HRT access drops after a decade of bad publicity

ACCESS to subsidised HRT has contracted in Australia, while the evidence base detailing its optimal use has grown, the Australasian Menopause Society (AMS) says.

AMS president Dr Jane Elliott says the therapy remained the most effective treatment for symptoms of menopause, and yet it had faced “10 years of adverse publicity” in the mainstream media.

Dr Elliott and another 11 current and past AMS presidents have signed a letter to the federal government and TGA complaining of a drop in PBS-funded HRT options and calling for regulatory reform.

Drug companies were quitting the sector, according to the letter which also lists five HRT medicines  withdrawn in Australia but still available in other countries.

“Through review of evidence and research we’re getting a more balanced view of HRT and as we’re doing that we’re finding that the options for choice have gone down,” Dr Elliott, an Adelaide-based GP, told MO.

“HRT is not ‘one size fits all’ … tailoring is important so it’s about choosing the right dose, the right delivery system.

“And at a time when we’re trying to tailor it, and women are wanting to consider HRT, the options that we have got have decreased and the low dose formulations on the PBS have decreased.”

Menopause guidelines state women should be initiated on low-dose HRT but there was no low-dose continuous HRT on the PBS, Dr Elliott said.

“Women can access this privately but not everyone can afford a private prescription,” she said.

The letter also cautioned the drop-off in subsidised options was resulting in some patients opting for untested alternative medicines.

Black box warnings on HRT packaging – ordered by the TGA in 2002 – were based on US data that, on later re-analysis, showed no extra cardiac risk in women aged in their 50s, the experts say.

“We want to work with government and try to make the guidelines and the availability more appropriate,” Dr Elliott said.