A WIDESPREAD SHORTAGE of a Hormone Replacement Therapy (HRT) drug has caused significant issues for doctors, patients and pharmacists around the country who supply and use the dermal patches.
In some cases pharmacists have had to manipulate patient doses, as certain strengths have become particularly scarce.
HRT is a treatment used to relieve the symptoms of menopause, and has been described as a “lifeline” for those suffering. A survey last year showed that more than half of women fear their long-term relationships are suffering due to their symptoms, while almost two-thirds said their sex lives have been damaged.
Shortages of HRT patches have occurred intermittently since 2019, creating ongoing stress for both pharmacists and patients, many of whom rely on them to function in daily life.
HRT tablets and gels are not currently in short supply.
Laois Pharmacist Peter McElwee told The Journal that in the final quarter of 2023, supply was “relatively okay”, but the patches have become scarce in recent months.
“We did have to do a lot of consultation with doctors with regards to sometimes mild dose changes, but sometimes more considerable dose changes, [because] we had to work within the availability of product,” he said.
For example, patches have been cut in half to accommodate patients on smaller doses.
McElwee added that in some cases HRT gels have been prescribed as an alternative.
Siobhan from Galway says she turned to HRT only after her menopause symptoms became “unbearable” and patches have acted as a “lifeline”.
“I know there was shortage of patches a few months ago but in the past two weeks, I’ve had to go to my pharmacy every day to see if they’ve had any luck sourcing them. They have told me there are none,” she said.
“It’s such a worry now because I don’t know how bad I would feel if they ran out and I had to try and function without oestrogen.”
Siobhan added that she will now have to go to her doctor and get a prescription for a different type of HRT, and worries it won’t be as effective.
Eimer from Dublin said the recent patch shortage is “really disappointing”, after she too spent months trying to find the right treatment for her stage of menopause.
“For me, I had a few months of the wrong amounts of oestrogen, progesterone, and it made life so challenging with the various symptoms,” she said.
The oestrogen gel she’s had to switch to makes her feel “lousy”.
“It cannot be too much to ask in this country to secure an adequate supply of anything like this, can it?
“So many women rely hugely on HRT to even function.”
The scarcity, McElwee says, has caused a lot of frustration for pharmacists, doctors and patients alike.
Last year, following advice by his pharmacies’ buying group totalhealth, McElwee bulk bought some of the drug to get ahead of the anticipated shortage. However, he is still struggling to accommodate patients on lower or introductory doses, such as 25 micrograms or 37.5 mcg.
The 37.5mcg and 50mcg strengths of Estradot, one of the most common brands of patches, are currently on the Health Products Regulatory Authority’s (HPRA) medicines shortage list.
McElwee says he has had to purchase alternative brands from Northern Ireland, the extra cost for which the pharmacy has largely absorbed.
Margaret O’Doherty, a pharmacist in Donegal, told The Journal that drug shortages in general are an ongoing issue for pharmacies.
She said that most of her suppliers impose quotas that can prevent pharmacies from placing larger orders to meet demand.
“As pharmacists can’t adjust prescriptions there’s a lot of having to contact doctors or send women back which is frustrating and time-consuming for everyone involved,” she said.
Brian Tynan said his pharmacy, Phelans in Waterford, is also noticing the shortage.
He said the appointment of a chief pharmacist within the HSE, for which the Irish Pharmacy Union has lobbied, could help resolve the issues impacting patients around the country.
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