Managing HRT Patch Shortages During Menopause

The shortage of estrogen patches, specifically estradiol, for hormone replacement therapy (HRT) has been a growing concern for several years, becoming more acute in the past month. Women in menopause are struggling to fill their prescriptions, with some having to cut higher-dose patches in half or pay extra to meet their prescribed doses—if they can find patches at all.

The Impact

For women in surgical menopause, induced by the removal of ovaries or cancer treatment, a lack of HRT poses long-term health risks, including heart disease and osteoporosis. For others, losing HRT can drastically affect quality of life, leading to symptoms like brain fog, sudden mood swings, and decreased self-confidence.

Why Is This Happening?

Several factors contribute to the ongoing shortages:

1. Increased Demand: Global demand for HRT has surged as GenX women, now in their late 40s and 50s, become more aware of menopause and seek HRT for symptom relief. This increase in awareness is positive but has led to supply shortages.

2. Manufacturing Issues: HRT manufacturers face unspecified manufacturing challenges, compounded by supply-chain disruptions from soybean fields in China to plants in Europe. These issues result in insufficient patches to meet global demand.

3. Limited and Rationed Stocks in New Zealand: Suppliers ration the limited stock of patches, making distribution fair but leading to shortages at pharmacies despite reported availability.

4. Lack of Funded Alternatives: Transdermal estradiol, acknowledged as the safest and most effective method, is only funded in patch form. Although alternative patches were funded last year to address shortages, even these are now scarce. Other transdermal products, like gels, are available but not funded, leading to additional out-of-pocket costs for women.

What Is Being Done to Fix the Problem?

Pharmac, New Zealand's drug-buying agency, is working to keep up with demand by evaluating proposals from estradiol gel suppliers and tendering for new patch suppliers. However, these measures are not quick fixes and will take time to implement. The agency is also considering reviewing the restriction on two patches per week to ease the shortage.

What Can You Do Now?

1. Stay Informed and Persistent: Keep checking the Pharmac website for updates on stock availability and try different pharmacies for patches. Limited stocks of certain doses might be back by the end of May. Cutting patches to achieve the correct dose is a temporary solution.

2. Consider Oral Estradiol: Although oral estradiol carries a higher risk of venous thromboembolism (VTE) and may not be suitable for everyone, it is a funded and valid option for many women. Discuss with your doctor if this might be appropriate for you.

3. Explore Estradiol Gel: Estradiol gel, available but not funded in New Zealand, can be prescribed by any doctor. Pharmacies can order the gel, which costs around $30 per bottle (plus additional charges), potentially lasting up to two months depending on the dose. Gynaecologist Olivia Smart notes that the gel is easy to use, with one pump equating to 25 micrograms, and can supplement lower-dose patches if needed.

Takeaway

The HRT patch shortage is a complex issue influenced by increased global demand, manufacturing challenges, and supply-chain disruptions. While Pharmac is working on long-term solutions, women can explore alternative HRT methods such as oral estradiol or estradiol gel and stay informed about stock updates. It is essential to discuss options with healthcare providers to manage symptoms effectively and maintain quality of life during menopause.