Amid Estradot shortage, a call to prioritise perimenopause treatments

A SUBSTITUTE FOR the hormone replacement medication Estradot is available but some pharmacies are having problems getting it.

After disruption to Estradot supplies for the past three years, Pharmac advised via its website that the Mylan alternative has been available since 11 May.

Estradiol TDP Mylan 25, 50 and 75mcg can be used to replace Estradot patches of the same strengths. Estradot 100mcg is still available. The 25 and 50mcg Estradot patches are expected to be available in July and the 75mcg is expected late May.

Pharmac director of operations Lisa Williams says demand for Hormone Replacement Therapy (HRT) continues to surpass available supply, and funded use of the treatment has more than doubled over the past five years with sharp increases in demand for the patches over the past two years.

Demand has also increased internationally, Ms Williams says, and the global supply chain has been disrupted by COVID-19.

As well as sourcing alternative brands, Pharmac staff are prioritising looking at if there are other presentations or products that can be secured.

“In regard to the Estradot brand, most of the stock in New Zealand is on allocation, which means pharmacies are only receiving a small volume each week, possibly not the full order they placed. Wholesalers and distributors use allocation as a technique to ensure equitable distribution of limited supplies around the country,” she says.

“We want to acknowledge the stress this supply issue might be causing some people.”

One central Auckland pharmacy employee, who could not give an interview due to contractual restrictions, says the pharmacy does not have any of the Mylan patches.

However, a pharmacy on Auckland’s North Shore was expecting to get a delivery of the 25 and 50mcg Mylan patches on 17 May. Bays Health Pharmacy owner and pharmacist Monterrey Wigglesworth has heard some other pharmacies can’t get them.

“Women have been told: ‘There’s nothing for you’ and have had to go off hormone replacement therapy,” says Mrs Wigglesworth.

Customers are very grateful her pharmacy can supply alternative oestrogen patch brands. However, some women have complained about one of these, Estraderm. “They are huge and plasticky, not filmy like Estradot,” she says.

More people are having rash reactions to Estraderm, adds Mrs Wigglesworth. It costs twice as much as Estradot, and she’s not sure whether the pharmacy is being fully reimbursed for it.

Endocrinologist Sasha Nair says half the population will go through menopause so treatments should be prioritised.

Dr Nair, who works at Fertility Associates in Auckland, understands there is an international shortage and says it’s good there are alternatives to Estradot. “There is a workaround, but we still need a long-term plan from regulatory bodies.”

Oestrogen patches or gel are vital for many women, she says, noting some women get really debilitating symptoms affecting their work and relationships. Hormone therapy can be “transformative”.

Dr Nair says different brands should work as well as Estradot in theory, but some patients report changes in symptoms or side effects. More than one patch can be used if the right dosage is not available. However, cutting a patch to get the desired dose may cause some of the dose to leach out, or it could be cut imprecisely.