For months HRT shortages appeared to be a problem visible only to pharmacists and their patients, but finally they are starting to garner mainstream attention.
The issue is now so bad that it made national headlines this month, while the British Menopause Society announced yesterday it will be meeting with the government “as a matter of urgency to discuss how we can resolve the issue”.
C+D has previously reported on the sheer range of HRT products experiencing supply problems, and we now wanted to explore how pharmacies across the UK are coping. They told a story of hours spent trying to source alternatives and frustration at a lack of information.
Northern Ireland
Eoghan O’Brien, owner of the C+D Award-winning Bannside Pharmacy in Portglenone, says the shortages are adding a “lot of extra time”. “First we have to check with a few different wholesalers to see who’s got what, then go back to the GP.”
With so many products in short supply, even sourcing an alternative for a patient is a major headache. “Elleste Solo went short first, so we had to get Zumenon. Then Zumenon went short, so we had to get Progynova.”
The issue is getting worse, he believes, and the problem is heightened for patients who prefer a specific brand. “We’ve had a couple of patients who’ve got upset with that,” he says.
However, in general patients have been understanding “if you explain it to [them] and come across as being helpful”.
England
Rifat Asghar-Hussain, superintendent pharmacist of Evergreen Pharmacy and Green Cross Pharmacy in Birmingham, says dealing with the shortages is “really frustrating”.
She echoes Mr O’Brien’s issues with finding alternatives. “We are referring patients back to the surgery,” she says. “But unfortunately we aren’t able to give alternatives, because the alternatives are out of stock as well.”
While she cites Evorel Conti as particularly difficult to obtain, “it seems to be quite a few products” at once, which is “really bizarre”.
Patients have “reacted well” to the shortages, all things considered, she adds.
Scotland
Jonathan Burton, co-owner of the 27-strong Right Medicine Pharmacy chain, spends most of his time as a pharmacist at their branch on the University of Sterling’s campus. Its location means the team “don’t have an awful lot of patients on HRT”. However, a cohort of transgender students use oestrogen HRT off-licence as part of their gender reassignment programmes.
Mr Burton has experienced some issues with shortages over the past two months, “although it does seem to be easing up a little bit now”. Initially he only struggled to obtain Elleste Solo, but the issues soon spread to Elleste Duet, Estraderm MX patches and, most recently, Zumenon.
“With tablet formulations, we’ve always been able to find a solution, whether it’s been the direct equivalent or working with the patient’s GP to find an alternative HRT product,” Mr Burton says, before adding: “It’s been more complicated with patches.”
His pharmacy staff have been diligently communicating the situation to patients. “When we get an HRT script that we ascertain we can’t get the exact product [for], we have a sit-down consultation with them.
“Most of the patients are now actually aware of this, because of the coverage in the news. So they’re almost turning up with a prescription expecting to have some sort of issue.”
There is now “more guidance out there on HRT”, which “genuinely helps”, says Mr Burton. But difficulties obtaining concrete answers about availability from manufacturers is “a little strange”.
Wales
For Kate Thomas, superintendent pharmacist at the C+D Award-winning Sylvia Williams Chemist in Cowbridge, the HRT shortages have been a constant since last year and are causing “a lot of stress”.
As well as the time spent trying to source these products for patients, “we don’t get any real answers as to why they’re [dis]appearing”.
“Most” HRT items are in short supply, says Ms Thomas. But these are just one category of medicines that she is struggling to obtain – alongside diabetes drugs and EpiPens – and “all the shortages are getting worse”.
Frustrated patients are “taking it out on the pharmacists”, she adds. “We spend hours trying to get the medicines that are available, then hours going back and forth with the doctors.
“There’s no clarity on how long these shortages will last,” says Ms Thomas, adding: “I think the situation is only going to get worse.”
You can find a recent list of HRT shortages – and when they are expected to be resolved – on the Pharmaceutical Services Negotiating Committee website