I've been on HRT for a long time, and I've marvelled at the wonderful physical enhancements it has brought. Nice skin, better hair, a younger look all over. HRT isn't so good if you are struggling with your weight, but it undeniably gives you a proper shape, and helps to keep you feeling feminine at a time of life when a lot of women have thrown in the towel where attractiveness is concerned. Not that I make any claims in the looks department, but I'd readily agree that were it not for HRT I would be, at age sixty-seven, a raddled, shapeless, odd-looking old hag. Or going that way.
My personal need for HRT is however deeper and more urgent. I take it not only to feel comfortable, but to stay in basic good health - in particular to ward off galloping osteoporosis and other serious medical issues. There's no choice about this. I can never come off HRT. I have to take it for the rest of my life.
I'm not of course the only one in this position, but I do wonder who at my local surgery - besides my usual doctor - really understands why I can't do without my twice-weekly hormone fix. I suspect I'm one of only a small handful of patients handled by the practice who need HRT for special and urgent reasons. Say a maximum of five out of several thousand. We might easily get overlooked. It's concerning.
And now there's a general shortage of HRT supplies, which I rather believe is down to the pharmaceutical companies being reluctant to maintain a sufficient level of manufacture when they can't make much money from it.
This is my regular HRT treatment: a 100mcg patch of estradiol on Tuesdays and Saturdays. It's Estradot, made by Novartis.
In February 2013 I asked my doctor what these eight-patch packs (each a four-week supply) cost the practice. She said it was about £5. Say £65 a year. That was reassuringly cheap - I didn't feel that in any way I was sucking the NHS dry by expecting free hormone therapy!
I dare say that by now, in 2019, the cost might have doubled. But even so, £10 every four weeks (or £130 a year) will scarcely be a drain on the NHS's resources. But the low cost to the practice must mean that the NHS are not paying anything like the full commercial price to the manufacturer. I rather think the commercial price - the wholesale price, anyway - is twice what the NHS pays. And the price to me, if I turned to the Internet for my own privately-funded supply, would be £36 for a four-week pack:
£36 every four weeks, if I could get it at all.
And the loss of profit to Novartis (and companies like them) - if they have a contract with the NHS to supply HRT for a lot less than £36 per pack - could well explain why they are not keen to over-produce HRT patches. The consequent lack of any big reserve leads to an easily-upset supply situation. In a nutshell: they can get a steady, large-scale order from the NHS, but can't make enough profit to make it really worthwhile.
Currently I am owed one four-week supply by Boots (the chemist I use). I've just asked my doctor to authorise another eight-week supply - the routine is to prescribe my regular medication in eight-week batches - but I expect that Boots will be unable to get hold of further patches for some time. So very soon they'll owe me three four-week supplies - twelve weeks' worth.
Well, I've got an appointment with my doctor on 30th September (soon after I return from my holiday in Wales), and we'll discuss alternative HRT medication to take until the Estradot supply problem eases.
I used Evorel patches for a short time once. I wasn't impressed with them, but they would do.
I don't mind trying gel.
I don't much want to go onto pills: when I first began HRT, the consultant told me that pills would hammer my liver, which was already having a hard time with my statin tablets. If it has to be pills, it might mean a spell of coming off statins, or not drinking alcohol. Hmm...
At the back of all this, the ongoing worry that the supply of HRT, so necessary to my continued good health, will never get back to normal. And what might happen if I can't get the HRT I need.
