Shortage of HRT medication 'a disaster' for women

The Novartis plant in Ringaskiddy, Co Cork. Picture: Jim Coughlan.

Menopausal women have been hit once again by shortages in crucial HRT medication, with a leading advocate calling the problem is “a disaster”.

Women have reported being unable to buy the popular Evorel Conti hormone patch, as well as other Evorel patches and the Estradot patch. The Health Products Regulatory Authority (HPRA) has listed these as medicines shortages.

Sallyanne Brady, co-founder of the 30,000 strong Facebook group The Irish Menopause, said her inbox is full of messages about this issue from affected women.

“It is a disaster for women,” she said. 

It takes long enough to get sorted in the first place, then they find something that is helping, then they go to the pharmacy and they don’t have it.

“It is medication. A lot of these women are anxious now.” 

The shortages began over the Christmas period, but Ms Brady said many women would pick up their patches once a month, so it's only now the scale of the problem is becoming clear.

“What we are seeing in the Facebook community is some women being told the pharmacy doesn’t have any and they have to go back to their doctor,” she said.

“We see reports then of women who can’t get into their GP because of Covid.” 

Dr Caoimhe Hartley, owner of the Menopause Health Clinic, estimates about one in four of her patients are affected, and her staff are taking five to 10 calls or emails daily on it.

“There has been a huge impact from this,” she said. “Evorel Conti is the only combination HRT patch, a combination oestrogen and progesterone, as far as I am aware that is completely out of stock everywhere.” 

Her patients are also having problems finding other patches including Estradot.

“One of the challenges with Evorel Conti in particular is we don’t have an alternative that is exactly the same,” she said. There isn’t anything else, so you end up having to switch women to new HRT preparations.”

 Dr Hartley, also a GP tutor at the RCSI University of Medicine and Health Sciences, said it can be really “unsettling” for women to change medications at short notice.

It can lead to side-effects like breakthrough bleeding when you switch [medication],” she said.

These patches are described on the HRPA medicine’s shortages list as hit by “unexpected increase in demand”.

There are 571,000 women of menopause age in Ireland, according to the Census. However, a HPRA spokeswoman said they do not have access to commercial sales data to quantify the level of demand for these particular products. 

A spokeswoman for Novartis, which manufactures the Estradot range, said: "With regard to 100mcg [size], there has been an increase in demand, driven by the increased awareness of HRT and the menopause during 2021." 

The company is increasing supply to meet demand, she said. 

In April, Theramex, which manufactures Evorel, said in a public statement that it had plans to increase supplies if needed. In early 2020, the Royal College of Obstetricians and Gynaecologists described HRT shortages in the UK which also affected Ireland as “catastrophic”.