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Menopause

HRT crisis: What the shortages mean for thousands of women in the UK

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HRT shortages have caused a rising panic among the one million women in the UK who use the treatment to manage perimenopause symptoms 

Demand for HRT – hormone replacement therapy – has gone up by 30 per cent over the past five years due to the increased awareness through mainstream media, better education and GP confidence in prescribing treatments.

However, the recent shortages are extremely worrying for many women dealing with perimenopause and menopause symptoms.

Dr Nicky Keay, member of the British Menopause Society and chief medical officer at the hormone testing company Forth, says that as concerning as it is, shortage of hormone replacement therapy is not a new problem.

“Supply issues have not been resolved since the last shortage a few years ago. HRT is a prescribed medication that in common with many medications required to maintain long term health and therefore, needs to be taken continuously.”

Due to shortages, women are advised to switch to different alternatives. However, Keay warns that there is a downside to this.

“Consistency is important with HRT and every woman has her own unique hormone orchestra,” she explains. “They often spend time working with their prescriber to personalise the type and dose of HRT.

“It is recommended that women are given a three-month supply max to combat supply issues, which is already a common process. So, I would highly recommend women taking HRT to get a prepaid NHS prescription.”

Menopause campaigners have also warned of a further surge in demand for already stretched HRT supplies as a result of Davina McCall’s Channel 4 documentary on menopause.

Department of Health and Social Care (DHSC) ministers hope that the lessons learnt from supplying millions of coronavirus vaccines rapidly throughout the UK will be soon applied to HRT product shortages.

Despite the rising awareness of perimenopause and menopause leading to more women being prescribed HRT, Keay says that there is still a black hole when it comes to hormone testing and understanding the importance of HRT.

Along with Forth’s female founder, Sarah Bolt, Dr Keay started developing a female hormone test called MyFORM that combines blood analysis with mathematically modelling and clinical expertise to map a woman’s hormones across her entire cycle.

“A product like this will allow women to visually see how their hormones are fluctuating and allow them to understand why they might be experiencing certain knock-on effects on the journey to perimenopause and menopause,” Dr Nicky Keay points out.

During perimenopause, oestrogen and progesterone levels decline as the ovaries become less responsive to the control hormones which rise to trigger a response from the ovaries. Helping women gain a deeper understanding of their hormones will help them make more informed decisions around treatment and HRT.

For more information, visit forthwithlife.co.uk.

News

Non-hormonal therapy shows menopause promise

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A non-hormonal therapy restored vaginal tissue in an animal study, suggesting a possible new treatment for menopause-related GSM.

Genitourinary syndrome of menopause, or GSM, is a chronic condition caused by falling oestrogen levels.

It affects the vulva, vagina and urinary tract, causing symptoms including vaginal dryness, painful sex and recurring vaginal or urinary tract infections.

Steve Nordeen, the study’s senior author and professor emeritus in the department of pathology at the CU Anschutz School of Medicine, said: “For too many women, the current options are either products that only provide temporary relief or hormone-based treatments they may not feel comfortable using.

“Our goal was to develop a therapy that addresses the underlying cause of the vaginal changes that follow menopause, not just the symptoms, without relying on steroid hormones.

“While more research is needed, these findings suggest we may have a promising new approach.”

Researchers at the University of Colorado Anschutz developed the treatment to restore oestrogen signalling only within vaginal tissue, without exposing the rest of the body to the hormone.

In a preclinical animal study, the therapy restored vaginal tissue structure and function lost through oestrogen deficiency.

The results suggest it could address the underlying cause of GSM rather than offer only temporary relief from symptoms.

An estimated 50 to 70 per cent of women experiencing natural or medically induced menopause develop one or more symptoms of GSM.

Women may have to choose between living with painful symptoms, using over-the-counter products with limited effectiveness or taking hormone-based treatments that replace oestrogen.

Some women cannot or choose not to use hormone therapy because of concerns about potential risks. This is particularly relevant to those with a history of breast cancer or an increased risk of hormone-sensitive cancers.

The researchers synthesised a novel non-steroidal oestrogen-signalling molecule called 3-fluoro 6,4′-dihydroxyflavone, or 3F.

Delivered as a vaginal suppository, the therapy regenerated the vaginal epithelium in a preclinical model of menopause. The epithelium is the layer of cells lining the vagina.

Researchers found no evidence of systemic oestrogenic activity, meaning the treatment did not appear to trigger oestrogen responses elsewhere in the body.

The team is seeking support to move the treatment into human clinical trials.

Nordeen said: “Our findings suggest the prospect of a safer and more effective therapy is within reach.

“The next step is securing the support needed to move this therapy into human clinical trials so we can determine whether it offers women a new treatment option.”

The researchers said the therapy could provide a new option for millions of women with GSM if future clinical trials confirm the findings.

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Fertility

Immunotherapy may temporarily restore fertility in premature menopause

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Immunotherapy may temporarily restore fertility in women with autoimmune premature ovarian insufficiency, a pilot study suggests.

Three of the 10 women who received treatment later gave birth to healthy babies.

Premature ovarian insufficiency, or POI, affects just over three per cent of women worldwide and occurs when the ovaries stop functioning before the age of 40.

The condition significantly reduces fertility and can have several causes, including autoimmune processes and genetics.

Researchers at Karolinska Institutet examined whether immunotherapy could make the ovaries temporarily responsive to hormonal stimulation in women with POI caused by autoimmunity.

The study included 12 women aged between 18 and 35 with autoimmune POI.

Two withdrew before treatment began. The remaining 10 underwent ovarian hormone stimulation before receiving rituximab and again four to six months after treatment.

Rituximab is an approved and well-established medicine used to treat several autoimmune conditions and cancers.

None of the women responded to ovarian stimulation before receiving the drug.

After treatment, six developed follicles that made it possible to retrieve eggs in response to ovarian stimulation.

Follicles are small sacs within the ovaries where eggs develop.

Professor Angelica Lindén Hirschberg, the study’s first author and a professor at Karolinska Institutet’s Department of Women’s and Children’s Health, said: “The results show that in some women there remains an egg reserve that can be activated when the autoimmune process is suppressed.”

In five women, mature eggs could be frozen or fertilised.

Three later had embryos transferred and all three gave birth to healthy babies.

For safety reasons, the embryo transfers took place no earlier than one year after treatment.

One serious side effect was reported and was linked to the hormone stimulation rather than the immunotherapy.

Women with autoimmune POI commonly have other autoimmune diseases.

All six women who responded to the treatment also had autoimmune Addison’s disease, a condition in which the immune system destroys the adrenal glands.

The study was a proof-of-concept investigation without a control group and involved a small number of participants, meaning the findings must be interpreted cautiously.

A proof-of-concept study is an early investigation designed to assess whether an approach could work before it is tested more widely.

Professor Lindén Hirschberg said: “This is a first step. To determine whether the method is effective and safe, larger, randomised studies are required.”

The research team has launched a larger randomised study.

The work was carried out by researchers at Karolinska Institutet, Karolinska University Hospital and the University of Bergen.

It was funded by organisations including the Swedish Research Council, the Knut and Alice Wallenberg Foundation, the Novo Nordisk Foundation and Region Stockholm.

The researchers reported no conflicts of interest.

POI is also linked to long-term health risks caused by oestrogen deficiency, including osteoporosis, an increased risk of cardiovascular disease, cognitive decline and poorer mental and sexual wellbeing.

Hormone replacement therapy can relieve menopausal symptoms and reduce many of these risks, but no treatment has been reliably shown to restore fertility in women with POI.

Egg donation was previously the only option for women with the condition who wanted to become pregnant.

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Menopause

EU committee warns of women’s health ‘blind spot’

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An EU committee has backed a report warning of systemic inequalities in women’s health research, diagnosis and treatment across Europe.

The European Parliament’s Committee on Women’s Rights and Gender Equality approved the report, which was initiated by Renew Europe.

Women remain under-represented in medical research and clinical trials.

Around 72 per cent of drug trials do not provide data separated by sex and gender, while only five per cent of global research and development funding is dedicated to women’s health.

The report was led by Renew Europe rapporteur Billy Kelleher MEP of Fianna Fáil in Ireland.

It calls for greater investment in women’s health research, stronger inclusion of women in clinical trials and gender-sensitive diagnostics and treatments, particularly for endometriosis, menopause and cardiovascular disease.

Kelleher, first vice-president of Renew Europe, said: “Women’s health remains one of medicine’s biggest blind spots.

“When research, clinical trials and medical data fail to reflect women’s experiences, the result is poorer diagnosis, treatment and care.”

The report also calls for improved access to sexual and reproductive healthcare, including follow-up to the successful European Citizens’ Initiative “My Voice, My Choice”.

Its recommendations include better support for women’s physical and mental health and access to high-quality care throughout pregnancy, childbirth and the postnatal period, free from discrimination.

It also highlights additional healthcare barriers faced by LGBTQI+ people and women in marginalised communities or vulnerable situations.

Kelleher said: “This report is about closing those gaps and ensuring that women’s health is recognised as a core measure of the quality and fairness of our healthcare systems.”

By placing women’s health higher on the political agenda, the report aims to support the implementation of the EU Gender Equality Strategy and shape future European health policies.

A final vote by the European Parliament is expected in September 2026.

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