Why is there a shortage of HRT in the UK?

Demand outpacing supply and disruption to manufacturing leaving menopausal women struggling to access key treatments as health secretary promises tsar to address crisis

Royal Pharmaceutical Society calls for change to law to prevent repeat of present shortfall (James Manning/PA)

The UK is currently facing an acute shortage of hormone replacement therapy (HRT) products.

More than one million women in Britain currently use some form of HRT, according to the National Institute for Health and Care Excellence (Nice), which is prescribed to treat the symptoms of the menopause by boosting oestrogen levels and other hormones, which in turn helps to alleviate the impact of a range of associated conditions like hot flushes, anxiety, joint pain, disturbed sleep, night sweats and vaginal dryness.

In some cases, women reliant on HRT have previously reported experiencing suicidal distress after suddenly being deprived of treatment, underlining the importance of resolving the present crisis.

The shortages are primarily affecting Oestogel, manufactured by Besins Healthcare UK, as well as other products including FemSeven Sequi patches, and are being blamed on increased demand outstripping supply and more general supply chain complications akin to the Covid-related disruption seen last summer, which is inhibiting the delivery of key ingredients and thus hindering manufacturing.

The increase in demand for HRT is being linked to an uptick in campaigning and media coverage about its benefits, a Department of Health announcement last October promising that women in need would be able to secure a year’s supply of medication for the cost of a single prescription from next April and a plan revealed in February to make some forms of HRT available over the counter in pharmacies.

According to the British Menopause Society (BMS): “Besins expects this to be a short-term issue and anticipates that supplies will be available to local wholesaler branches soon.”

The government’s patient safety minister Maria Caulfield has likewise insisted that supply will soon be “back on track” and that the manufacturers have advised the Oestogel should be available again in normal quantities “roughly around June”.

She was speaking after health secretary Sajid Javid told The Mail on Sunday he was planning to appoint an HRT tsar to prevent the problem recurring in future.

“I will be urgently convening a meeting with suppliers to look at ways we can work together to improve supply in the short and long term,” he added.

But his response was criticised by Labour MP Carolyn Harris, chair of the government’s menopause taskforce, during an interview with BBC Radio 4’s Woman’s Hour on Monday, in which she argued that Mr Javid should take responsibility for the situation himself rather than outsourcing it.

“The trouble with the menopause is for far too long women have not been listened to, women have been ignored, they’ve been prescribed and diagnosed with other conditions and the menopause wasn’t even considered,” she said.

“For a menopausal woman this HRT is as important as insulin is to a diabetic.”

The Royal Pharmaceutical Society (RPS) has since called on the government to change the law surrounding prescriptions, allowing pharmacists to be more flexible and offer alternative products in times of medical shortage rather than sticking rigidly to what GPs have prescribed.

“At the moment pharmacists cannot amend prescriptions for HRT, so have to refer women back to their GPs when a medicine is not available,” said RPS president Claire Anderson.

“Enabling pharmacists to do so will save time for patients, pharmacists and doctors, as well as lessening the anxiety for women waiting for medicines.”

The BMS said in its statement on Monday that women currently struggling to obtain Oestrogel should ask their GPs about “equivalent alternative HRT preparations”, including 0.5mg or 1mg of Sandrena gel or Lenzetto spray, to boost oestrogen and progestogen.