Where's all the HRT?

"We are out of stock, none of our suppliers have any stock, you will have to try somewhere else". I have lost track of the number of times I have been told by a pharmacist that they are out of stock for HRT, whether it be oestrogen or testosterone, HRT medications are frequently out of stock across the UK. One month, I tried 8 different pharmacies and eventually I found one that could order some HRT in for the following week.

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) has increased in popularity and demand over the past few years, especially as celebrities and prominent medical professionals are advocating and busting the negative myths that have surrounded HRT since the 1960s.

HRT works by replacing the hormones that are no longer being produced by the ovaries, typically oestrogen and progesterone. Here is a breakdown of how each hormone in HRT can specifically help with menopausal symptoms:

1. Oestrogen: Oestrogen is the primary female hormone, and it plays a key role in regulating the menstrual cycle and supporting reproductive function. During menopause, the ovaries produce less oestrogen, which can lead to a range of symptoms. Oestrogen replacement therapy can help relieve symptoms such as hot flashes, night sweats, vaginal dryness, and mood changes.

2. Progesterone: Progesterone is a hormone that plays a key role in preparing the uterus for pregnancy. In women who have a uterus, oestrogen therapy alone can increase the risk of uterine cancer. Progesterone is often given along with oestrogen to reduce this risk. Progesterone can also help alleviate symptoms such as mood changes, bloating, and breast tenderness.

3. Testosterone: Testosterone is a male hormone that is also present in women in smaller amounts. Testosterone replacement therapy is sometimes used in combination with oestrogen to help alleviate symptoms such as decreased libido, fatigue, and decreased muscle mass – some women also report that it has significantly reduced brain fog.
   

It's important to note that HRT is not appropriate for all women, and there are potential risks and side effects associated with its use. Women who are considering HRT should talk to their healthcare provider to discuss the potential benefits and risks, and to determine whether HRT is a suitable treatment option for them.

Originally, HRT was made from horses urine & given by pill – which gave an increased risk of stroke, blood clot & breast cancer. Modern HRT is made from yams (a plant), it is usually body identical and it is mostly supplied in gels or patches so it’s absorbed through the skin. This decreases the risk of clot or thrombosis as the hormones bypass internal organs.

For any woman with a womb taking oestrogen, she must also take progesterone as it safeguards against womb cancer. Progesterone can be gel or pill form or it is released from a mirena coil which is inserted into the cervix (and needs to be changed every 5-7 years).

For many women, HRT has been a lifesaver. Having limited supply is having a significant impact on the lives of many.

Why is HRT currently limited in supply?

There are several reasons as to why supply of HRT is limited:

• Supply Chain Disruptions: One of the primary reasons for the HRT shortage in the UK can be attributed to disruptions in the global supply chain. The pharmaceutical industry heavily relies on a complex network of suppliers, manufacturers, and distributors. Any disturbance along this chain, such as raw material shortages, transportation issues, or production challenges, has led to a shortage of medications.

• Regulatory Changes and Brexit: The UK's departure from the European Union (Brexit) introduced new regulatory processes for importing and exporting goods. These changes have led to delays at the borders, customs checks, and increased paperwork, affecting the smooth flow of pharmaceutical products, including HRT.

• Manufacturing Challenges: Some HRT medications are manufactured by a limited number of companies, often concentrated in specific regions. If these manufacturers face production setbacks due to reasons like equipment failures, quality control issues, or workforce problems, it can result in reduced supply.

• Increased Demand: The demand for HRT has been rising due to various factors, including a growing aging population and an increased awareness of gender diversity. This heightened demand, when combined with existing supply chain issues, can exacerbate shortages.

• Stockpiling and Panic Buying: Reports of shortages can lead to patients and healthcare providers stockpiling HRT medications out of fear that their supply might run out. This panic buying further strains the available stock, making it even more challenging for those who genuinely need the medication to access it.

For now, there are many people advocating for change and encouraging Governments, as well as pharmaceuticals, to increase their efforts in safely manufacturing and supplying greater quantities of HRT as well as improving the supply chain to help meet the growing demand for menopausal women, globally.

Hopefully, over the next few years, as further research into menopause is conducted, there may be additional and alternative options for women as they transition through menopause. In the meantime, women should continue to speak with their healthcare professionals to identify the most effective treatments and HRT dosage for their needs.

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