Recent hormone replacement therapy (HRT) shortages have been a real issue for many women. ‘I've been left to go from store to store checking which chemist might have it.’ ‘I've been given something completely different and it does not suit me.’
First tablets went out of stock, then patches, and before long many of the most commonly prescribed HRT methods were completely absent from shelves. Women were left to knock on the doors of pharmacies far and wide and some even resorted to going to Spain to buy their HRT.
Speculation was rampant. Was it the manufacturers? Was it the wholesalers? Was it pre-Brexit stockpiling? Was it the NHS itself? Yet, if you were to speak to those of us who regularly prescribe HRT, it was rare for our patients to go without.
Did we have secret supplies?
No, we simply knew how to access other HRTs that were very similar or as good as those HRTs that were not available. Yes, gels and tablets may not be as convenient as a single patch, but they offered better alternatives than using nothing. A change in brands occasionally led to minor side-effects or a change in bleeding pattern, but on the whole women appreciated the chance to try a close equivalent to their usual medication. The simple fact is that no-one needed to go without any HRT at all.
So, as we fortunately start to see the return of many HRT products that were previously hard to find, let us consider two of the main reasons why thousands of women were left high and dry and consider how well-placed primary care nurses are to help women.
Inadequate HRT knowledge among many health professionals
It is clearly the responsibility of prescribing health professionals to have a suitably in-depth knowledge of HRT. After all, menopause impacts a huge proportion of their patients and National Insitute for Health and Care Excellence (NICE) guidelines (2015) recommend HRT as the most effective way to manage bothersome symptoms.
Yet many health professionals knew of only one or two products and often had no concept of the constituents and nuances of each HRT. They were not in a position to suggest alternatives. Nurses who have completed my courses (www.themenopausecourse.com) report a much greater understanding of products and HRT management after. Yet funding for primary care nurses to attend menopause study days can be hard to get. Many end up utilising bursaries, such as the Sylk Bursary (https://sylk.co.uk/health-professionals/the-sylk-bursary/) or paying for themselves. Yet often it is nurses who are doing the HRT checks as well as repeat prescribing.
Information about switching is readily available: the British Menopause Society produced guidance (2019). I published guidance last year (Abernethy, 2019). But many professionals did not seem to know where to look or how to access information when the shortage began.
Women struggled to access personalised menopause advice
Women frequently report that it is hard to get the personalised advice needed for menopause at the best of times. During the HRT shortage, this became even more apparent.
Women turned to social media and to non-medical websites, not just for support, but for personal medical advice. Many desperate women were given specific prescribing advice in great depth, by individuals without the qualifications and experience to provide advice safely.
As we move on from the saga of HRT shortages, we need to learn from it. We need to ensure that HRT prescribers, many of whom are nurses, have a greater knowledge than just one or two products, that they can switch appropriately and offer a choice of products. When it comes to HRT, one size does not fit all.
‘Women frequently report that it is hard to get the personalised advice needed for menopause at the best of times. During the HRT shortage, this became even more apparent.’
Women need improved access to personalised menopause support; we need practitioners, such as primary care nurses, to step up and guide women through the system, to be proactive, make a management plan with women as partners, and help women to make choices that are right for them, even when times are tricky. Nurses are great at this when given the opportunity.
Finally, nurses in primary care need high quality evidence-based menopause education, so that they can prescribe effectively and support women through any shortages.
The absence of adequate HRT knowledge and access to personalised support were, I feel, the real reasons why women ended up without HRT during the shortages.