32 | Nursing in Practice | Summer 2022
WOMEN ’ S HEALTH
Supporting
patients through the HRT shortages
Menopause specialists Dr Louise Newson , Hayley Berry and Amanda Worsey explain the shortages of HRT and how nurses can advise and support patients who are struggling to access their usual treatment
Why is there a shortage of HRT ? In our experience , the current shortages of HRT are mainly due to increased demand . Women are much more aware of the benefits of taking HRT as well as the treatment options , due to media and political coverage . The menopause is no longer an unspoken taboo subject so there is a greater awareness of the full range of symptoms . As more women discuss the improvements HRT brings , demand naturally increases , and growing knowledge of its long-term health benefits , such as for bone and cardiovascular health , means women come for treatment at an earlier stage to protect their future health . In addition , training has made healthcare professionals more confident to prescribe HRT .
When are the shortages likely to ease ? The Government has introduced Serious Shortage Protocols ( SSPs ) on certain HRT medicines , which it is hoped will help ease problems going forward .
These SSPs mean pharmacies cannot dispense more than three months ’ worth of certain HRT drugs at a time and aim to ensure equal access to treatment for as many women as possible , while helping to manage demand . The Pharmaceutical Services Negotiating Committee ( PSNC ) provides more detail on the current SSPs . 1
The Department of Health and Social Care has also established a UK Menopause Taskforce to support women across all four nations . 2
What drugs are in short supply ? The three medicines currently under SSPs are Oestrogel ( estradiol 0.06 % gel ), Ovestin cream ( estriol 1 %) and Premique low-dose tablets ( conjugated oestrogens 0.3 mg / medroxyprogesterone 1.5mg modified-release tablets ). Disruptions to supply can change rapidly and on a localised basis , however .
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Dr Louise Newson is a GP and menopause specialist , Hayley Berry is a pharmacist with a special interest in the menopause and Amanda Worsey is an advanced nurse practitioner specialising in the menopause
NHS data show significant increases in HRT drug prescribing rates . For example , the year to February 2022 saw the following increases :
• Oestrogel ( estradiol , gel ) by 76 %.
• Estradot ( estradiol , transdermal patch ) by 74 %.
• Lenzetto ( estradiol , transdermal spray ) by 1,106 %.
• Sandrena ( estradiol , gel ) by 146 %.
The British Menopause Society ( BMS ) also has some detail on stock , updated on a regular basis . 3 This may be useful to help your patients come to a decision about alternatives if their usual product is unavailable .
The manufacturer of the Sandrena gel is releasing small quantities as it becomes available . Women who don ’ t wish to change may see a short delay , which is outside pharmacies ’ control .
What alternative HRT preparations can we recommend ? If patients are struggling to source their HRT , they may come back to their prescriber to ask for an alternative .
Newson Health Menopause Society has produced an ‘ Easy HRT prescribing guide ’, which helps consider dose equivalents when switching between different HRT preparations . 4 There is also a BMS guide on HRT preparations and equivalent alternatives . 5
For example , women unable to obtain their usual Oestrogel prescription may switch to Sandrena gel where available . Alternatively , two pumps per day Oestrogel ( 1.5mg estradiol ) may be substituted by a twice-weekly Evorel 50 patch ( containing 3.2mg estradiol , released at rate of 50mcg in 24 hours ). There is no shortage of Evorel patches of any strengths .
Always involve the patient in the decision process , to find out what preparation would work for them and how they feel about switching . Many will have tried several combinations to reach an individualised treatment plan , so they may be anxious about symptoms returning .
It is also important to choose a clinically appropriate treatment . For example , in women with a uterus , we need to ensure any alternative regimen supplies the necessary progestogen . An estradiol with progesterone combination called Bijuve , which is body identical ( made up of natural plant-derived , rather than synthetic hormones ), may be considered for those needing combination HRT who are unable to obtain an alternative .
How can we offer reassurance ? Explain to patients that there is no need to stop taking HRT if their current treatment is out of stock . Discuss alternatives , reassure them about dose equivalents and ensure they are involved in the decision to switch . Encourage them to update you on how they get on – regular follow-up will help you monitor the suitability of the treatments and allow signposting to useful resources .
It is important that teams are confident in delivering these messages and that they access the free training available . Encourage patients to contact their surgery if there is a clinician who specialises in the menopause or women ’ s health . Your community pharmacy team can also offer support and signposting .
Conversations with your patients linked to their lifestyle can support symptom control and also help protect their future health . Encourage them to think about sleep , managing stress , exercise , eating well and cutting down on alcohol and smoking ; all have an impact on menopause symptoms alongside prescribed treatment . 6 The wellbeing section on Balance has useful resources including leaflets and podcasts to support lifestyle alongside HRT ( scan the QR code above for the online version of this article with a list of resources ).
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