The current Hormone Replacement Therapy (HRT) shortages are crushing many women in menopause. Too many of these women are fighting an uphill battle to relieve painful, life-altering symptoms. One such person, Karen Golden, experienced the impact of HRT shortages half a decade ago as she managed her menopause. She remembers the struggle of balancing her symptoms during a time when the only thing that kept her life manageable was hard to come by.
The current crisis really took off in 2020, when there was a major shortage of HRT medications. Since then the outlook has only gotten worse. Drug Shortages Canada lists 92 shortages and four product discontinuations for estradiol, the most commonly used estrogen in HRT. These shortages hit women particularly hard. They further compound other obstacles to care for healthcare providers who need to find alternatives that will best allow their patients to treat their symptoms effectively.
A study released in 2002 first implicated these HRT drugs with increased breast cancer and heart disease risk. Over the past ten years, scientists have proven this idea completely wrong. Consequently, more physicians are prescribing HRT. As women seek relief from perimenopause symptoms—hormonal changes that last an average of seven years—many healthcare professionals like Dr. Michelle Jacobson advocate for more widespread use of hormone therapy.
Growing Demand for HRT
Data from last year indicates that the demand for HRT has increased pretty dramatically among women ages 45 to 65. Looking at Manulife’s aggregate claims data, we see a great success story. From 2020 to 2023, more women began seeking HRT for menopausal symptoms by 21 percent. This influx has exacerbated the current shortages, putting many women at a loss.
Dr. Alison Shea explains the dangerous impact that these shortages have had on women’s health. She explains that without access to HRT, women will have to put up with key mood swings and intensify different menopausal signs. Yet HRT is more elusive than ever. Healthcare providers are further pressed to seek out more effective alternatives, muddling treatment plans for their patients.
“As a pharmacist with expertise in HRT, Mina Tadrous, PhD, RPh, explains the complexities of where we get our HRT medicines. “It can be complicated to pinpoint the exact source of a shortage,” she explains. The multi-faceted and complex nature of drug creation plays a role in these hurdles.
“If anything along that supply chain breaks, it sort of feels like a slow-moving train because it takes a few weeks or months for it to hit.” – Mina Tadrous
Impact on Trans and Non-Binary Communities
Furthermore, the implications of HRT shortages go beyond cisgender women. According to Dr. Kate Greenaway, these shortages can be deeply impactful to Canada’s trans and non-binary population. For individuals undergoing hormone therapy as part of their gender transition, limited access to necessary medications can create significant barriers to achieving their desired health outcomes.
There is a general increasing awareness that HRT is an important medication for various populations. In addition, healthcare providers are taking action to address these shortages as a priority. Garnet Anderson, a scientist with the Women’s Health Initiative at the University of Washington, underscores the need for better support systems for those affected by hormonal changes during this critical life stage.
“You have a product that’s a little harder to make, and then all of a sudden, you also have very few companies that are active in the marketplace.” – Mina Tadrous
The Road Ahead
As healthcare professionals strive to navigate the ongoing crisis, many are hopeful for resolution in the near future. Recent estimates indicate that the HRT shortage will clear up by July or August. The complicated logistical and scientific realities of drug production pose challenges that can delay access for years.
Here’s why – manufacturing medications is much more complicated than making something simple like bread. As Christian Ouellet put it, “It’s not manufacturing a molecule like you manufacture a loaf of bread, it’s very different. This complexity can result in chinks in the armor of their ever-elusive supply chain. As a result, patients could experience increased wait times to receive critical drugs.
Dr. Jacobson urges that all women at the median age for menopause should have appropriate access to hormone replacement therapy. This is essential, particularly for those already suffering side effects such as hot flashes and night sweats. “That is agreed upon by every guideline and every organization out there who have opinions on menopause,” she says.
“If we actually used it more often, then the pharmaceutical companies would want to make more.” – Mina Tadrous
The conversation about access to HRT is far from over as providers push for more diverse and inclusive policy guidelines and recommendations.
