I brokered a drug transaction this week. It involved two school mums. One is almost literally climbing the walls because she is without a medication, the other had a box of it in her bathroom cupboard, which she had never used. The exchange took place on a local footpath.
If, God forbid, there was ever a fire in my house, the rest of the family and the dog would be top on my priority list, but at the back of my mind would also be my own blister pack of these meds. To which crucial drug do I refer? Well hormone replacement therapy (HRT) of course. If you think it is difficult to get a Coronavirus-related face mask at the moment, you should try sourcing a HRT patch from an Irish pharmacy.
Some women are buying on the internet, at hugely inflated prices, which has obvious dangers. Others travel to Spain. One woman I know got her adult son to visit a few pharmacies while on holidays in the Canaries and buying over the counter he came home with 6 months worth of patches for under €30 in total.
As a woman of a certain age I began taking hormone replacement therapy over a year ago. It wasn’t just for the emotional or psychological aspects but some serious, quality of life health issues. The fact that it assists the memory loss, mood, the broken sleep and the internal volcano that at times took residency in the body, are a definite added bonus.
HRT which can be taken in many forms - tablets, skin patches, creams and gels - has made a major change to my life even though I began it most reluctantly given that my mother died very young from breast cancer. The good news is while clearly significant, this is my only history, despite a slew of female relatives.
The reasons for the current stress around HRT are to do with shortages and some women, like my friend, being left without any supply. There has been scant coverage of the situation affecting Irish women. Over two weeks ago the Institute of Obstetricians and Gynaecologist said many women were unable to fill prescriptions and this was causing them “distress and inconvenience”.
Last week the Health Products Regulatory Authority, HPRA, issued a statement to The Journal saying that medicine shortages have been a global issue for some time and HRT shortages are being experienced in multiple countries. “The suppliers have stated that the causes of the shortages relate to both active substance availability and manufacturing delays”. It went on to say that while there are shortages of some specific brands, alternatives are available. This week it added that none of these shortages are due to Brexit.
There are indeed alternatives, but for so many women getting their hands on these, can be down to the luck of the draw, plus if they have found something that works they understandably don’t want to change. In some cases GPs are simply not well versed enough, and have not taken the time to inform themselves, to be able to suggest an alternative. In fact there are some GPs whose mindset is such that HRT automatically equals breast cancer and there is no more to be said. One friend was told by her male GP that her symptoms simply weren’t ”bad enough” for him to prescribe it. She took herself off to the Irish Family Planning Association where she got her prescription. She declares herself a “changed woman”.
Of course there are risks, not least that slight increased breast cancer risk. But as the British Menopause Society points out the risk of breast cancer diagnosis associated with HRT is “equivalent to, or less that of other lifestyle risk factors for breast cancer” such as being overweight or a certain level of alcohol. You rarely, if ever, get to hear about HRT from the media unless it is to do with cancer and death. Any woman thinking about taking it should educate herself through a discussion with her GP (shop around if yours is one of the ones who hasn’t bothered to educate themselves, or seems to have a set against it).
HRT was demonised and abandoned by women and the medical profession worldwide following the 2002 US based Women’s Health Initiative Study, and the manner in which this study and its findings were reported. There is also no doubt that the female menopause is seen in many circles, not least some medical ones, as something women should just endure and keep quiet about it. Suck it up, is the attitude.
For their part many women simply do not wish to discuss the subject, often out of embarrassment, or a feeling that it’s a signal they are now “passed it”. Therefore when you see something like this current HRT shortage, which can wreak such personal havoc, you hear hardly a peep from those affected.
Last October, the UK Department of Health banned the export of some HRT from the UK to ensure there was more to go round there. The reasons given for the general shortage vary wildly from new rules from the European Medicines Agency, to supply problems in China with some of the components for HRT. An excellent piece of investigative reporting from UK journalist Emma Hartley, looked at an incredibly complex scenario, but pinpointed a decision by the UK Ministry for Health in June 2018 to reduce the price it paid for certain HRT products.
This ultimately, she wrote, made it unattractive for the pharmaceutical companies involved to sell to the UK. Oddly this story has not been not widely taken up in the coverage of the HRT shortage in the UK. But the situation has gotten so bad there the Royal College of Obstetricians and Gynaecologists, the British Menopause Society and the Faculty of Sexual Healthcare have urged the UK Government to set up a working group to investigate the crisis.
Back in Ireland GP Dr Deirdre Lundy says there’s been a huge increase in women wanting HRT in recent years. She has been dealing with the HRT shortage for a year and a half.
As co ordinator of education for women’s health with the Irish College of General Practitioners she trains other GP’s in this area. She has extensive knowledge so is able to work out alternative prescriptions for patients who had previously been prescribed patches which are now in such short supply. However these alternatives are often not listed on that MIMs drug directory you always see on your doctor’s desk. Plus many doctor haven’t bothered to inform themselves of the alternatives. Added to this the situation for pharmacy supplies has been so “volatile” a lot can depend on what chemist you visit to get your prescription filled.
More generally, she said, as a doctor she rarely, if ever, gets asked to speak about HRT in terms of the hugely positive difference it can make to the lives of women. As well as the obvious ones she said there is a “long list” of positives relating to long term HRT use including reduction in coronary heart disease, strokes, osteoporosis, certain types of dementia, colon cancer and colorectal cancer. “I don’t ever get asked about those though.” Hopefully that situation and the shortages will change soon.