Delays to HRT scheme roll-out add to frustrations of women impacted by shortages 

Delays to the roll-out of the free HRT scheme are adding to the frustrations being experienced by some women in Cork as a result of recent shortages of certain products, writes DEIRDRE MCARDLE

Like so many women around Ireland, Mary Tighe, from Midleton, said she “did a happy dance” when the free HRT scheme was announced in October by then health minister Stephen Donnelly.

But the joy was quickly replaced by frustration as issues she had been experiencing around HRT supplies continued.

In recent months, there have been shortages of a number of HRT products or of certain doses of products.

For example, at the moment there is currently a reported shortage of the 50mg dose of a patch called Estradot and of another called Evorel.

The Estradot shortage is impacting women in multiple countries.

In its latest update, the Health Products Regulatory Authority (HPRA) says that Estradot is expected to be available again at the end of next month.

The Evorel shortage is currently impacting women in Ireland and the HPRA says this is expected to return next month.

“It’s been stressful not knowing if you’re going to be able to get your prescribed medication when you go into the pharmacy,” said Mary.

“When the initial shortage happened a few months ago, I went into every pharmacy in Midleton looking for Estradot patches.

“I was eventually switched to an alternative patch,” she said.

However, Mary, who runs a menopause/perimenopause support group on Facebook, said the new patch did not agree with her and she switched to a HRT gel, which she says is working out for her.

“I feel so much better now on the gel.

“It’s a bit different because you have to put it on every day, unlike the patch which was twice a week, but I’ve settled into it now.”

For Mary, HRT has made a massive difference.

But it took her a while to get to this point.

“I hadn’t realised for years what I was experiencing was perimenopause. There’s a great quote in Davina McCall’s book on menopause where someone said it feels like you’re ‘wading through treacle’ and that’s how I felt. Every little thing felt so overwhelming and I couldn’t cope.

“I’m only on HRT one year now but I think I must have started experiencing symptoms as far back as 10 years ago, in my early 40s.”

Cathy Duggan, from Crosshaven, has a similar story.

“I’ve been on HRT for about two years now, but it took me ages to get a diagnosis. My symptoms were awful: I was having a lot of mood issues, hot flushes, brain fog, and anxiety. When I finally got on the HRT, it made a massive difference, it was just amazing.

“When the shortages came in, I was moved to a different patch. After about three months, my symptoms were back with a bang. My mood was up and down, I was exhausted, I had really bad brain fog. But it was only when I started having hot flushes again that I went back to my GP and got prescribed the gel, and I’m feeling great again.”

‘Uncertainty isn’t helping’

As a single mom, Cathy says the situation with the HRT supply is stressful.

“I have a million things going on in my life, and my kids are so dependent on me to be OK, the uncertainty about the HRT isn’t helping.”

Cloyne-based Patricia Murray says she’s annoyed about the issues that she and so many women are experiencing.

“I remember going into the chemist to get my patch one day and I was told they didn’t have it, I would have to wait a few days for a new supply to come in and I just started bawling crying in the chemist I was crying with frustration more than anything - I was thinking, ‘what do I have to do to get my prescription’?”

Like Mary and Cathy, it took a long time for Patricia to be diagnosed with perimenopause.

“I was just 39 when I realised it must be what I had. My anxiety was through the roof. I thought I was going insane actually.”

Now, Patricia has also made the switch from the patches to an alternative and is feeling better.

Alternative options

This is a course of action many women in Cork have taken, and Carrigaline and Douglas-based GP Monica Oikeh advises anyone who is anxious about supply or is having issues to get in touch with their GPs.

“There are options of HRT gels, sprays and even tablets, but it all depends on what dose the patient is currently on, if they’re continuous or cyclical HRT, and also their comorbidities. Speaking to their GP is the best option.”

West Cork pharmacist Caitriona O’Riordan was initially positive about the free HRT scheme, but is also seeing, daily, at first-hand, the anxiety some women are experiencing with the current HRT shortages.

“As a women’s initiative, it’s really positive. But as it stands right now the finer details have yet to be worked out.

“If we look at other schemes - the medical card scheme, the drug payment scheme, and the contraception scheme - they’re all supported by high-level IT between departments and pharmacies, and a lot of that still needs to be worked out for the free HRT scheme.

“We also need to get guidance from the Government on what’s encompassed in the scheme, because we have some HRT medications that are not licensed - there’s no licensed progesterone in Ireland, and there’s no licensed female testosterone, or at least for use in females.

“Hopefully, they’re just details that need to be worked out and we look forward to taking part in any scheme in the near future.”

But the over-riding concern for Caitriona is the ongoing supply shortages.

“It’s just not satisfactory. It’s really stressful. It appears to be a worldwide shortage - there’s been a huge drive in menopause awareness, and a huge increase in usage, but production hasn’t matched the demand.

“In my own pharmacy, nobody’s being turned away, but we’re having to make do and with the patches, we’re offering alternatives.”

Although a small allocation of Estradot 37.5, 75 and 100 became available at the beginning of January, shortages of Estradot persist, according to Catriona.

For now, she says that Estradot 37.5 is available, but supply of 75 and 100 has dwindled again.

For patients who need to change their product, like Mary, Cathy and Patricia, to an alternative, there’s an increased delay because it involves going back to their GP.

Caitriona says that pharmacists could be empowered to be able to do some therapeutic-led substitutions, which would speed up the process for patients.

Currently, pharmacists around the country are spending about four and a half hours a week on shortages, explains Caitriona.

“I had been working a 47-hour week, but now it’s more like 52, every week. At the end of the night, I have to work on finding alternatives for around 50 drugs. I know pharmacists are working really hard to try and ensure that patients end up with something and that they’re not left hanging. There needs to be more transparency around the supply chain.

“I would say to anyone coming in, we’re really willing to chat about this. Don’t worry about how busy we are, feel free to tell us in confidence how this is affecting you.”

Commitment to roll-out

There is still uncertainty around the exact date when the free HRT scheme will be rolled out.

In a statement, the Department of Health says it is working with the Irish Pharmacy Union “on the practical implementation” of the scheme, and “the goal is to introduce this measure as soon as possible”.

The recently-published Programme for Government, ratified by the incoming government in recent days, commits that “the planned roll-out of free HRT medicines is available at no cost for the drug/product”.

There’s been a huge drive in menopause awareness, a huge increase in usage, but production hasn’t matched demand.