HRT shortages: what's going on and what help is available?

Many people who rely on HRT (hormone replacement therapy) to treat menopause symptoms are facing worrying shortages due to supply issues.

Demand for HRT has risen steeply in the past couple of years. According to prescribing data from NHS England, around 512,000 prescriptions for HRT were issued in February 2022, up from about 324,000 in February 2020.

At the moment, Oestrogel (estradiol 0.06% gel), which is one of the most popular treatments, is particularly affected. The manufacturer, Besins Healthcare, says it is experiencing 'exceptionally high demand.'

Find out what's being done about shortages, and who you should talk to if you're concerned.

Tips for living well - get our free Food & Health newsletter: shop savvy, eat well, stay healthy

What's being done to resolve HRT shortages?

There have been moves by the government to mitigate the situation, including putting a three-month max prescription limit on the most in-demand HRT products to try and even out distribution.

The three month limit applies to:

• Oestrogel
• Ovestin cream
• Premique Low Dose

It's expected to be in place until at least 29 July 2022, but may be either extended or revoked if the situation changes.

The government has also created an 'HRT taskforce' to look at shoring up supplies in both the short- and long-term - but the taskforce has only been in place for a week, so it's early days. 

Longer-term, a prepayment certificate for HRT is set to be implemented in England in April 2023. 

This means that people can pay a one-off charge equivalent to two single prescription charges, currently £18.70, for all their HRT prescriptions for a year.

The argument is that a prepayment certificate will mean people can access HRT on a month-by-month basis if need be, which could ease pressure on supply and improve affordability. 

But there has been criticism, including from the Royal Pharmaceutical Society, that the scheme is not being brought into place more quickly.

Botanical supplements explained - need-to-knows about herbal extracts, including potential interactions or side effects to watch out for

What other HRT treatments are available?

If you can't get hold of your normal HRT prescription, your doctor should be able to help you out with an alternative prescription, though it's possible that an exact match may not be available. 

There is information online for prescribers to clarify equivalent doses between different HRT preparations.

According to the British Menopause Society (BMS), people who are having issues getting hold of Oestrogel should consider equivalent alternative HRT preparations, including Sandrena gel (0.5mg or 1mg), Evorel patches, and Lenzetto spray preparations - but stock is changing all the time.

The BMS said doctors could also consider prescribing oestrogen and progestogen separately to make the closest match possible.

Pharmacists we spoke to said it would help if they were cleared to amend prescriptions to provide a suitable alternative, as currently patients or pharmacists have to go back to the GP to get a different prescription.

One pharmacist said that it's difficult for them to advise GPs on what to prescribe, as stock is fluctuating quite a lot due to shortages and the hunt for available alternatives. 

Switching to an alternative isn't always smooth sailing, either, as it can take some trial and error to find which type of treatment works best. But it could be better than nothing at all. 

There are alternatives to HRT, including herbal supplements and behavioural changes you can try, but the evidence for these is mixed and is unlikely to have the same effect if you're taking HRT.

How to get help if you're struggling to get hold of HRT

Menopause can debilitating for some, and HRT shortages can therefore be a serious concern. 

Your GP should be able to help, but don't forget that pharmacists are also there to offer advice and support on prescriptions.

Women's Health Concern is the patient-facing arm of the BMS, and provides up to date advice and information about menopause and treatment on its website. 

It also runs a telephone and email advisory service that is staffed by specialist nurses.

Accessing mental health support, including Cognitive Behavioural Therapy (CBT) may help some people with anxiety and low mood associated with menopause and worrying about medication supplies. 

This isn't instead of taking HRT, but rather as an additional management tactic if you're struggling.