For generations, any talk of “the change”, as it was euphemistically dubbed, was strictly taboo. Millions of women suffering brain fog, sleeplessness and mood swings were forced to soldier on in the face of unsympathetic bosses and partners – while cast as the butt of demeaning jokes.
Worse, this state of affairs was compounded by medical sexism. Lack of training for doctors typically meant women presenting with menopausal symptoms were given short shrift or misdiagnosed. All this came at a huge cost to women’s physical and mental health.
Thankfully, in recent years there has been a cultural shift. Women talk openly about the menopause – TV programmes, books, online forums and podcasts have busted the taboo – and campaign groups and politicians push hard for much-needed changes. A Channel 4 documentary presented by Davina McCall last year aimed to break down the stigma associated with hormone replacement therapy (HRT), which replaces the oestrogen lost by the body during the perimenopause and menopause, and dispel myths about its safety. It led to a sharp rise in the number of people requesting HRT to relieve many of the worst symptoms.
In the past five years, demand for HRT has doubled. There were 238,000 prescriptions issued in England in January 2017, compared with almost 538,000 in December 2021. Around one million women in Britain take HRT, administered via gels, patches or pills. Now those women face a new challenge. Supply has not kept up with demand. There are shortages of several of the 70 HRT products available in the UK, exacerbated by global supply chain problems. One brand, Oestrogel, is nearly impossible to get.
Tens of thousands of women are affected. Women reportedly meet in car parks to buy or share medicines and travel hundreds of miles on pharmacy crawls. Others ration their doses, resort to the private sector and procure supplies from abroad.
Many are experiencing the return of debilitating symptoms, including night sweats, heart palpitations, hot flushes, anxiety attacks, low mood, joint pains, loss of libido and even suicidal thoughts. Every woman’s experience of menopause is different and symptoms can vary at different times. While some manage without medication, others find symptoms wreck their lives. Studies report 14m working days a year are lost to the UK economy as a result of menopause, with one woman in four having considered leaving her job.
On Friday, the government said it had appointed Madelaine McTernan to lead an HRT taskforce to identify the cause of the shortages. While we welcome the move and hope this will solve long-term supply issues, action should have been taken much sooner. Shortages are not new or unexpected. Demand has been steadily increasing for some time, while shortfalls of products have been a problem for years. Many women need their HRT now, not in two or three months’ time. An alternative is available but most women can’t get hold of it thanks to a postcode lottery. Bijuve, made by Theramex, is in ample supply, but only women in Somerset and Norfolk can access it due to delays in signing off new medicines at local NHS level. Campaigners are calling for a national formulary – or list – of approved HRT treatments, available in warehouses, to ensure women everywhere have equal access.
A simple change to the law on prescribing could also ease the crisis. Pharmacists must currently dispense the exact product and amount of medication on the prescription. Those in England are urging the health secretary, Sajid Javid, to let them make minor changes to a prescription without consulting the GP who wrote it so that they give a suitable alternative when something is out of stock.
The “Davina effect” is expected to strike again after her follow-up documentary tomorrow. The government must be prepared.