Haitham Hamoda, clinical director of the menopause service at King’s College Hospital and president of the British Menopause Society, said that while patients should not be burdened with the crisis, there are some practical steps that could be taken. “There have been many reports of people entering the Internet and the black market, which gives a shocking aspect to it,” he said. Instead, Hamoda recommends that, if necessary, women can switch to different HRT formulations designed to provide the same hormone concentrations. The British Menopause Society has published an equivalence guide for GPs and GPs that suggests the closest alternatives to drugs that are deficient, such as Oestrogel, an estrogen-only HRT form produced by Besins Healthcare UK, and FemSeven Sequi patches. “There may be some variation in absorption, you may get a little more or less, but it’s not going to be a huge difference,” he said. “It is in the meantime that I will encourage people to do.” In order to avoid an exchange of views between GP surgery and a pharmacy, a patient may ask their doctor to check availability with pharmacies in advance. Similarly, most community pharmacies will be able to contact GPs to ask if they can give an alternative medicine, instead of sending the patient back for further consultation. Claire Anderson, president of the Royal Pharmaceutical Society, is calling for the law to be changed so that pharmacists can make such small changes without further consultation with doctors. Anderson urged women not to exchange drugs with friends, as MP Caroline Nokes described what she did this week. “People should not use other people’s drugs. Your medicine is prescribed individually for you and you should never share medicines. I would really discourage him. “ HRT boosts hormone levels that decline as women approach menopause, especially estrogen. This helps reduce a wide range of symptoms associated with changing hormone levels, including hot flashes, night sweats, vaginal dryness and mood swings. Some also take HRT to protect bone health. However, Anderson points out, different products have different benefit-risk profiles. Combined HRT (containing estrogen and progestogen) is associated with a slight increase in breast cancer risk, while HRT tablets – but not gels or patches – are associated with a slight increase in blood clots. Professor Waljit Dhillo, an endocrinologist at Imperial College London, said he would advise patients to try to stay on the same treatment if possible, as it may take up to six weeks for symptoms to stabilize after starting a new form of HRT. “The problem is that people are stabilizing in one preparation, changing to another; it’s not just like changing bread,” he said. However, he said, if the shortages are expected to last more than six weeks, it is probably worthwhile for patients to switch to another drug. Dhillo said that while some people find helpful alternative therapies, clinical evidence that such therapies are effective “is not very good” and therefore should not be treated as a substitute for HRT. Previous research has also shown that lifestyle changes such as reducing caffeine and alcohol and regular exercise can help manage the symptoms of menopause. “Exercise is good to do, but it’s not going to be that effective,” Dhillo said.
