There are women who have been visiting pharmacies for months, calling other cities and even going to Portugal to get a medication that until recently they picked up normally at their neighborhood pharmacy. Women who had managed to control their symptoms, regain sleep and feel well again, and who now wait to see if they will be able to continue their treatment. How is it possible that in the 21st century a woman has to leave Spain to get the hormonal treatment prescribed by her doctor?
This seems from another time. During menopause, the ovaries progressively stop producing estrogens, hormones that are involved in numerous body functions. Its decrease can cause hot flashes, sleep disturbances, vaginal dryness and other symptoms, in addition to accelerating the loss of bone mass. Hormone therapy can provide estrogen to alleviate many of these problems and, in women who retain the uterus, systemic treatment with estrogen is usually accompanied by progesterone or a progestin to protect the endometrium. They are treatments that considerably improve the quality of life of women.
The problems began with Lenzetto, an estradiol spray used in hormone therapy and the only one of its kind marketed in Spain. The first incidents were reported in February and in March the supply problem was already evident. Then came the domino effect: demand for other forms of estradiol, such as patches and gels, increased, and new shortages began to appear. Added to this are problems with certain presentations of progesterone.
What seemed like a specific absence has been complicating the treatments of many patients for months. The explanations for these shortages point to manufacturing problems and an increase in demand. But there is another issue: the price of medicines. In Spain they are, in many cases, cheaper than in other European countries, and free trade allows them, under certain conditions, to be sold in markets where they fetch higher prices.
Symptoms return
And we are not talking about a problem exclusive to hormones: in pharmacies we have been seeing for some time how it is becoming more and more difficult to obtain certain medications. The consequences of all this are women who have been stable with their treatment for a long time and who now need to change it. Some have hot flashes again, sleep worse, or feel like they are going backwards after having managed to feel better. Others do not tolerate the alternative that has been prescribed to them in the same way.
And I also see women who had endured symptoms for years because they thought it was normal or because they were afraid of hormones. When they finally decide to consult, it turns out that getting treatment becomes another problem. For years, menopausal hormone therapy was surrounded by fear and misinformation. Many women rejected these treatments and many professionals were reluctant to prescribe them, even when they could be beneficial.
Today, thanks to better interpretation of scientific evidence and more individualized care, more and more women know their options. And precisely now, when we are advancing in information and access to adequate care, we find ourselves with difficulties in obtaining medications.
This crisis does not only affect women with natural menopause. There are also women with premature ovarian failure, those who have suffered surgical menopause and those who need hormonal treatment after certain medical processes. For some of them, hormone replacement is especially important to protect their long-term health.
Problems for trans women
Also affected are trans women who use estradiol in their gender affirmation treatments and patients who need certain hormonal preparations during assisted reproduction processes. Faced with this scenario, Catalonia has proposed resorting to master formulation as a possible alternative in the absence of certain commercial presentations.
As a pharmacist, I consider that it is an option that deserves to be studied, but I also defend something else: when a compounded formula replaces a funded medicine that is not available, it should still be funded. We cannot pass on to patients the cost of a solution they need due to a supply problem beyond their control.
