Joint BMS, FSRH, RCGP and RCOG position statement on the supply shortages of Hormone Replacement Therapy (HRT)

The current impact of shortages of HRT products on women cannot be underestimated. HRT for many women is a lifeline which helps them to effectively manage their symptoms, and when they are unable to access it, this can have a profound impact on their quality of life. Reports in the media of women having to travel across the country, or try to access products they need on the ‘black market’, are incredibly worrying, and action is clearly needed.

The current challenge
We understand that the causes of the current supply issues for some HRT products are complex and multi-factorial. Alongside long-standing issues with securing sustainable supply of HRT, we are also seeing increasing demand for products.

HRT supply has not always been reliable in recent years, with multiple factors including manufacturing capacity, understanding current and future demand, disruption of global supply chains, all contributing to this. In response to this, the BMS provides regular updates on current shortages.

In recent years, we have seen a sea change in the public conversation around menopause. A series of spotlights on women’s experiences of the menopause in the media, alongside awareness and information campaigns both from patient and professional groups, and from governments across the UK, has resulted in many more women having the information they need to seek help with menopausal symptoms. In turn, this has resulted in the number of women being prescribed HRT in England doubling in the last five years.

The recent announcements from the Government that the costs of repeatable HRT prescriptions will be cut, in some circumstances resulting in women being prescribed 12 month supplies of HRT, may also be a factor that could further contribute to uneven and unreliable supplies.

This increase in women accessing the care and support they need for their menopause is extremely positive. It will reduce the numbers of women who are experiencing unmanageable menopausal symptoms, and move us towards a society where no woman suffers unnecessarily because they don’t or can’t access the care and treatment they need. In order to ensure this is the case, there must be significant action to ensure that supply first meets, and then continues to meet, increasing demand for HRT.

The solutions
We welcome the Government’s appointment of Madelaine McTernan as a new ‘HRT tsar’. We hope this role will galvanize action to effectively respond to the current shortages in HRT. We hope to work closely with Madelaine and her team to consider ways in which the impact of supply issues can be mitigated in the short-term and in the long-term and to identify measures to minimise the risk of such a situation happening again.

Short term solutions should include utilising the BMS guidance on equivalent alternative preparations of HRT to provide healthcare professionals, pharmacists, and women themselves, with advice on equivalent alternatives that they may wish to substitute for their usual HRT if it is out of stock. We support authorising pharmacists to support women to substitute out-of-stock products where there are set protocols on safe equivalents agreed centrally, following BMS guidance.

This guidance is based on evidence of pharmacokinetics, clinical trials and clinical experience, and is supported by both the RCOG and the FSRH. What we do recognise is that these solutions aren’t always perfect, individual women will experience variations in absorption and metabolism. We are clear that in the long term, women need reliable access to the form of HRT that best suits them that they have agreed on alongside a healthcare professional, and that suits them and their lifestyle.

It is therefore paramount that solutions are found to ensure that access to all forms of HRT is reliable and sustainable in the long term, giving women and healthcare professionals the confidence they can decide upon the right HRT product for them based on their individual needs and clinical background, without needing to consider the products that are most and least likely to remain in good supply in the coming months and years.