Sharp rise in HRT prescriptions

More women are accessing treatment for the menopause, data shows

The number of patients being prescribed hormone replacement therapy (HRT) in England has risen by almost a third in just a year – from 1.8 million in 2022-23 to 2.3 million in 2021-23, according to official figures from the NHS Business Services Authority.

New and existing patients are receiving an increasing number and variety of HRT items too – there were 11 million HRT items prescribed in England, a 47% increase from the previous year.

HRT is usually the first-line treatment for women, according to National Institute for Health and Care Excellence guidelines which have been in place since 2015. By replacing hormones, HRT relieves symptoms and also helps to protect a woman’s heart, bones and body.

Uptake of HRT has been rising for several years, thanks in part to increased menopause awareness and campaigns. Yet research shows that around 14% of menopausal women take HRT but, in some areas in the UK, it is as low as 2%.

In April 2023, HRT became more affordable and accessible with the introduction of the HRT pre-payment certificate (HRT PPC) – a one-off charge the equivalent of two single prescriptions (currently £19.30), which can be used without limit during the 12 months that it’s valid. The certificate includes a range of HRT prescription items, including patches, tablets and topical preparations, but it does not cover testosterone.

While the recent data, which is based on prescriptions from primary care providers in England not secondary care or private prescribers, highlights a sharp rise in HRT prescriptions, it has raised concerns that not all women have equal access to help for their menopausal symptoms. More than twice as many patients were prescribed HRT items in the least deprived areas compared to the most deprived.

There are also concerns that some women are unable to obtain their prescriptions owing to HRT shortages. Last year, the Department of Health and Social Care issued serious shortage protocols (SSP) for numerous HRT drugs – this allowed pharmacists to substitute specific HRT drugs for substitutes because of shortages in supplies. In May 2023, a restriction was placed on Utrogestan (a progesterone) because of short supply. Now, most of the 70 HRT products available in the UK are in good supply. The current serious shortage protocols covers just one HRT drug, Estradot 100mcg patches – the SSP was issued in August and has been extended until 3 November.

Balance founder, GP and Menopause Specialist Dr Louise Newson, says: ‘The fact that more women are accessing the treatment they need to manage their menopause symptoms is fantastic, and illustrates that awareness of the menopause is increasing and women are more confident in seeking help.

‘But we want to ensure that all women have equal access, whatever their income or circumstances, and that no woman experiences supply issues with the medication they rely on.’