Women need more options for hormone therapy, not fewer

The recent Pharmac decision to exclusively fund Mylan oestrogen patches without consulting major stakeholders has generated significant concern among users who fear a resurgence of debilitating menopausal symptoms, with significant physical, mental and socioeconomic implications.

As health professionals who prescribe Menopausal Hormone Therapy (MHT, formerly known as HRT), we are aware of this anxiety and are troubled by the decision to fund a single brand of oestradiol patch.

MHT is the most effective way to control menopausal symptoms, such as hot flushes and night sweats. Growing public discourse about menopause, and recognition that it is safe for use for most younger midlife women, has led to an increasing number of women seeking treatment.

It is also standard of care for younger women with premature ovarian insufficiency (POI, a condition where a women’s ovaries stop working before they’re 40) and early menopause, and for transgender women seeking gender-affirming hormone treatment.

In New Zealand, demand for estradiol patches has tripled in three years, with nearly five million patches dispensed annually. However, global supply shortages since the Covid-19 pandemic have meant that women are unable to access their preferred brand(s).

Some have had a suboptimal experience of Mylan, citing poor adhesion, skin irritation, and less effective symptom management. Pharmac has stated that only a quarter of oestradiol users use the Mylan patch. The recent funding of oestrogen gel has been a positive step toward providing more transdermal MHT options in New Zealand, but it may not be an appropriate or effective treatment for all women.

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We believe some women will feel compelled to pay for an alternative brand of oestrogen patch, and this raises a significant equity issue – those who can afford it will access a better product, while others are left with a potentially inferior option.

There may be a disproportionate burden placed on those who are socially and economically vulnerable, and those receiving higher doses (thus bigger or multiple) of oestrogen patches, such as with POI and trans-women.

As women’s health specialists, we urge Pharmac to fund not fewer but more options for MHT, including transdermal oestrogen treatments, combined oestrogen/progestin preparations, non-progestin containing options such as the tissue selective oestrogen complex, and ultra-low dose vaginal oestrogen.

As women become more educated about their health, the call for better menopause care continues to grow. Supporting women’s health is not just a healthcare matter – it is an economic imperative. Optimising women’s health in midlife is critical to the workforce and economy and more so with an aging population. We urge Pharmac to prioritise the health, equity and well-being of all women affected by this decision and be more inclusive in their decision-making and consultation process.