By Jennifer Upton
I started taking Hormone Replacement Therapy (HRT), now sometimes called Hormone Therapy, almost a year ago.
A combination of estrogen delivered via a transdermal patch and, for two weeks a month, a dose of progesterone.
For the first 7 months, I had no problems filling my prescription.
The 2022 shortage where British women were forced to ration and share prescriptions in the UK happened before I began treatment.
HRT HISTORY REPEATS ITSELF
Recently, things changed.
My pharmacist called me with the dreaded news, “We don’t have those items and we aren’t sure when they will be back in stock.”
When I asked why, there was silence.
My life suddenly became a sequence of phone calls and googling every pharmacy within the greater London area to find the estrogen patches and progesterone tablets I so desperately needed.
My fear of the return of night sweats and insomnia drove me.
After the tenth phone call, I wondered if this was “drug-seeking” behavior.
I went to the medicine cabinet and counted my remaining doses.
The prospect of quitting cold turkey grew with every “out of stock” alert.
Why take both estrogen and progesterone?
Doctors commonly prescribe the combination of estrogen and progesterone to women experiencing symptoms of menopause and perimenopause who still have a womb.
Taking estrogen on its own can cause a thickening of the uterine lining or sometimes cancer.
Progesterone helps prevent this.
Progesterone is typically stopped within 5 years of starting HRT but every situation is different.
People in menopause and perimenopause require care from healthcare providers with specialized knowledge.
Quitting HRT Cold Turkey
Many who suddenly quit HRT experience withdrawal.
The symptoms are similar to perimenopause and menopause and can include:
- Temperature sensitivity
- Hot flashes
- Night sweats
- Difficulty concentrating
I finally made the decision that many cannot afford.
I found a private online pharmacy where I could fill both of my scripts for a grand total of £105 plus shipping.
On the National Health Service, each medication normally costs £9.35 per item.
I count myself among the lucky.
As an American living in the UK, I’m in the unique position to have experienced two very different health care systems.
One nationalized with many private options and one that operates entirely for profit.
Neither system is perfect.
Both currently have a problem serving those in perimenopause and menopause.
The U.S. has no shortage of HRT, but the fact remains most women in the US will never have access to HRT for several reasons:
- Even with insurance covering part, HRT can cost between $120 to $240 per month.
- Half of U.S. counties have no ob/gyn.
- Lack of menopause education among physicians in medical school.
Innovation can help fill the health care gap.
Apps and blogs such as mySysters give women a place to learn about what their bodies are going through and offer alternatives when they can’t get the treatments they need.
If you are currently on HRT and can no longer afford it or find it in your area, consult your doctor about the best way to taper your doses to minimize your symptoms.
What are the alternatives to HRT?
If you’re unable to continue taking HRT or can’t start, there are alternative ways of controlling your menopausal symptoms.
Alternatives to HRT that may control symptoms include:
- Regular exercise
- A healthy diet
- Cut down on caffeine
- Drink little or no alcohol
- Cutting down on spicy foods,
- Quit smoking
- Tibolone – a drug that is comparable to combined hormone replacement therapy (oestrogen and progestogen), but may not be as successful and is only appropriate for women who last had a period more than a year ago.
- Antidepressants – Although they can have unpleasant side effects including agitation and dizziness, some antidepressants can assist with hot flushes and night sweats.
- Clonidine – a non-hormonal medicine that may help reduce hot flushes and night sweats in some women, although any benefits are likely to be small
Yet another issue to contend with is the tendency for the media to criticize “the commercialization” of menopause.
Some argue this is the leading cause for the UK shortages, but research shows it’s a combination of demographics and ongoing supply chain challenges brought on by the Covid-19 pandemic.
If we want companies to come up with solutions for menopause symptoms, we need to stop complaining when companies create solutions for** menopause symptoms** that become popular to the point of shortage.
America needs to make them available at a reasonable price as part of a national health care strategy.
The UK is making strides where the U.S. is failing on that point.
Beginning in April, 2023, “women prescribed HRT - the primary treatment for menopause symptoms - will have access to a new scheme enabling access to a year’s worth of menopause prescription items for the cost of 2 single prescription charges (currently £18.70.)”
Will this boost demand? Most likely.
But, we’re still better off than in the States where we have not even discussed the possibility of such a program.
In the future, both countries will continue to struggle to keep up with the needs of increasing menopausal populations.
It’s time to stop blaming the victims for falling for “commercialization” and step up our games.
mySysters is an app for women in perimenopause and menopause.
Good Housekeeping and Woman’s Day named mySysters the Best App for Women in Perimenopause and a Must Have App for Women.
The information and other content provided in this blog, website or in any linked materials are not intended and should not be considered, or used as a substitute for, medical advice, diagnosis or treatment.
Jennifer Upton is an American (non-werewolf) writer/editor in London. She currently works as a freelance ghostwriter of personal memoirs and writes for several blogs on topics as diverse as film history, punk rock, women’s issues, and international politics. For links to her work, please visit https://www.jennuptonwriter.com or send her a Tweet @Jennxldn
Sources: https://medicalxpress.com/news/2012-05-counties-ob-gyn.html https://menopausesupport.co.uk/?p=14434 https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/alternatives/ https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/overview/ https://www.menopause.org.au/hp/information-sheets/tibolone-as-menopausal-hormone-therapy https://pubmed.ncbi.nlm.nih.gov/7145250/ https://www.gov.uk/government/news/hundreds-of-thousands-of-women-experiencing-menopause-symptoms-to-get-cheaper-hormone-replacement-therapy