Menopause treatment patch supply issue at ‘crisis point’

Women are facing the "unpleasant and very frightening" prospect of missing out on menopause treatment as hormone replacement therapy supply issues have reached "crisis point".

Christchurch woman Beatrice Cheer was "shocked" to be told her pharmacy had no oestradiol patches in stock, and likely would not for a couple months. And she is not alone.

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New Zealand's supply of all oestradiol patches is "very limited" amid a global shortage, and Pharmac is anticipating some people "will not be able" to get patches.

Pharmac's website shows there were varying stock levels (across different brands and strengths) at the end of May, and some were out of stock.

Gynaecological endocrinologist Dr Anna Fenton, of Oxford Women's Health, said this has significant impacts on people's quality of life.

The patches are a type of menopause hormone therapy (MHT), also known as hormone replacement therapy (HRT), used to help manage symptoms.

Patches release oestrogen in a continuous and controlled way, just as ovaries would prior to menopause. They can also be used after hysterectomy, and by trans and non-binary people.

Cheer became aware of the issue when trying to fill her prescription recently.

The pharmacist "basically said to me, there are none".

When she spoke with Stuff, Cheer had spent all morning on the phone trying to find HRT, and said her pharmacist had gone to significant lengths trying to help her and many others find patches.

In the end, they sourced a box from the North Island, she said.

The ramifications of supply issues were "huge", Cheer, who has been using patches for nine years, said.

Menopausal symptoms hit her hard: she was "virtually getting no sleep", waking hourly drenched in sweat, and slept with ice packs.

She had brain fog and was "terribly" sleep deprived.

Cheer was frustrated and "absolutely devastated" by ongoing HRT supply issues, saying millions worldwide would suffer as a result.

"Women are really trapped by this crisis. We need to jump up and down and say this is not good enough."

Pharmac says demand for patches in New Zealand more than doubled over the past few years, from about 1.3 million patches in 2021 to 3 million in 2023.

International suppliers were also reporting "extraordinary increases" in demand for oestradiol patches, Pharmac says.

As a result, they are building up production capabilities, but continue to "experience challenges in meeting this increasing demand".

Fenton said there have been HRT supply issues for about four years.

In 2022, Stuff reported women were cutting patches in half due to supply constraints.

But these issues reached "crisis point in the last couple of weeks", Fenton said, leaving women going from one pharmacy to the next trying to find patches.

Some can be switched to alternatives, such as oral tablets, but patches are the preferred option for those with certain existing conditions, she said.

There is also oestradiol gel, though not funded, and some non-hormonal prescription medicines to help manage symptoms, Fenton said.

Fenton said it appeared from the manufacturers' website there may be some improvement in one to two months.

Ongoing supply issues have created a "complete nightmare" for those needing HRT, Fenton said.

She said of the 75 percent of women who experience menopause symptoms, about a third of that group have significant symptoms.

Having to go "cold-turkey" can bring back symptoms significantly and quickly for some, essentially bringing them "back to square one", she said.

Fenton said there has been a "huge uptick" in HRT use worldwide, and demand has outstripped supply.

However, she also thought ongoing supply issues "exemplifies underinvestment in women's health".

Auckland pharmacist Vicky Chan said it had been "stressful" for patients, prescribers and pharmacists.

She has had women coming to her Pakuranga pharmacy in tears, and often gets emails from patients contacting pharmacies in bulk asking about stock.

Chan imagined this would be even more challenging in rural Aotearoa, with fewer pharmacy options.

Pharmac spokesperson Alexandra Compton said it knows people are "unable to access" some strengths of oestradiol patches.

"There's a global supply issue with these patches, and we acknowledge that this supply issue may be causing stress for some people.

"We're doing all we can to ensure people can continue to access this treatment."

Pharmac was working closely with the supplier and had sourced alternative brands to try keep up with demand, Compton said.

"Unfortunately, we have not been able to prevent some supply gaps."

Pharmac recently tendered for the supply of patches, and would release more information when there's a confirmed supplier.

"Unfortunately, this situation is likely to continue through 2024, and for some time into 2025."

In the meantime, Pharmac encouraged people speak with their healthcare provider about what treatments are available.

- This story was first published by Stuff