Rebels Without a Patch: The Cruel Reality of the HRT Patch Shortage for Perimenopausal & Menopausal Women

Our guest writer just filled out this national survey on the impact of the HRT shortage on women, and other users, in Aotearoa New Zealand. Now, she implores you to do the same.

If you’re in your 20s or 30s, a bunch of agitated 40 and 50+ women moaning about the sudden shortage of oestrogen patches to slap onto their ageing, sagging stomachs probably doesn’t mean very much. If you’re those said 40 and 50+ women, then you’ll know EXACTLY what I’m about to rage about.

This isn’t a menopausal mountain out of a medical molehill. I’m here to tell you that there are some very real reasons that you should be as livid about this as me, or your grumpy, greying-around-the-temples colleague, friend, sister, or mum, because this affects so many women going through perimenopause (which, as we mentioned earlier this week, hits women from their THIRTIES) and menopause.

Yes, the shortage of HRT (stands for hormone replacement therapy, sometimes known as MHT which stands for menopausal hormone therapy) patches is a global one, so what right do we have to protest? The thing is we have plenty of reasons, not least of which is that our human right to medication is being withheld, when most of us could, quite reasonably, expect an alternative.

This shortage is a huge issue, with a huge amount of women across the country having issues filling their HRT prescriptions, or whose supply is rapidly running out. The result? Women who, through no fault of their own, unable to function.

So in case you’ve been wondering what all the fuss is about, here’s a cheat sheet:

1. HRT is life-saving medication. It doesn’t cure cancer, but it replaces hormones in the body that slowly wane as women age. For many women, perimenopause starts in their 30s or early 40s, and usually lasts about 10-12 years – and for lots of us, we struggle to think clearly, suffer anxiety, we sweat all the time, bleed relentlessly, our heart races, our joints ache and it can be difficult to maintain a career. Also, we’re at our highest risk of suicide when we reach our menopausal years and frankly, it’s not hard to understand why if you’ve been suffering from symptoms like this, without relief.
   
2. Pharmac knew about the looming oestrogen patch shortage two years ago. Let’s say that again. TWO YEARS, PEOPLE. Which is long enough to make a Plan B for continued access to life-changing medication, amirite?
   
3. So, what did Pharmac do? Um… nobody actually knows. Responding to an Official Information Act request to find out, the government drug buying agency made a series of vague statements and references to old material which you can read here. They wouldn’t supply all the information requested because it would take them too long and “interfere with the day­-to-­day workings of Pharmac”, which is, presumably, giving the people who make up 50% of the population the option to take accessible and affordable medicine. Medicine that allows them to work, manage a family, volunteer and continue to be productive members of society (oh, and not kill anyone). Hey Pharmac, do you want to know what really interferes with day-to-day output? A LACK OF OESTROGEN IN THE BODY. That’s what.
   
4. While patches, which sit against the skin and release medication into the body, are the gold standard in oestrogen medication, there are alternatives, like oral tablets (clue’s in the title) and gels which are dispensed via a pump and rubbed in. These are not in such short supply and could be made available (eg, become approved medicines) via Pharmac but, you guessed it, have not been. David Seymour, the Minister responsible for Pharmac says they are “working on it” but given that most OECD countries have already approved these medications for general use, surely this should take weeks/months, not years. In fact, in their OIA response, Pharmac themselves notes “listing a gel product would alleviate supply pressures on the estradiol patches… the impact could only be positive.” That was in May 2023. It’s June 2024 and most women who are seeking the gel as an alternative still don’t have access, or if they do find some, have to pay for it.
   
5. Contrary to the rhetoric of 10-15 years ago, most forms of HRT medication are safe for most people. The breast cancer risk is lower than it would be if you consume a couple of units of alcohol each day. HRT is known to reduce incidences of heart disease, osteoporosis, dementia and bowel cancer. So, it’s not the devil. It’s largely protective, and, importantly, improves mental health outcomes. 

So, that’s the lowdown on the very low place we rebels without a patch find ourselves in. At my pharmacy, they are completely out of my prescribed dose – but they do have a HUGE patch (75mg) I can obtain and cut into three pieces (someone recently compared the measurements to those of a fitted sheet. It’s not that bad, but let’s be real, it’s not ideal).

My neighbour has the opposite issue, as it happens. She’s getting my usual dose (25mg) in triplicate and is slapping those patches all over her abdomen. The thing is, Pharmac only funds one box of patches per month, irrespective of dose, so even though her dosage hasn’t changed, she’s paying for two boxes just to get the medicine she needs.

Meanwhile, she and I have organised a mailbox drop –  swapping our doses so she gets mine and I get hers. Middle-aged women are nothing if not ingenious, and it turns out our brains are not yet so addled that we can’t do basic maths. It won’t be long before dinner parties where an invitation to bring a plate is switched out to bring a patch. BYO oestrogen.

So, what’s the main issue here? It’s this. Access to medication is a basic human right. If, suddenly, antidepressants or anti-psychotics were unavailable, or there was a global shortage of insulin, blood thinners, chemotherapy or, dare I say it, Viagra, there is no way that the situation would go TWO YEARS, 730 days, without adequate action.

Women, as per, are expected to get on with life, without access to the drugs that keep them firing, functional, and fun to be around.

This could happen to you.

Hawke’s Bay doctor Dr Samantha Newman has launched the survey to gather Kiwi HRT user’s stories, and already responses to the survey have shown the problem is as disturbing as it is widespread, with women reporting they’re unable to work or parent well, had increased levels of depression and anxiety and more heart palpitations, sweating, joint pain and fatigue.

And, as she told Radio New Zealand, she even had one woman frightened for her life.

“She was suicidal before her doctor prescribed HRT and now that she can’t get it anymore, she is panicking. The stories I hear almost hourly are terrifying,” she said. “I’m deeply worried for the mental, emotional and physical health of HRT users. Will it take a death before the government acts?”

My request is simple. Send this survey to the perimenopausal or menopausal woman in your life, so she can have her say. The data will be used to help ensure there is change – change that means your human rights will, we sincerely hope, never be violated again.

Fiil in the survey here, and if you have an experience or story you’d like to share, please email us on hello@capsulenz.com