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New Zealand women in mid-life are being let down by Pharmac, say two doctors specialising in women’s health.
A worsening global shortage of the “gold standard” estrogen patch Estradot means women who rely on hormone replacement therapy to mitigate the symptoms of estrogen deficiency are being offered unsatisfactory alternatives.
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Dr Megan Ogilvie, an endocrinologist at Fertility Associates, told Susie Ferguson that HRT is a game-changer for women going through peri-menopause or menopause. Estrogen deficiency symptoms vary, but include sleep issues, hot flushes, sweats, menopausal depression, joint pain, fatigue and loss of cognitive focus.
“It [HRT] really helps women be productive in the workspace and in their family space,” Ogilvie said.
While estrogen is also available in tablet or gel form, Ogilvie said the trans-dermal patches (which allow a steady release of estrogen) are considered superior. However, not all patches are made the same: many women who have been switched to other brands find that the patches don’t stick properly, which lessens their effectiveness, or they cause an allergic reaction.
For some women, taking oral estrogen puts them at higher risk of blood clots in the legs and the lungs. It can also exacerbate migraines in women who suffer from them.
“The other big group of people that will be affected by this condition or by this shortage is trans women. These women use the Estradot patch because it's much safer for them in terms of clot risk than the tablets,” Ogilvie said.
“We have a real sector of the community that is being significantly affected. I have many women that would not be able to turn up to work if they lost the availability of estrogen.”
Dr Linda Dear, a menopause specialist, has launched a petition asking Pharmac to fund more options for New Zealand women taking HRT. Dear said the current situation could be improved markedly by Pharmac making simple changes to prescription rules in the short-term, so more GPs were aware of useful alternatives.
“It makes women feel so anxious when they can’t suddenly get the same patches they’re used to. Some brands do seem to work better than others, a lot of women do get allergies from some of these alternative brands. It’s quite frightening for these women when they are so reliant on it, if they’re told these patches aren’t available.
“It just shouldn’t be this hard to get gold-standard HRT.”
There are two types of estrogen gel that are widely used in Australia, the US and the UK, but these are not currently licensed in New Zealand or funded by Pharmac.
“Gels are just as good as patches and in a lot of other countries, women use them more than patches,” Dear said.
“This is not some sort of weird, brand new thing we're talking about. It just needs to come to New Zealand and it needs to be licensed here. And preferably funded here.”
Dear said a lot of women would be left with no option of they couldn’t find a treatment that worked for them.
“They’re really left in this hole, this frightening dark spot where that that treatment they've been relying on is suddenly gone.
“The whole point of this [HRT] is to stabilise hormone levels. It's the fluctuations that nature throws our way that make us feel so out of control. So women need the steady supply.”
Looking at every option
Geraldine MacGibbon, Pharmac's acting director, Pharmaceuticals, said the increased global demand for Estradot was “a great news story” because it showed increased awareness of treatments for the debilitating symptoms of estrogen deficiency.
She said it was unfortunate that supply had not kept up with massively increased demand.
“We are absolutely looking at every single possible option that we can to get treatment to people so they can get relief from these debilitating symptoms. We're bringing in more stock weekly, we've funded two other patches, there are the oral options, though we know they're not for everybody.
“People should be talking to their healthcare practitioner about what their various options will be while we work through the shortage.”
MacGibbon said Pharmac was trying to ensure equitable distribution of patches throughout the country and investigating estrogen gels. She said Pharmac was hoping to be able to “have some progress” in the next couple of weeks.