Women on hormone replacement therapy (HRT) face continuing disruption in sourcing their medication until at least July.
The drug companies making the patches and gels used in HRT say they have been scrambling to catch up with surging demand for the products.
Medicines regulator – the HPRA – says it is aware of the "current challenges regarding the intermittent supply of some hormone replacement therapies, notably transdermal patches".
There have been supply interruptions in two of the more frequently prescribed HRT options for Irish women – Evorel and Estradot – at several points over the past couple of years.
Evorel is once again available, according to the HPRA, after a supply problem at the beginning of the year. However, Estradot, which is made by drug company Novartis, is not expected to be fully available until July. That will have forced women using this therapy to find an alternative for a four-month period or face dealing with menopausal symptoms without any HRT.
It has coincided with a gap in supply for Oestrogel, one of the more popular gel HRT products. Oestrogel, produced by Besins Healthcare, has been off the shelves for about six weeks but is expected to be available again from this week.
Another gel treatment, Divigel, has also suffered supply glitches this year, compounding the issue.
Intermittent
Novartis conceded that supply was “intermittent”, something that it attributes to “currently unprecedented demand for menopause treatment in Ireland”.
Industry sources say health awareness campaigns in Ireland and Britain in 2019, with a "huge emphasis on HRT" have led to a surge in demand with which suppliers cannot cope. Few have figures but all agreed that the increase over the past couple of years was well in excess of 50 per cent and possibly close to 100 per cent.
That’s a multiple of expected growth worldwide for HRT products. Prior to 2020, they say, demand for HRT products had been stable for many years.
A spokeswoman for Novartis said: “We have significantly increased supplies of our HRT medication [across all doses] into Ireland on a number of occasions since 2021 to reflect the increased demand.”
She said the company was continually monitoring the situation but conceded that “supply is intermittent at present, but we hope this situation with Estradot will be resolved in July”.
Pharmacists
In an effort to manage the crisis, pharmacists have been restricting purchases to one month’s supply.
Niall Mulligan who runs a chain of family-owned pharmacies in the southeast, said there was no one reason for the supply constraints, which were not just limited to HRT medications.
He said the supply issue had been exacerbated by women having to move from one treatment to another as certain products became unavailable.
“Suppliers cannot just accommodate a major and sudden increase in demand like that,” he said. However, Mr Mulligan added there were other options for the missing products that could be used, and on which his pharmacies were consulting with local GPs and patients.
Dr Ciara McCarthy, clinical lead on women’s health at the Irish College of General Practitioners, said it was important for women using HRT to “ensure continuity of treatment, and to look at the options available with their GP or pharmacist. Suddenly stopping HRT is not advised as it may result in a decline in symptom control,” she said.
“Medicine shortages are increasingly prevalent worldwide over the past decade,” the HPRA said, “and several other countries have also experienced shortages of HRT patches at various times in recent years.”
