HRT Alternatives during the Oestrogel Shortage

The current shortage of HRT products is frustrating, to say the least, and has gained national press this last week with women describing feeling stressed and anxious about their supplies running out.

Oestrogel in particular is one of our most popular HRT treatments and the manufacturer, Besins Healthcare UK, is working hard to meet the increased demand for their product (1). This increased demand is the main cause of the Oestrogel supply issues at the moment.

Some positive news for all of us is that these shortages are expected to settle down within the next few months, according to a group of HRT product manufacturers (1).

In the meantime - what can you do if your preferred treatment is unavailable?

We would not recommend you stop taking estrogen if it can be avoided. Many perimenopausal and menopausal symptoms are caused by a lack of estrogen and without treatment, you may see a return of symptoms such as sleep problems, migraines or headaches, joint stiffness and muscle aches, lowering of mood, increase in brain fog, dry or itchy skin, urinary tract infections or genital discomfort, as well as others.

In addition to a possible return of symptoms, stopping estrogen could lose you the protection that estrogen replacement gives to your future health, such as lowering your risk of cardiovascular disease, osteoporosis, dementia, depression, type 2 diabetes and bowel cancer.

Advice from experts at The Menopause Charity (2) suggests considering alternatives, as although they might not suit you as well as your usual treatment, they can be suitable for temporary use while stocks of our favourites replenish.

Dr Radhika(3) suggests considering products you have tried successfully before and although HRT tablets are less ideal treatments (see note on Bijuve below), they are still readily available.

She also notes that anxiety and frustration feed more anxiety so try to practice stress management techniques alongside such as exercise, mindfulness and talking.

How do I choose which product to change to?

The table below details the equivalent doses of estrogen across different types of product(4).

Brands for estrogen-only patches include Evorel, FemSeven and Estradot. Not all strengths are available in each brand and double-check that you are selecting an estrogen-only product (also spelt oestrogen or referred to by its drug name estradiol) and not one that also contains progesterone (norethisterone).

The gel pump is branded as Oestrogel and is available in only one concentration, the dose is measured by the number of pumps used.

Gel sachets are Sandrena, available in 0.5mg and 1mg strengths.

Estrogen spray is available as Lenzetto. Again, the dose is adjusted by varying the number of sprays used.

We are currently experiencing no issues with obtaining micronised progesterone as the product Utrogestan, and nor do we expect any.

A note on Bijuve capsules

Bijuve capsules are the first oral HRT treatment to contain a bioidentical estrogen as well as combined micronised progesterone.

If you are using continuous HRT, so estrogen and progesterone together every day, then Bijuve could also prove a good solution for you and would be our recommendation over most of the other oral preparations.

The big pro for Bijuve is that both the estrogen and the progesterone are bioidentical (also referred to as bio-equivalent). Real-world evidence, recognised by NICE and the British Menopause Society, suggests that the use of body identical hormones is associated with lower risks compared to synthetic versions. (5)(6)

In particular, the evidence base demonstrates that body-identical hormones have not been shown to increase the risk of venous thromboembolism and are safer forms of HRT with respect to the risk for breast cancer, heart disease, heart attack, and stroke. (7)(8)(9)

It is also worth mentioning that, as with all oral preparations, estrogen and progesterone are fixed doses and must only be taken once daily. Therefore with Bijuve, being able to adjust your estrogen dose independent of the progesterone is not so straightforward.

As always, we are working hard to get stock updates ourselves and are happy to answer any questions or provide advice as needed.

References:

1. British Menopause Society update on HRT supply. British Menopause Society.
2. The Menopause Charity. The Menopause Charity.
3. The Menopause Charity - HRT Shortages. The Menopause Charity.
4. HRT preparations and equivalent alternatives. British Menopause Society.
5. Menopause: diagnosis and management. NICE guideline [NG23].
6. Climént-Palmer M, Spiegelhalter D. Hormone replacement therapy and the risk of breast cancer: How much should women worry about it? Post Reprod Health. 2019;25(4):175-178.
7. Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med. 2009;121(1):73-85.
8. Mirkin S. Evidence on the use of progesterone in menopausal hormone therapy. Climacteric. 2018;21(4):346-354.
9. Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103-111.

Related articles

• Menopause - the taboo word
• World Menopause Day and HRT update
• HRT Guide
• HRT What Are My Options?