Leading UK doctors call for investigation into HRT shortage

Leading doctors are calling on the government to set up an expert working group to investigate the reasons for the continuing shortages of hormonal treatment for women, which now appear to extend to some contraceptives as well.

Many women who need hormone replacement therapy (HRT) to alleviate severe symptoms of the menopause have been struggling to access their supplies for over a year, the Royal College of Obstetricians and Gynaecologists, the British Menopause Society and the Faculty of Sexual and Reproductive Healthcare (FSRH) have said.

In a letter to the health secretary, Matt Hancock, they say they are alarmed to find the shortages appear to also be affecting hormonal contraceptive supplies – particularly a long-lasting product called Sayana Press, which women self-inject once a month.

This could lead to a rise in unplanned pregnancies and abortions, they say, as well as causing distress. Some of the women who use long-term injectable contraception are among the most vulnerable in society, they say.

“We understand the HRT supply situation should begin to improve from February 2020 as the range of products which supply 70% of the HRT patch market will be reintroduced to the UK market. However a number of HRT medications and contraceptives remain unavailable, some until the end of this year, and some with no timeline as to when they will be back on the market,” said Dr Edward Morris, the president of the Royal College.

“While we are grateful to the Department of Health and Social Care (DHSC) for working closely with suppliers to reintroduce some of these products to the market, it remains unclear why there is a shortage in the first place or when the normal supply of the products might resume. The lack of transparency around why these shortages have occurred is extremely frustrating.

“Thousands of women and girls have been adversely affected by this ongoing situation and they deserve better. We are calling on the DHSC to set up a working group with industry, regulatory agencies and our organisations to get to the root of why shortages in both HRT and contraceptives have occurred. This working group must work together to ensure that this situation is prevented from happening again.”

Dr Asha Kasliwal, the president of the FSRH, said it was concerned about reported shortages of certain contraceptives, which could lead to unplanned pregnancies. “We have received queries from our members who are finding it increasingly hard to prescribe contraception,” she said.

The FSRH said it had been aware of a number of shortages, both of long-acting reversible contraceptives, such as the Sayana Press, and the oral pill. There are shortages of Norimin and Synphase, which are combined pills with more than one hormone. Some are being completely discontinued, such as Cilest and Loestrin. There are also shortages of the progestogen-only pill, such as Noriday.

“We are aware that women are sent away with prescriptions for unavailable products and end up lost in a system that is frustrating to navigate. This is causing utter chaos for patients, clinicians and pharmacists,” said Kasliwal.

There was no true equivalent for the Sayan Press self-injectable contraceptive, she said. This means women would have to go to their doctor or practice nurse to be given an injection on a monthly basis instead. That puts a burden on them – some of whom might not be able to get to a GP surgery on a monthly basis or might not want their families to know – and also on the hard-pressed NHS.

“These shortages disproportionately affect the most vulnerable in our society, for example a woman struggling to access clinics, or a transgender patient, who is already under psychological distress and for whom changing contraceptive preparations could cause further difficulties,” she said.

Nursing staff could not stand by while pharmaceutical shortages are damaging women’s health, said the Royal College of Nursing, which backed the call for an investigation. “Shortages of contraceptives and HRT mean that women are sometimes going for months on end without their medication, leading to complications, poor symptom control, a decreased quality of life, and in the case of contraception, unplanned pregnancies. Women are contacting nurses expressing their frustration about not being able to obtain their medication but unfortunately there are often no suitable alternatives.”

The British Menopause Society continues to update its website on the availability of HRT products and alternatives. “For the majority of women, supplies of alternative HRT products are available and women affected should discuss alternatives with their doctor,” said Haitham Hamoda, its chair.

“It is very frustrating that we still do not know why these shortages are happening, and why they seem to be unique to the UK. While we understand the DHSC is working with suppliers, we remain concerned about these shortages which need to be addressed urgently.”

A Department of Health and Social Care spokesperson said: “We understand how distressing medicine shortages are and we want to reassure patients we are doing everything we can to help them access treatments as soon as possible. We are working closely with suppliers and stakeholders to resolve this as soon as possible and continue to ensure we share relevant information across the NHS on a regular basis.”


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