Last week, Pharmac’s decision to swap hormone replacement therapy (HRT) providers was met with outcry — the change would mean menopause treatments, like popular Estradot patches, would no longer be subsidised.
Pharmac said the proposed alternative, Mylan, was more accessible than other treatments like Estradot, of which there was a global shortage.
However, some women felt a lack of consultation had left them in the lurch and on Monday Associate Health Minister David Seymour announced the decision would be reviewed.
Dunedin gynecologist Kate van Harselaar said the Estradot shortage and the decision to swap providers was extremely stressful for patients.
"[It] almost correlates with people that have to go to the chemist for their once-a-day methadone prescription," she said.
Generally, transdermal delivery was safer than oral medication and she was thrilled when, last month, Pharmac began funding Estrogel — a gel containing estrogen which is applied to the skin.
"So where we didn’t want women on oral, the only alternative then was a patch and then you couldn’t get the patch," Dr van Harselaar said.
"These women, their lives and their daily functioning was dependent on the patch. To not be able to access it and have flares of their symptoms, you can just see the anxiety [rising]."
She said, anecdotally, patients found Estradot more effective then any alternative patches — some of which brought unwanted side effects and failed to address symptoms.
Women were cutting up patches to ration their Estradot doses, she said.
"I was ecstatic when Estrogel came on the market — if patients can’t get Estradot, I’ve got another alternative that I think is equally as effective as Estradot and, in many ways, much better."
"Certainly as a clinician, it gives me less sleepless nights because I’ve got options for patients.
"I think the Estrogel is a game changer because it gives women an alternative in terms of the way we’re delivering it that isn’t solely reliant on Estradot."
Dr van Harselaar said HRT use had declined rapidly about 20 years ago, following the early results of the Women’s Health Initiative Study in 2002, which indicated there were significant risks with taking HRT.
"Internationally, overnight, women came off it, clinicians all stopped — it was very much scaremongering," she said.
"A reanalysis of those results and more recent studies have shown HRT to be safe, effective and even have prophylactic [preventive] benefits under certain circumstances."
In the past five years, global demand had outstripped supply, as more perimenopausal women saw HRT as a suitable treatment. — Additional reporting RNZ
