One of New Zealand's leading menopause specialists says it's "upsetting" what women are being forced to do to access medication that is once again in short supply.
Menopause and perimenopause can come with the well-known hot flushes, but more common is anxiety, weight gain, body pains and, in some cases, heart palpitations and severe depression.
For many women, Hormone Replacement Therapy (HRT) can relieve those symptoms – but now it is in short supply.
Oestradiol (Estradot) patches are considered a game changer for menopausal and perimenopausal women. It releases oestradiol, a form of oestrogen, in a continuous and controlled way. It is also taken by some transgender people to affirm their gender.
According to Pharmac's website, as of last week, there was low stock in many of the lower dosages of the brand Mylan, while some dosages of Viatris were completely out of stock as well as 100 mcg of Estrodot.
"There is limited stock of the various brands at different wholesalers. If your usual wholesaler doesn't have a specific strength, try other wholesalers. We acknowledge this is a challenging situation for everyone," Pharmac said.
"This is a fast-moving situation and stock levels will change.
"We're working closely with the suppliers to understand demand for this product, which continues to grow, and how they can meet that growth."
Unfortunately, people struggling to access the patches aren't new.
Since 2020, there's been an ongoing shortage of it because of the COVID-19 pandemic and a huge rise in demand.
Globally, suppliers are reporting extraordinary increases in demand for oestradiol patches, and in New Zealand demand has grown from 1.2 million patches in 2020/21 to over 3 million patches in 2022/23.
Menopause specialist Dr Samantha Newman, founder of FemaleGP, said one of the reasons contributing to the shortage is that New Zealand has fewer options for oestrogen medication, as well as a lack of global planning and a little bit of misogyny.
"It's a worldwide issue and I think in New Zealand, it's a little more pronounced because we only have patches we don't have the gels and other options available," Dr Newman told AM on Friday.
She said the lengths some women are going to to get the patches is upsetting.
Some women who are on higher dosages have to get another prescription and buy extra boxes of a lower dosage to make it up. While others are cutting their patches to make them last longer.
"It's a really unique prescription and so being told to just cut a bit of the dose off, actually can be really, really negative and destabilising for when women have spent months trying to get that right dose," Dr Newman said.
"… It's just more barriers for women."
She is advising her patients to have a backup plan. Some women cannot take oral oestrogen, so Dr Newman would encourage them to talk to pharmacists to ensure they can continue with this medication.
For women who can take oral oestrogen or can afford to buy gels, which aren't funded in New Zealand, she would discuss those options with them.
"But I don't ever want to anyone to not have a patch or the medicine they need because people wouldn't not ever have blood pressure medications or antidepressants and this is same but more," Dr Newman said.
She said the easy fix would be to allow pharmaceutical companies to make more patches and fund the gel medication in New Zealand.
Due to the ongoing supply issues, Pharmac said it is exploring whether there are other presentations or products it could secure and fund in New Zealand.
Pharmac issued last year a Future Procurement Opportunity (FPO) for the supply of transdermal oestradiol products, that is products that deliver oestradiol through the skin. It hopes the process will alleviate supply pressures.
Pharmac's director of advice and assessment/chief medical officer Dr David Hughes said over the past few months, Pharmac has been working on developing what the procurement process would look like and expects to be able to share this within the coming weeks.
"As we work within a fixed budget, the next steps in this process would continue to depend on bids received from suppliers and available budget," Hughes said in a statement.
"We have talked with clinicians throughout this time and continue to hear from people in the community about the desire for an alternative treatment option. Hearing from people is really important to ensure that what we’re planning for will provide the best health outcomes for New Zealanders."
Pharmac said it has been and will continue to work closely with our suppliers of oestradiol patches and take every measure to ensure that people can continue to access this treatment.
