Why are Estrogen patches in short supply? Who should consider hormone therapy? HealthDay speaks with Dr. Stephanie Faubion, Director of the Mayo Clinic Center for Women’s Health and Medical Director for The Menopause Society.
Andy Meyers, CEO, HealthDay
According to recent reports, there have been shortages of supply of hormone replacement therapies. The shortage appears to be particularly acute for estrogen patches.
Today, we are happy to be joined by Dr. Stephanie Fabian, the director of the Mayo Clinic Center for Women's Health and the medical director for The Menopause Society.
Thanks so much for joining us today.
Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director for The Menopause Society
Delighted to be here. Thanks for having me.
Andy Meyers, CEO, HealthDay
So, we're hearing about some shortages for common HRT. Tell me, you're definitely on the front lines of this. Are you hearing some instances and some talk about this?
Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director for The Menopause Society
We are hearing some, although I have to say it's sporadic and it's some doses and not other doses.
So, it's patchy. It can be a little hit or miss. And usually if we rewrite the prescription, if they couldn't get the once a week patch, we do the twice a week patch or we get to the dose a little bit in a different way by either doing two lower dose patches together.
So, usually we can cobble it together. But I think this is sort of occurring because we have more women asking about hormone therapy than have in the past.
We don't have data yet that more women are actually using it yet. And I'll tell you a preview for an abstract that we published over a year ago now, but the paper is about to come out, that says that hormone therapy usage rates in this country are still at an all-time low at 1.7%.
That was as of the end of 2023. So, we don't have data over the last year, two years to say that there's been an uptick, but it appears to be the case.
But we know that that hormone therapy usage rates were really, really very low.
Andy Meyers, CEO, HealthDay
Interesting. So, some people have said that this recent uptick in use or shortage, however you want to look at it, is a result of the FDA requiring makers to change the labeling on the hormone replacement therapy packaging. Do you think that there's any truth to that? Or do you think there are some other important factors that are really driving this?
Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director for The Menopause Society
I'm not sure that I could pin it to that specifically. Although that may have contributed to more women using hormone therapy, most of the women who are in my office really have no idea that any boxed warning has been removed. So, I think it's more than that.
I think it's that women and clinicians and people in general are talking about menopause much more so now than in the past, which is a good thing.
And so, I think women are starting to ask questions about, well, are all these symptoms related and are there any treatments and what about hormone therapy and can I be using it? Is it safe for me?
So, I think there's a lot more discussion around menopause in general.
This is a different generation than the baby boomers who really didn't talk about things like menopause in public.
So, we have a different generation, the Gen Xers and the first of the millennials are now in the age range where they would start to experience symptoms. And hearing that there's nothing that can be done for their symptoms is not acceptable to this generation and you got to love it.
So, they're not only asking for answers, they're crowdsourcing answers and using social media to do so.
They're educated. A lot of them have money and their own jobs and they have a need that has not been fulfilled. And so that sucking sound, that vacuum has created an industry around menopause now, which did not exist before.
Andy Meyers, CEO, HealthDay
So, I'd like to step back for just a second and kind of talk about what your feeling is on people's perception about the safety of hormone replacement.
Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director for The Menopause Society
So, backing up, we don't call it hormone replacement therapy anymore. We call it hormone therapy.
And the reason for that, we don't use the replacement part because we're not actually trying to replace what the ovaries used to make premenopausally.
We are trying to manage symptoms and the dose required to manage symptoms is way lower than the dose that would be required to fully replace the ovary if the ovary wasn't there or wasn't working.
So, the Women's Health Initiative, very important key study. The initial results were published July 9th, 2002, which anyone in the menopause world remembers the date that it actually came out because it was such an impactful thing. And it was also reported in a way that was very scary.
And they said, you know what, hormone therapy is not as safe as we thought. And it not only does not prevent chronic disease, it can actually increase the risk of cardiovascular disease. So heart attacks, stroke, blood clot, et cetera. There was a secondary outcome of breast cancer that also was increased in that group. Now, all of these risks were relatively very, quite rare in younger women.
Eventually they broke down the data by age… and what we ended up finding out is for those women in their 50s… hormone therapy was actually pretty safe. And for those women, the risk of heart attack and stroke is quite rare anyway, because these are younger women.
Now, does this mean that all women should be on hormone therapy? Absolutely not. It does not. And I just want to make that clear.
Andy Meyers, CEO, HealthDay
Because one of the things that we're always most concerned about is delivering news you can use, what are the factors that. for women, should either trigger using it or not using it?
Stephanie Faubion, MD, MBA, Director of the Mayo Clinic Center for Women’s Health; Medical Director for The Menopause Society
Yeah, so let's break that into who should take it and who should not take it.
If you're younger than 60 or within 10 years of menopause onset and having bothersome symptoms like hot flashes, nights, sweat, sleep disturbances, mood disturbances, all the things that are really impacting your life. Not just a little bit, but having an impact to where you say, yes, I would do something about these if I could. That would be the woman that we would want to talk about.
The other thing that we look at when you're in the office is what is your risk for heart disease? We look at cardiovascular risk factors. If you have, for example, diabetes or high blood pressure, it doesn't mean that you're not a candidate for hormone therapy, but it might affect the type of hormone therapy and the route of delivery that we give to you.
Contraindication, so who should not take it? Women with a history of breast cancer, women with a history of heart attack, a history of stroke, a history of blood clot, severe liver disease.
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