Please sign and share this petition asking Pharmac to expedite its funding process for estrogen gel to provide more options for New Zealand women taking HRT (hormone replacement therapy).

Dr Linda Dear, Émilie Joyal and Kiri Turketo have created this petition on behalf of all women of Aotearoa.

Menopause is an inevitable phase in every woman’s life.

By 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion (1)

Most menopausal and perimenopausal women will experience symptoms. Some have symptoms so severe they negatively impact their physical health, mental well-being, relationships and careers (2)

Hormone replacement therapy (HRT) (also known as Menopausal hormone therapy - MHT) is a highly effective treatment for all menopausal symptoms. When started before the age of 60, it also reduces the risk of heart disease, osteoporosis and leads to a longer lifespan (3).

HRT is therefore a key aspect for the health and quality of life for many women, particularly those who are plunged into an early or sudden menopause through surgery or medical treatments. 

Estrogen is one of the main hormones used in HRT.

The safest way to take estrogen is through the skin (the ‘transdermal’ route) rather than taking it as an oral tablet (4)*

Here in New Zealand, only one type of transdermal estrogen (in the form of patches) is currently funded. 

Other countries have the additional option of transdermal estrogen in a gel form (in products called Sandrena and Estrogel). 

However, these gels are not yet licensed or funded here in New Zealand.

We need better access and funding options for these alternative transdermal estrogen products for several reasons:

1.    Some women do not absorb the patches properly, often because they do not stick well on their skin. A patch must stay in full contact with the skin for at least 3 and a half days to achieve the aim of delivering a stable and sufficient estrogen dose.

2.    There are women who are allergic to the adhesive used in the patches and get skin reactions. 

3.    There are often worldwide shortages with the supply of estrogen patches meaning patients can struggle to obtain them. Many woman are having to attend multiple pharmacies to try and source them, or cut-up patches to achieve their required dosage. Other women are unable to access any patches whatsoever. If oral estrogen is not a safe option for them, these women end up having to stop their MHT altogether and suffer a return of their often debilitating symptoms. Patch shortages are not only causing huge anxiety for women, they are also placing additional workload stress on pharmacists and prescribing doctors. 

Unlike in other countries, New Zealand women have no funded access to any other type of transdermal estrogen. 

For many, the option of self-funding a gel is not affordable and this creates health inequity. 

Even if self-funded, estrogen gels remain difficult to access as they are not licensed in New Zealand and are therefore considered ‘unapproved’ medications and only available for doctors to prescribe under section 29** (5)

New Zealand is lagging behind other developed countries, where these alternative transdermal estrogen options are readily available.

MARCH 2024 UPDATE TO ORIGINAL PETITION:

On 15th August 2023, Pharmac issued a Future Procurement Opportunity for transdermal estrogen products, which is an early stage in the funding process (6)

However, these processes can take time. It took a total of 10 years for Pharmac to fund body-identical micronised progesterone for HRT (7)

This petition is therefore urging Pharmac to avoid another decade of delay and expedite the funding process to give all New Zealand women equitable access to more transdermal estrogen options.  

 

(1)  https://pubmed.ncbi.nlm.nih.gov/8735350/

(2)  https://pubmed.ncbi.nlm.nih.gov/24083674/

(3)  https://pubmed.ncbi.nlm.nih.gov/35797481/

(4)  https://www.bmj.com/content/364/bmj.k4810

(5)  https://www.medsafe.govt.nz/profs/riss/unapp.asp

(6) https://pharmac.govt.nz/news-and-resources/news/2023-08-15-pharmac-indicates-interest-to-fund-more-oestradiol-treatments-to-relieve-supply-issue

(7) https://connect.pharmac.govt.nz/apptracker/s/application-public/a102P00000BPAvz/p001756

*Transdermal estrogen does not appear to carry any increased clot risk, unlike oral estrogen. It is safe for women who get migraines and contains body-identical/bio-identical estradiol. It also does not affect Sex Hormone Binding Globulin (SHBG) levels and therefore does not impact testosterone levels.

**Section 29 is a law that allows doctors here in New Zealand to prescribe medications that have not yet been given Ministerial consent and approval.