Manufacturers struggle to keep up with soaring demand for HRT
It’s a position that most businesses would love to find themselves in: booming demand for their products.
But soaring requests for hormone replacement therapy (HRT) among British women going through menopause have seen some manufacturers fail to keep up, leading to months of supply shortages and stories of women struggling to sleep or work effectively after being unable to obtain their prescriptions.
Several HRT drug providers describe it as the “Davina effect”: the documentary Davina McCall: Sex, Myths and the Menopause, fronted by the TV presenter, which was first broadcast on Channel 4 in May 2021, sparking an immediate surge in demand.
Yet almost a year later, this shows no signs of abating. Demand for HRT products surged by 30% in the month after the broadcast, according to Theramex, a global pharmaceutical company focused on women’s health.
Orders continued to grow through the year, climbing by 130% during the second half of 2021, according to Tina Backhouse, UK country manager for women’s health at Theramex.
Millions of women go through the menopause each year, and many experience a range of symptoms, which can be severe, including anxiety, low mood, hot flushes and difficulties sleeping.
“As an industry we didn’t have any warning of [the documentary],” Backhouse said. Theramex subsequently increased manufacturing of its HRT products, which are made in Germany, but this is continually under review.
“Every month we are looking at it and putting it up again. I thought at the worst we’d have nine to 12 months of safety stock in the warehouse and that is not the case. But we are bringing in enough.”
However, the company, owned by private equity firms PAI Partners and Carlyle, said ramping up production has required significant investment, so has not immediately led to higher profits.
“It is expensive to increase production capacity. You’ve got to take a leap of faith,” Backhouse added. “It’s not like ordering a load of groceries for next week, [the manufacturers] have to source raw materials.”
HRT shortages in previous years have been blamed on manufacturing and supply chain problems, however the industry says lack of availability in recent months stems from growing numbers of women requesting the products.
The number of prescriptions for HRT in England has doubled in the past five years to more than 500,000 a month. As a result, some products have not been available for periods of time.
Earlier in April, the British Menopause Society warned members and doctors of noticeable ongoing shortages of Oestrogel, a gel that contains the hormone oestrogen and is applied to the skin.
Its manufacturer, Besins Healthcare, said it had been experiencing “continuing extraordinary demand” for the gel in the UK.
The privately owned, Brusselsheadquartered firm said in a statement it regretted “the continuing situation regarding insufficient supplies of Oestrogel into the UK”.
Despite delivering almost double
the amount of the gel – which is produced in France and Belgium – to the UK between January and April, compared with the same period in 2021, the company acknowledged supplies were sometimes “insufficient”.
“Besins are acutely aware of the impact this situation is having on patients and understand that they are worried about fulfilling their prescription,” the company said, advising any concerned patients to speak to their doctor or pharmacist.
Besins said it plans to further increase its production, so it can supply more product to the UK in the longer term.
HRT gels or patches that are applied to the skin are prescribed more frequently, according to Dr Paula Briggs, chair elect of the British Menopause Society, and a consultant in sexual and reproductive health, because they do not increase the user’s risk of developing blood clots. Although the risk is small, this can be a side-effect of HRT tablets.
Producers of HRT rarely join forces because of commercial sensitivities, even at a time of shortages.
Some hope the government’s appointment of an ‘HRT tsar’ to tackle lack of availability will bring about more joined-up thinking and collaboration within the industry.
“At the moment it feels like menopause management is celebrity-driven, and the clinical focus is not as it should be,” said Briggs. “Whoever is appointed needs to have involvement with national organisations and be in collaboration with the royal colleges.”
Briggs is also calling for availability of HRT products to be standardised across the regions and nations of the UK, regardless of whether they are prescribed at GP surgeries or hospitals, to ensure patients can access replacement drugs if their usual prescription isn’t available.
HRT producers are not expecting demand to reduce anytime soon. Studies have suggested that between 13% to 14% of UK women are prescribed
HRT, despite the fact that an estimated 80% experience some menopausal symptoms.
“I think that in the UK lots of very powerful women in politics and the media have all hit menopausal age at the same time and are using their platform to discuss that,” Backhouse said.
TV producers have confirmed McCall’s latest documentary on the menopause will be broadcast in early May. HRT suppliers are braced for demand to rocket once again.