Dr Michelle O'Driscoll: Update on HRT plans 

In recent months, an exciting announcement was made by government that HRT would become freely available to women as part of an initiative to support women’s health.

Hormone Replacement Therapy is not required by or suitable for all perimenopausal or post-menopausal women, but for many it plays a significant role in the reduction of uncomfortable or even debilitating symptoms arising due to the reduction of natural hormone production.

It also has evidence of improving health long term, including heart, bone and mental health which could otherwise be negatively impacted by the lack of oestrogen protection and overall hormone depletion at this stage of life.

Therefore, supporting its availability for women through removing financial barriers would be very welcome.

The announcement of free HRT came off the back of a very successful free contraception scheme that has been established and is now running here for a number of years, expanding its eligibility over time to a wider age range.

This scheme’s success has been due to its all-encompassing approach to covering costs for women. This includes any consultation regarding contraception, the contraceptive products themselves, and the dispensing of same, leaving no patient or healthcare provider out of pocket due to the way it has been set up.

Precedence like this meant that of course it felt promising and possible that a free HRT announcement would be delivered upon.

While the exact details of how this would be rolled out were unclear at the time, the anticipation of what could be so transformative for women, and the track record of the successful contraceptive scheme before it kept spirits and hopes high.

Unfortunately, the development of this to date, and the realisation of what the proposed scheme will actually entail currently, has led to confusion and disappointment amongst women and healthcare professionals alike.

As the finer details of the proposal emerge, it has become apparent that what would be covered is the cost of licenced HRT medications only. This won’t include products prescribed that are unlicenced in this jurisdiction (of which there are many, that are also often quite expensive), nor will it cover the appointments needed to avail of the clinical evaluations or writing of prescriptions needed to obtain these products. Furthermore, it does not provide a fee for pharmacists dispensing the product – essentially requiring them to deliver this service without remuneration if the product was to ultimately be provided free to the patient.

Whilst any financial support of the provision of HRT is welcome, the narrative around it needs to be clear. Hopes are being dashed at the realisation that not all financial barriers are being removed, leaving continuing inequities in access to this care. 

Until all financial aspects of HRT access are addressed, HRT is not and cannot be provided for free to women in Ireland. The steps being implemented are most certainly proceeding in the right direction, but there is a way to go yet, and the hope is that more will be done to action this.

The impact of menopause on the health of half of the population warrants this funding and support, so progress in this regard is imperative. Laying the groundwork through covering the price of licenced products will hopefully be the first step towards more comprehensive financial support. The impact on the public health budget will be counteracted by the positive impact on women’s health and subsequent reduction in treatments required for other conditions, both physical and mental.

This is far from the end of this story, hope remains that further progress will ensue. Notwithstanding, HRT shortages are frequent and problematic, another consideration that contributes to the overall current HRT landscape and warrants further exploration.