GP Fears Women Will Die As HRT Supplies Dwindle

A national survey launched on Friday to uncover the breadth and depth of issues for the many thousands of Kiwis accessing hormone replacement therapy in Aotearoa New Zealand is already revealing “terrifying” insights into possible outcomes of the shortage, including death.

The global supply of transdermal estrogen patches, which sit against the skin and release hormones into the body, began running out almost two years ago, says Hawke’s Bay GP Dr Samantha Newman. She’s saddened and angry that the government drug buying agency, Pharmac, was slow to act while they had the opportunity to, and that now, HRT users are overwhelmingly being denied regular medication.

“It’s Pharmac’s job to plan ahead,” she says. “They’re the ones with access to international supply, with the real-time insights into local demand for medications, and with the expertise to make decisions that would have ensured women, and other users of hormone replacement therapy, had continued access and affordability. Patches are not the only way that estrogen can be delivered into a hormone-depleted body – there are gels, tablets and sprays also. Why, then, do we not already have gels, tablets and sprays in the country, approved and funded for use?”

Since it launched on Friday 14th June, the survey – written and distributed by a collective of women including GPs, pharmacists and researchers – is being filled out every six minutes by HRT users across the country pleading for urgent action from Pharmac and the Ministry of Health.

“I’ve had an email from one woman who is frightened for her life,” continues Dr Newman. “She was suicidal before her doctor prescribed HRT and now that she can’t get it anymore, she is panicking. The stories I hear almost hourly are terrifying. I’m deeply worried for the mental, emotional and physical health of HRT users. Will it take a death before the government acts?”

The survey collects demographic data as well as the recent experiences of women who are being turned away from their pharmacies, resorting to cutting the remaining patches they have in half to make them last longer, or are fortunate enough to find patch alternatives, such as the estrogen gel product, for sale – but at a huge personal cost. “One woman has told us she pays around $200 every couple of months for the gel,” says Dr Newman. “However as of last week, we now know from the business that imports the gel product that its stock is also on the verge of running out. Women have nowhere to turn, and no information, and the Ministry of Health, Pharmac and government are telling them nothing.”

Over the ditch, Australian authorities have approved alternative brands of patches called Estramon and Estradiol, until their stocks of the popular brand Estradot are replenished this month.*

Meanwhile, an Official Information Act request to Pharmac for copies of documents that outline what work it is doing to progress alternatives has been refused in full, and redirects interested parties to its website for information.

On the website, Pharmac says it’s “sorry” for the lack of patches in our country. It points to an article about global supply barriers published in 2022 and notes that a tender process for alternative estrogen gel has closed. It provides no evidence that gels, or any other estrogen products, have been procured. Dr Newman says that’s far from good enough.

In an effort to make sure fellow GPs, pharmacists and HRT users understand the current situation, she is creating videos and leaflets giving up-to-date information on the HRT crisis, which she distributes to her colleagues and posts on her social media channels. The survey is Dr Newman’s latest attempt to respond to what is an ever-evolving situation.

“But, let me be clear, this is not my job,” she says. “I’m a busy GP with a full patient roster. I would love nothing better than for the Ministry to create a public awareness campaign under urgency, share relevant and useful information, and respond to this public health disaster themselves.”

Meanwhile, Dr Newman continues to receive emails and calls of support from around the globe. “A fellow menopause specialist and GP in the United Kingdom says the British government has proactively worked to maintain a reliable estrogen supply there and that she is deeply concerned for our community. As am I. The survey is already showing us that women are unable to work and parent effectively while their hormone levels are impacted. They’re getting sick – mentally and emotionally with anxiety, depression and suicidality, but also physically, with sweating, heart palpitations, severe fatigue and joint pain.

“They’re helping each other out as best they can, arranging swaps and facilitating a black market of sorts. But they’re desperate, and I fear for their health, wellbeing… and lives.”

Results from the survey will be forwarded to government agencies and the Minister responsible for Pharmac, David Seymour, as further evidence that the situation is an emergency and that the government’s neglect is reprehensible.

“We need the government to understand that this medication is not a nice-to-have or a lifestyle choice – it’s not a supplement, or a vitamin. It’s vital medicine and without it, people are in agony.”

The survey for HRT users is open and can be filled out here: https://www.surveymonkey.com/r/estrogen

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