Pharmacists have said trying to get hold of the two most popular HRT patches is like a lottery (file picture). Photo: BSIP via AFP
"Where's the dignity in it?"
That is the message from women missing out on hormone replacement therapy patches as a nationwide supply shortage worsens.
Pharmacists have described trying to get hold of two of the most popular types of HRT patches - which are used to mitigate symptoms of perimenopause and menopause - as a lottery.
Nationwide supply shortage in HRT patches worsens
It has meant some women are forced to mix their dosage, pay extra for treatment, or simply go without.
Jenny Cussins has been using HRT patches for a year.
But over the last six months it has become harder to fill her prescription - last week she was unable to get any patches at all.
"I went to get my prescription filled and the pharmacist said, well, we're really sorry, but we don't have any stock and there's no stock in New Zealand.
"We can't help you, we can't give you anything, go back to your doctor and see if he can find alternatives for you."
Cussins said the shortage was depriving women of the medical support they deserved.
"It's like, where's the dignity in it as well, you're sort of lining up with a whole lot of other people to get your ration of something that feels like, you know, we're a first world country surely, we can solve the supply issues with these things."
After ringing around dozens of pharmacies she has sourced enough patches to last the next month.
Without the patches, Jenny's mental and physical health takes a turn for the worse.
"So immediately I'm not sleeping, the brain fog comes back, my fuse is a lot shorter to the extent where I've had to you know, tell my colleagues and my boss what's happening with me."
A hormone replacement therapy patch sticks onto the abdomen, lasts three to four days and contains the hormone estrogen - the same hormone ovaries produce before menopause.
When applied to the skin an HRT patch is supposed to ease the symptoms of perimenopause and menopause which can be both physical and neurological.
Problems like brain fog, forgetfulness and fatigue are just some of the changes.
Gemma Perry owns Saunders Pharmacy in Te Awamutu and said it was a total lottery each month to find out whether they would have enough stock.
"Communication has been really limited on this suppliers are not giving much information away to the wholesalers everyone's pretty in the dark about when the stock actually does arrive."
The shortage is a global one - and not just affecting New Zealand.
The patches come in different dosages depending on the severity of symptoms.
Parry said they have not had all four strengths in stock for quite some time, so patients are having to do DIY fixes to mix different strengths.
"People are having to third a patch or some months they're quartering a patch and next month they're having a different brand."
The issue with that is Pharmac only funds two patches of the same strength per week.
So, if a patient is on 200 micrograms a week and there are only 50 microgram patches in stock, they need to use four patches and will be charged for the extra two.
"You know why are patients having to pay the cost because the Pharmac have not been able to do the job that they need to do, which is to ensure a supply of medicines into New Zealand," Parry said.
Dr Linda Dear specialises in menopause and said until the shortage was addressed patients should be aware of other options.
The patches are considered superior, but estrogen pills or gels are alternatives.
The estrogen pills are fully funded but not suitable for people who get hormonal headaches or are at risk of blood clotting.
While estrogen gels are a good option, they are not funded so cost more.
Dr Dear said Pharmac was considering funding one brand of gel, but they needed to make a decision - and fast.
"We just don't know which one, and we actually don't yet know when, but the sooner that happens the better, because the problem is not going away and we need an alternative option, especially for women who cannot switch to estrogen pills."
Demand for HRT patches in New Zealand has more than doubled over the past few years, growing from around 1 million patches in 2021 to 3m in 2023.
Dr Dear said that steady increase should have been a clear indicator to prepare for future demand.
"Was it really that surprising, could there not have been more forecasting and prediction that this was going to become more of a popular and necessary treatment that people want to use?"
In a statement Pharmac acknowledged that the HRT supply issue may be causing stress for some people and said it was doing all it could to ensure people could access this treatment.
It is currently evaluating proposals for estrogen gels and aims to provide more information at the end of July.
Pharmac said the shortage would continue for some time into next year.