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British Menopause Society update on HRT supply - British Menopause Society
Last updated: 23 May 2023 The British Menopause Society has issued an update on HRT supply to provide guidance to BMS members and clinical practitioners on the current availability of HRT products. Prescribers should consider using equivalent preparations to those that their patients are...
thebms.org.uk
The British Menopause Society has issued an update on HRT supply to provide guidance to BMS members and clinical practitioners on the current availability of HRT products.
The British Menopause Society very much welcomes the appointment of Madelaine McTernan, the Vaccine Taskforce Director-General, as head of the new HRT Supply Taskforce. We hope that the work of the Taskforce will provide a better understanding of the causes behind the shortages and introduce measures to help resolve this issue soon.
The UK continues to experience shortages in supplies of Oestrogel. Besins have indicated they are receiving deliveries of this product on a regular basis and acknowledge that the current supply is sometimes insufficient to meet the continuing extraordinary demand. Besins have delivered significant volumes of Oestrogel to wholesalers recently, which is approaching double the amount supplied in the same period from January to April last year. The company is working to increase and expedite supplies to wholesalers and pharmacies across the country. In addition to the increases described above, Besins Healthcare plans to further increase production capabilities to enable further supplies of this product into the UK market in the longer term.
The BMS advises women who are experiencing difficulty in obtaining Oestrogel to consider equivalent alternative HRT preparations. This could include Sandrena gel (0.5mg or 1mg) or Lenzetto spray preparations.
Prescribers should consider using equivalent preparations to those that their patients are currently using. If an exact match is not possible, prescribers can seek guidance available on the BMS website to clarify equivalent doses:
BMS HRT preparations and equivalents
BMS HRT – practical prescribing
Consideration could also be given to prescribing estrogen and progestogen separately to make the closest match or to find a suitable alternative. Different brands for the same medication may vary in appearance or excipients. However, they would provide equivalent amounts of hormones when used in similar doses.
Besins have recently released a new Testogel sachet (40.5mg/2.5 ml). The current 50 mg/5ml sachet will be available until the end of March 2022.
The new 40.5 mg/2.5ml sachet could be administered off-label over 8 days (1/8th of a sachet will deliver 5 mg) and this is contained in a smaller volume of gel.
Alternatively, Testim (off-label use), Tostran (off-label use), or Androfeme could be prescribed as referred to in the update.
The ongoing challenges brought on by the COVID-19 pandemic have resulted in many women experiencing difficulties in obtaining their HRT supplies. We appreciate that continuing HRT intake is likely to help many women control their often difficult menopausal symptoms, particularly relevant given the additional stress some women may be under in view of the strains of the current situation in society. In addition, General Practitioners’ surgeries have been under ongoing additional pressure as a result of the pandemic.
We recommend that Healthcare Professionals and prescribers follow the joint guidance issued by the BMS, RCOG, RCGP, and FSRH which recommends that General Practitioners and healthcare providers consider advising women about menopause issues through telephone and virtual consultations where possible to reduce face-to-face engagement, and with easy access to repeat prescriptions of HRT supplies (especially to women who have been on HRT and have not been experiencing any problems with their intake). This will help to avoid the need for many women to visit their GP surgery to discuss these issues and assist with obtaining repeat prescriptions. This can be accessed through the following link:
Framework for restoration of menopause services in response to COVID-19
Signposting could also be provided to resources on the BMS website as well as the Women’s Health Concern (WHC) website, Menopause Matters, and the Primary Care Women’s Health Forum (PCWHF).
BMS members can post prescribing queries on the BMS forum if any clarifications are required.
The information on stock availability and supplies below was obtained from the pharmaceutical companies manufacturing these products. We are not in a position to comment on availability at the wholesale suppliers’ level and appreciate that availability from wholesale suppliers may lag behind and thus sometimes vary from the information provided by the manufacturers.
