The Government has promised action to address supply chain problems that have led to rationing of three hormone replacement therapy (HRT) products

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Health Secretary Sajid Javid imposed serious shortage protocols (SSPs) to limit dispensing to 3 months’ supply of Oestrogel®, Ovestin® cream, and Premique Low Dose® in response to a steep rise in demand for HRT products.

Meanwhile, a recently appointed HRT ‘tsar’ would focus on improving procurement practices to meet short- and long-term demand, the Department of Health and Social Care (DHSC) said.

Greater menopause awareness

Shortages have been linked to the so-called ‘Davina effect’, after Davina McCall’s 2021 documentary focused on the experiences of women going through the menopause.

However, ahead of her follow-up programme, aired on Channel 4 on Monday, Davina McCall: Sex, Mind and the Menopause, the TV celebrity said she was ‘kind of annoyed’ at being blamed for trying to help women. ‘There were shortages way before that documentary came out last year,’ she told BBC TV. ‘Apparently there is a surplus of hormones in Europe. Why is it taking this long to sort this out?’

The DHSC agrees that greater awareness of the menopause, coupled with GPs being more confident about prescribing HRT, has led to rising demand. It reports a 38% increase in the number of HRT prescription items over the last 7 years, but a more recent hike in demand for oestrogels.

It pointed out that the vast majority of HRT products, including alternatives to those affected by supply shortages, were currently available.

The SSPs, set to expire on 29 July 2022, apply across the whole of the UK to:

  • Oestrogel pump-pack 750 mcg/actuation gel
  • Ovestin 1 mg cream
  • Premique low dose 0.3 mg/1.5 mg modified release tablets.

Community pharmacists will be able to supply these products according to the protocol, rather than the written prescription, without needing to seek authorisation from the prescriber. They would be expected to use their professional judgement when deciding to apply the SSP, and must consult patients, the DHSC said.

The SSPs do not authorise pharmacists to dispense alternative products.

Besins Healthcare, manufacturers of Oestrogel®, said it regretted continuing shortages caused by what it described as ‘extraordinary demand’. In a statement published on the British Menopause Society website, it said: ‘With demand continuing to increase we are doing everything we can to manage, increase, and expedite supplies to wholesalers and pharmacies across the country.’

HRT tsar appointment

Last week, the DHSC announced the appointment of Madelaine McTernan as head of a new ‘HRT taskforce’ to streamline the supply chain. Ms McTernan, the current head of the vaccine taskforce, is expected to apply lessons learned during the pandemic to overcome procurement constraints.

Mr Javid promised to ‘leave no stone unturned to help make sure women can get the HRT they need’.

The Royal College of Obstetricians and Gynaecologists welcomed Ms McTernan’s appointment. Its president, Dr Edward Morris, described the current shortages as ‘incredibly distressing’. He said: ‘It’s unacceptable that women are facing barriers to accessing HRT and we are pleased to see the tsar’s role focused on ensuring the UK has a long term plan for the sustainable supply of HRT.’

The DHSC said it would also help to reduce the cost of HRT products for patients, so that from 23 April 2023, women could pay a one-off charge equivalent to two single prescription charges—£18.70 on current NHS prescription charges—for a year’s supply of HRT. Women would be able to access a month’s supply at a time if they chose, without incurring additional charges, it said.

The menopause was a ‘key priority’ in the Women’s Health Strategy for England, the Department said.

This article originally appeared on Medscape, part of the Medscape Professional Network.

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