The cost of hormone replacement therapy (HRT) prescriptions still pose a barrier for some, the APPG wrote in a report published today (October 12).

While the Department of Health and Social Care (DH) has committed to making HRT cheaper on prescription, the group criticised that this measure will not be implemented until April 2023.

“HRT is not a luxury, and it ought to be freely available for all who wish to use it,” the APPG argued, calling on the government to scrap prescription costs in England, “as is the case in Wales, Scotland and Northern Ireland”.

This should include vaginal hormonal preparations as well as systemic HRT, it added.

It separately urged the government to create a national formulary that would allow GPs and other healthcare professionals to prescribe HRT and gain “the correct understanding of the medicines available”. 

Read more: HRT supply: Are key manufacturers still experiencing stock issues?

Such a move would “improve equity of access”, the APPG stated, as patients in England currently find themselves at the mercy of a “postcode lottery” when it comes to receiving menopause care.

“There is a stark divide between those who can afford to seek treatment elsewhere, and those who cannot,” APPG chair Carolyn Harris said.

A DH spokesperson said that the department has “put women’s health at the top of the agenda”, by taking actions to boost HRT supplies and reduce the cost of these prescriptions.

“We have accepted the recommendations of the HRT supply taskforce, including the continued use of serious shortage protocols when appropriate to manage shortages and further exploration of NHS formularies,” they added.

 

Reforming menopause education

 

“We are still a long way off from ensuring all healthcare professionals have adequate menopause training,” the APPG wrote in the report.

Although it welcomed NHS England’s move to develop an awareness-raising package for healthcare professionals, including pharmacists, to ensure more women are advised to seek support earlier in their menopause, the APPG stressed this was “simply not enough”.

Read more: HRT drug Gina 10mcg available OTC in all pharmacies by end of month

“Great urgency is needed in delivering reforms to all these sections of our healthcare system, so practitioners can be educated on menopause,” the group stated.

Referring to the DH’s Women’s Health Strategy for England, the APPG said “the gap between primary and specialist services must be bridged”, particularly for patients waiting for specialist care.

Other healthcare professionals, including pharmacists, could support women through the menopause, it noted.

 

MHRA should amend HRT info

 

Lastly, the APPG claimed that the Medicines and Healthcare Products Regulatory Agency’s (MHRA) information on HRT was “currently inaccurate and misleading” and therefore “confusing for both healthcare professionals and women”.

It referred specifically to the MHRA stating that transdermal oestrogen can increase risks of clotting, and that vaginal oestrogen is linked to the risk of heart disease.

The APPG recommended that the DH work with the MHRA “to amend and update their information”. In response, the MHRA told C+D that its information on whether HRT is connected to increased risk of blood clots is “under review”.

However, it stood by its information about the risk of breast cancer increasing with the prolonged use of systemic HRT containing oestrogen only, or oestrogen with progestogen.

Overall, HRT is safe and effective for the majority of menopausal individuals, although patients with a history of breast cancer or blood clots should not use these prducts, as reflected in National Institute for Health and Care Excellence guidance and HRT product information, the MHRA spokesperson said.