Alison O'Connor: HRT is a lifeline for women, so why do we tolerate such a shortage?

Menopause isn’t a feminist or a niche issue. This affects our whole society — women make up over half the population

Healthcare professionals in Ireland are not routinely educated on menopause or the benefits of HRT and health advice is often out of date.

A white sticker on the outside of my pharmacy bag containing my prescription says: “Please inform Alison that Estradot is still unavailable”. This message from the pharmacist was relayed at the counter, and, no, there was no news on when stocks might be replenished.

I am just one of thousands, probably tens of thousands, of Irish women who are hearing the same story as they try to source HRT prescriptions around the country.

Women are absolutely desperate and have been scouring pharmacies, some travelling to the North. Others are borrowing from friends in the hope of being able to pay them back in a few weeks, and doctors are struggling to prescribe alternatives when their patients contact them to say what they usually use is not in stock.

This is a really serious issue for women. According to estimates, there are up to 600,000 Irish women in the age bracket who could be affected by peri-menopause or menopause. Not all of them will be on HRT, or need to be, but certainly the demand is growing.

In Britain, there are similar problems with chronic HRT shortages. Their health secretary Sajid Javid has just said he is appointing a new HRT tsar, modelling the role on that of the government’s Covid vaccine taskforce, to solve the shortage, particularly of oestrogen patches and gels.

In Ireland, we are still awaiting an official announcement regarding anything specific being done to help women.

If you want first-hand accounts of how awful it is for many of those involved, listen back to the RTÉ Liveline of March 31 when so many women spoke of their utter frustration and desperation at the lack of HRT availability.

Corkwoman Jessica Ní Mhaoláin, who is stuggling to find certain HRT medications, pictured with Sinn Féin at the launch of their menopause document in March this year.

The official explanation is that demand has increased so much, there has been no way of keeping up with it in the short term. Indeed, according to the Department of Health, medicine shortages have become increasingly prevalent worldwide over the past decade and are a feature of modern health systems around the world.

The Health Products Regulatory Authority (HPRA) works to prevent, wherever possible, and manage medicine shortages when they occur. It is in regular contact with the relevant companies, according to a spokeswoman.

According to a response from the Department of Health, the supply of one range of HRT patches has increased by between 77% and 117%, for the three most-used strengths, compared to 2020.

In addition, based on demand in recent months, the company involved expects a similar increase in the demand for all strengths during 2022. This would mean that the usage of this patch in Ireland would be approximately 4.5-7.5 times higher in 2022 (depending on the strength) compared to 2019.

Supply of HRT patches, according to the department, has already been increased this year and the companies are “working to find solutions to the immediate supply issues”.

The HPRA has also told the companies it is open to providing accelerated regulatory approval to supply a product originally intended for other markets if available.

So as women become more aware of the overall safety of HRT and its protective properties in terms of their health, the demand has been increasing steadily. Indeed the succession of Liveline programmes devoted to Irish women’s experience of the menopause last year — which heard some incredible stories from women of how their symptoms had been dismissed by GPs, or that their doctor simply would not prescribe HRT — without doubt contributed to this increase in demand.

One GP I know told me she has prescribed more HRT in the last two years that in the previous 15.

But, be all of that as it may, I wrote a column in 2020 about HRT shortages and how I had arranged a drug deal at the school gate between one mother desperate for a month’s supply of patches and another woman who happened to have one spare.

Other issues

If you’ve been on HRT for the past few years, you’ll know shortages and having to find substitutes are a common experience. So we are left with a sense that there are other issues involved, not just increasing demand, or that the availability of HRT may not be the priority that it should be.

In a Dáil debate on March 31 on the Government’s Women’s Health Action Plan, a number of deputies raised the issue of these shortages, including Sinn Féin Health spokesman David Cullinane. But it was Cork TD Mick Barry who best expressed the frustration so many thousands of women are feeling at what is happening.

“Why does this society tolerate an extreme shortage of an essential medicine for women?...Would the same toleration be shown if, for example, the medicine in extreme short supply was Viagra? The hot flushes, joint pain, anxiety, insomnia, pain, and discomfort caused by menopause has, when untreated, caused women to give up their jobs and make other unnecessary sacrifices,” said the Solidarity TD.

I couldn’t have put it better myself and somehow it seems to have more validation when it comes from a man, especially one who is speaking in the Dáil.

Not all women suffer from menopausal symptoms, but a hell of a lot of us do and HRT medication is a lifeline.

Mariella Frostrup, British MP Carolyn Harris, Penny Lancaster and Davina McCall with protesters outside the Houses of Parliament in London last year.

Back to Britain where some well know women have set up the Menopause Mandate website. They include Davina McCall, Mariella Frostrup, and Penny Lancaster, wife of Rod Stewart, who came out in support of sorting out the HRT shortage this week.

As they point out on the website the menopause has, thanks to campaigning, become the biggest women’s issue of the moment.

Yet menopause provision in Britain remains shockingly poor. Unsurprisingly, they have a petition. “We are saying enough is enough. This isn’t a feminist issue or a niche issue. This affects our whole society as women make up over half the population. There could be more than 50 symptoms of menopause, and the majority of women will experience at least one…

Ensuring that women are seen by trained doctors and nurses and given the latest and best advice isn’t a luxury, it’s a human right.

We have had some significant improvements in Ireland, but all from a desperately low base.

Just as in Britain, healthcare professionals are not routinely educated on the subject and health advice is often out of date.

Irish family doctors are making significant efforts to “train up” on the menopause, although efforts are clearly hampered by these HRT shortages.

To be fair, Health Minister Stephen Donnelly has shown serious intent when it comes to women’s health. He recently launched the Government’s women’s health action plan. It includes four menopause clinics, several new see-and-treat gynaecology clinics around the country, breastfeeding supports, women’s mental health, and free contraception for women aged between 17 and 25.

But a bird never flew on one wing. If a crucial part of women’s healthcare — hormone replacement therapy — is unavailable, then this action plan is seriously undermined. It’s not the same as Covid vaccines, yet what happened there did show us how political pressure can make a difference.

“I sorted your HRT” would be a pretty good election slogan when the time comes.