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.
ONLINE Scan the QR code to access the full article with references and a list of resources
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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