"I personally can’t comprehend being without HRT. It fills me with terror."
For mum-of-one Joanne Harding, to think about life before hormone replacement therapy is almost too painful. Crippling anxiety, insomnia, joint-pain and brain fog led her into a downward spiral she feared she'd never recover from.
The Labour councillor from Urmston genuinely believed she was suffering from early on-set dementia when she started experiencing symptoms of the menopause several years ago.
Her doctor recommended she try a medication known as hormone replacement therapy (HRT), which replenishes hormones that are at a lower level when you approach the menopause. And after years of trialling different products, Joanne, who is now 55, finally feels like the woman she was before, and has been able to resume her busy life as a mum and politician.
READ MORE: Women left 'suicidal' amid supply shortage of drug used to treat menopause
But for thousands of women like Joanne, the security that comes with HRT has now been replaced with confusion and anxiety, as several forms of the medication are currently in "ridiculously" short supply.
The shortage, which has been branded 'scandalous' and a step backwards for women's health equality, has reportedly left some women feeling suicidal. Others have been driven to sharing their prescriptions with friends and family, driving hours to trade medication in car parks and buying it illegally from abroad.
Health Secretary, Sajid Javid has now been forced to implement Serious Shortage Protocols (SSPs) which means women prescribed some of the types of HRT in short supply will be limited to a three-month supply. It comes as he announced the appointment of Vaccine Taskforce Director General Madelaine McTernan - in a bid to alleviate the shortages.
Fiona McKay, an entrepreneur from Sale, went into surgical menopause seven years ago after a total abdominal hysterectomy and suffered with 160 hot flashes a day, brain fog, and anxiety. She now takes oestrogen patches, which she says she 'couldn't function' without.
Fiona still has a good supply of medication, but says the thought of being without it isn't worth thinking about. Some of her clients haven't been as lucky. The 50-year-old launched her business, the Menopause Maze, during lockdown - which aims to help working women cope with the symptoms of the menopause.
"I haven't experienced any shortages yet thank God - I can't even think about it. But I am inundated with comments and experiences from women sharing their horror stories with me all over the UK," she said.
"Women are literally driving for hours trying to find a chemist. They are driving for hours to give their last pack or pump to their sisters or friends. It's just horrific. One woman messaged me on Facebook saying she was on the last pump of Oestrogel and doesn’t know what she is going to do - and she is a headteacher."
For women like Joanne and Fiona, the prospect of managing their busy jobs and personal lives without HRT is something that fills them with complete dread. Joanne recalls a total feeling of disengagement before she was prescribed the life-changing medication.
"The main thing for me was just that I had no interest in life. I was very demotivated and completely disengaged," she said. "I've always been a confident person but my confidence was at an all time low. I just didn't want to be around other people - I was quite miserable really.
"I am incredibly concerned about the shortages because you don't just take a tablet and it becomes a magic bullet. I had to take three different types of HRT and it's taken me several years to get the dose right. The terror I feel about going back to those symptoms - that is enough to trigger my anxiety. I don't want to go back to the way I was living then."
For women like Fiona, who have had a surgical menopause, taking hormone replacement therapy is essential to protecting her body. She compares the situation to someone who has had their kidney removed being left without their medication.
"If you'd had a kidney removed you'd need medication to stay alive and to live normally. I've had my major oestrogen producing organs removed so I need that treatment," she said.
"I have had to deal with the challenges of the menopause seven or eight years ahead of my peer group which has been challenging as well. As a female entrepreneur you've got to get back to business and back to business very quickly. The majority of the clients I had were very senior male CEOs. The last thing I could do was go in and say, actually I'm managing the symptoms of the menopause as well. That's why HRT is so important.
"I think this scenario we are in is fundamentally scandalous and goes to the very heart of the gender health gap and women being treated as less than. The consequences shouldn't be left in the women’s hands."
Dr Siobhan Brennan has felt the strain of HRT shortages on both a professional level as a GP in Marple, and on a personal level, as someone who also went into surgical menopause several years early.
The 52-year-old says she is increasingly concerned that women who haven't been able to get their normal HRT prescriptions are turning to drastic measures, such as swapping medication and purchasing it from unregulated websites.
"With the oestrogen gels and sprays, which are often the safest for some patients, the availability is so variable and so low. There are ridiculous shortages of both the gel and the spray at the moment which is causing extreme difficulty," she said.
"Patients are prescribed HRT on a regular basis and when there is no supply of what they would use normally it's a logistical nightmare. The worry always is if some women can't get their HRT they will look online and try to source it from providers who might not have their best interest at heart - it's a real worry."
Dr Brennan says there have always been issues with the supply of hormone replacement therapy, with known shortages of the medication in the immediate aftermath of Brexit. But the doctor says she's never seen shortages as "extreme" as they are currently.
Ministers have blamed an uptake in the demand for HRT in the last few years, coupled with Covid-related global supply problems for the shortages. But Labour MP Carolyn Harris, who co-chairs the UK menopause taskforce, said the Department of Health has to take responsibility.
"There doesn't seem to be any end date to this problem either which makes it very difficult and certainly must be adding to pharmacies workload as well," said Dr Brennan.
She says she hasn't run out of any medication yet, but "dreads" the day that she does. She had her ovaries removed at a young age after being diagnosed with endometriosis - which triggered the menopause in her early 30s - much earlier than normal.
"There will be a lot of women who have had surgical menopause after having organs removed at a young age who really need to be on this medication," she said. "I'm one of those patients and I have to be on HRT in terms of protecting my bones.
"Touch wood I've been able to swap to different preparations and I've not run out of anything yet but I dread the day that I do. I can understand that there has been a spike in usage of HRT but to be honest that's a good thing. What's frustrating is that the supply has not caught up."
Thorrun Govind is a pharmacist in Manchester and chair of the Royal Pharmaceutical Society UK. She says the shortage of hormone replacement therapy is a "difficulty" she and her colleagues are encountering on a "daily basis." She says she's been left concerned by reports of women swapping their medication with each other, and is encouraging women to come in and have a conversation with their local pharmacist.
"These shortages have been going on for quite a while. We are advising women to speak to their local pharmacy team and to make sure they are given an appropriate alternative," she said.
"It is about working together as a team because this is a difficult one for all concerned and we want to make sure women get the medication they need. We have got pharmacies which are finding it really hard. We have no control over the supply but some of the anger is definitely being directed towards staff."
The Health Secretary has now set up a HRT Supply Taskforce with the aim of applying lessons learned during the Covid vaccination programme to identify ways to support the HRT supply chain for both long and short term demand. Serious Shortage Protocols (SSPs) will limit the dispensing of Oestrogel, Ovestin cream and Premique Low Dose to three months’ supply per person to "even out" the distribution.
"I want to reassure women I have listened to their concerns and will not hesitate to take decisive action to ensure they can access the HRT they need," he said. "We will leave no stone unturned in our national mission to boost supply of HRT – and this next step will ensure women across the UK will be able to reliably access this vital medication and maintain this lifeline for millions who need it."
Minister for Women’s Health Maria Caulfield said: "HRT can be a lifeline for menopausal women, so it’s understandable women may find reports of shortages distressing. I want to reassure women HRT remains available and I’d urge any woman who is concerned to speak to her GP.
"There are over 70 HRT products available in the UK, most of which remain in good supply, however we are aware of some issues with women being unable to access certain products. The Secretary of State and I want more women to be able to access HRT and to make sure the supply chain can cope with any future rises in demand so we will be appointing a new HRT supply chairperson, and convening an urgent meeting of suppliers to look at ways we can work together to improve supply."
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