a global movement accelerating the progress being made around the world.