Oestrogel shortage?

[Hop243]

Hello, first post from a long time lurker! I got a prescription for oestrogel and utrogestan from my GP but the local pharmacy are saying there is a national shortage of oestrogel. This is my first attempt at HRT so wasn't expecting that! Has anybody else been affected, I am in the south east area.

Yes, there’s a big disparity in what people are paying.

The single charge (£18….whatever 2x prescription charges are) will make a big difference. From that article I linked to, looks like it will be another year though.

If I had received a smaller prescription this time, I was going to take out a pre-payment certificate before taking it to the pharmacist to fulfill….especially if the shortages continued meaning I might need to get lots of short generic estraodiol gel prescriptions, allowing pharmacists to give me Sandrena or Oestrogel.

As it was, when I spelled out that I wanted 6 months supply and told the GP that 6 months required 8 bottles (3 pumps per day) which would be a prescription for 640g, they gave it to me.

One of the problems and reasons why people get small prescriptions sometimes or unvenlybalanced prescriptions between progesterone and oestrogen, is GPs are not familiar enough with pack size and how many doses in each ir how long one will last, given people use different amounts of pumps. They are always in a rush and in order to actually calculate how many pump dispensers to issue, need to know there are 64 pumps per bottle and that 1 pump is 0.75g. They need to know a pump dispenser will last someone using 2 pumps daily 1 month and only 2 weeks if they have 4 pumps daily.

I have found when speaking to the GP it’s best to know the exact quantities you need and to tell them those and also to ask them to confirm the quantity in the prescription.

I partly understand why they prescribe wrong quantities or get the prescriptions unbalanced so oestrogen/progesterone runs out before the other. They deal with so many drugs and actually aren’t necessarily familiar with the number of doses per pack. It’s complicated further by the fact women take different doses ranging from less than 1 pump per day to perhaps 4 (or even more) and actually sometimes vary it over time.

I had a big success yesterday in terms of asking my GP to move me to 6 monthly prescriptions, to make them on repeat and to getting 4 bottles of oestrogel within 10 minutes if having the appointment. I wrote a thread about it yesterday - about the prescribing success. But I did spend 2 hours doing legwork ahead of the GP appointment to make it happen.

JinglingBells, the article I linked to (which I think might not be fully accessible via the link…but you can Google it, which is how I found it) refers to the fact that GPs can currently give a 12 month prescription, which for the 2 HRT items would cost £18… the same as the price will be after the legal changes next April.

Of course, this is a CAN give, but I’d imagine few do and 6 months is the most available for even the more fortunate.

At my first GP appointment, the GP (a locum so I never saw them again) said that after 3 months the surgery might prescribe me 12 months. Clearly from what people say on MN, some surgeries have very specific short term prescribing policies and will only give 1 or 2 months and some won’t put HRT on repeat anymore. In other surgeries, what you get seems to vary according to which GP you speak to, and also whether they manage to do the calculation accurately of how many pump dispensers are needed for the period you want and the no of pumps per day. Lots seems to simply not do the calculation correctly, but probably aren’t attempting to withhold supplies, because they’ve often given more months of Utrogestan, where the quantities are more standardised.

Its just another inequality in the NHS for women isn’t it! Some women have a GP practice with good, knowledgeable GPs and some where the knowledge is poor and they are reluctant to prescribe. Others are willing, but for whatever reasons are prescribing such limited amounts that it becomes far more costly and also hugely inconvenient, compared to those who by nature of GP lottery, are able to get sizeable prescriptions which means the yearly cost is far less.

By receiving 8 bottles on my prescription yesterday, the cost per bottle was just over £1 each. If I’d just had 1 bottle, it would have cost me £9.35. That’s okay if over the same period you need a very limited supply, but if you’ve having to get a new prescription every 3 weeks, then 8 bottles costs 8x£9.35. How can that difference be fair or a reasonable system?

This thread has gone off on another tangent @WombatChocolate :) It was about shortages, now it's about repeats prescriptions and costs.

Personally, I feel the whole new payment system for HRT is a fairly low level appeasement move, which is trying to make women feel menopause is on the agenda, when it's not in reality as it's still a taboo topic in many situations. The number of women on HRT is about 10% and very few women will take it long term. And after age 60 it's free anyway.

I think the real issue is the way some GPs seem reluctant to prescribe it, per se, and are maybe trying to discourage women from using it by making it very hard to maintain a supply (ie issuing one month at a time.)

I went to my local Lloyd’s today and they said they are out of stock with no sign of resuppply anytime soon...no idea what to do now! Wondering if I should ask the GP for an equivalent....can I have a patch instead of 2 pumps?

Yes, I’m not so bothered about the cost (I know I’m lucky in that respect), I just would like to be able to get hold of my medication!

@MrsPuddle , I went from patches (Evorel Sequi) to the gel (because I became allergic to the patches…so I can’t go back to them unfortunately). I had the Evorel 50 patches in the pack, which is 3.2 mg estradiol/patch, and went from that on to 2 pumps of gel/day. But I was getting some hot flushes on those patches so probably would have asked for the higher strength if I’d been continuing with patches.

Clawing this discussion back to the starting point ...

I just had my review after my first 6 weeks on Sandrena and Utrogestan. I saw a different GP to the one who'd put me on it (to address the very unpleasant palpitations I've been getting for years now) and he gave me a lecture about how I'd only really be allowed to be on it for 5 years (then he said, 'five years past 50' because of the average age of menopause or somesuch. I'm 48) and that while current research supported the idea that HRT was 'the bees knees' research tended to fluctuate and was prone to trends and it would very likely paint a different picture in 5 years time, so ...

I just nodded and smiled and said VERY FIRMLY 'Well, I'll be led by the research both now and in 5 years time'.

He also suggested that while he could prescribe me something that made me 'feel better' it might not necessarily 'be better' and said he'd give me an admittedly facetious analogy of prescribing me cocaine which would make me feel wonderful but not be doing wonderful things for me. (To be fair on him, I know him fairly well and his sense of humour, he did say he was going to be a bit silly.) I said 'but HRT is taken to treat the symptoms of something, so if it makes you feel better then it's fulfilling its brief (and also it's not fucking cocaine)' and got a bit more patronising flannel.

ANYWAY, I then took what I suspected would be a fairly ornamental prescription for one month's more Sandrena (3 boxes of 28 sachets) and Utrogestan (2 boxes) and braced myself to ring round. I started with independent pharmacies and imagine my delight when only the third one I rang said 'uh.... yes! we have some of that'. They only gave me 2 of the 3 boxes of Sandrena and asked me to call again after the bank holiday, but it's something. I'd come down from my 3 sachets a day because of having to wait for this appointment and because of the shortages.

I was also told there was a shortage and my (private) gynaecologist issued me a back-up alternative prescription in case I couldn't get Oestrogel. As it happens, the third pharmacy I tried was able to order some and it only took a week to arrive. Good luck.

There's a thread in feminism that @JustineMumsnet has commented on (agreeing with) around the idea of a mn campaign about both the shortages and general state of womens health care.

This may resolve soon but I feel could easily rise again as more and more women become better informed about the safety and benefits of hrt. Davina has another programme out this week I believe for example. For the first time I'm finding colleagues are openly talking about it at work.

he gave me a lecture about how I'd only really be allowed to be on it for 5 years

He's wrong. Evidence is beginning to show that transdermal and micronised progesterone is safe longer term.

Jingling has good stats etc  I think on the bms website and I found the oestrogen matters book good for this.

@JinglingHellsBells

Jesus what a patronising twunt glom. Cocaine?! Fuck off!

Thread:

HRT - nobody gives a fuck about women www.mumsnet.com/Talk/womens_rights/4537789-hrt-nobody-gives-a-fuck-about-women

@JustineMumsnet, I mean, experiences like Glom's - you fucking what?!

@GlomOfNit Your GP's a twit.

I didn't even start HRT till almost 53.

The 5 year rule was chucked out years ago.

What's SO annoying is that experts- menopause specialists- don't spout this twaddle, as they are better informed. It's GPs who are ignorant.

Both my own meno specialist and another (who does masses of research and runs a specialist NHS meno clinic in London) have women in their 90s on HRT.

Basically, your GP has to have very sound medical reasons to stop your HRT and you have to agree with them.

The whole NICE guidance from 2015 stated that drs have to have a discussion with women and allow them to choose what they want to do, having discussed risks and benefits.

So unless you have one of the few, but serious contraindications, you do not need to stop.

Glom. I started HRT eight months ago at the age of 58. I think your GP might not be fully up to date with guidelines.

He's mostly very nice and great with our younger son, who has LDs, but this was more of what I'd come to expect from my regular GP (who is currently on leave so I've not seen her in years, and more to the point, a much younger GP at the practice actually prescribed me the stuff! )

I mentioned that I'd got a lot of my info from the 'well thought of' Menopause Matters website (because I know that invoking MN just gets eyerolls) and he said 'ah well, you have to remember they're VERY well financed by pharma companies with clear vested interests' - is this now just the standard GP stance on information obtained anywhere other than the NHS?

thanks everyone! God it's frustrating, both the attitudes and the out of dateness. For the record, unless I want to, I have absolutely no intention of stopping HRT at 5 years unless it's medically indicated.

I think I'll bookmark this thread.

I sterted the thread on feminism about this. and I am now even more fuming. GPs!! even if you only had a morning tuition on Menopause all you have to do is listen to the news to find out you are out of date.

ah well, you have to remember they're VERY well financed by pharma companies with clear vested interests

Well I do sometimes wonder that and great of you're "sailing through." At the same time there seems to be very clear evidence showing positive effects of hrt on bones and heart health plus vaginal atrophy which can have horrific effects on older women, including extra risk for falls due to urgency.

@GlomOfNit what a cheeky bugger your GP is.

It's a shame you couldn't contradict him.

Menopause Matters is run and owned by Dr Heather Currie who is an NHS gynaecologist in Scotland.

It's her business, run I think by her and her H.

BUT pharma does not as far as I know, pay for advertising on that site because all the advertising is for alternatives to HRT.

And is your GP denying that many drugs he prescribes are sold to him by pharma- like anti depressants and the like?

It's odd how gps vary if the guidelines and medical facts don't! My gp is actively offering me hrt, seemed disappointed that I didn't want to try it. I was in for a review of a different prescription.

Apparently Estrogel is in short supply around here too and so having to go to the doctors for a new prescription of spray instead of gel, just in case there is still none available when I run out in a month.

I'd be fully behind any sort of campaign. Attitudes in general towards the menopause and HRT are shocking.

Even my supposed menopause expert doctor alluded to the fact she might take me off HRT if I didn't lose weight. (I am overweight, but not in the extreme)

I promptly read up on the NICE guidelines - thanks Mumsnet! - and armed myself with a suitable response should the need ever arise.

My GP keeps banging on about the 5 yr thing too! So frustrating.
She told me that she was going to do some training in menopause & women's health the last time i saw her. Lets hope they'll cover this!! 🙈🙈🙈