“Decades of conflicting information and debate on the risks versus benefits of menopausal hormone therapies (MHTs) have negatively affected women’s beliefs,prescriber attitudes,and prescribing practices,ultimately leading to the underuse of these treatments even when considered appropriate or beneficial,” the Society of Hospital Pharmacists said.
The Royal Australian College of GPs pointed to research from 2021 that found healthcare providers were unsure about how to manage menopause and that hormone therapy was prescribed only to women with severe symptoms.
“Another barrier to providing appropriate medication management is that Australia has a problem with MHT supply and cost. Australia can have shortages of MHT preparations due to manufacturing and shipping delays. Many MHT products are not available on the Pharmaceutical Benefits Scheme (PBS) making them costly for some patients.”
A submission from the Royal Women’s Hospital agreed,and said hormone therapy was the most effective treatment for many symptoms. “The cost of MHT can be prohibitive for some people and presents a potential equity issue,” it said.
“In Australia,Pharmaceutical Benefits Scheme-listed products (such as Estalis Conti) cost around $25 per month but widely prescribed non-PBS items,such as Estrogel Pro,cost over $50 month.”
Supply issues were also a recurring problem the government needed to deal with. However,the hospital warned that pharmaceutical companies,and some clinicians who worked with them,had a financial interest in pushing hormone treatments to more women.
Loading
“It can also be difficult for clinicians and consumers to know whether the content of ‘educational’ webinars,conferences and videos about MHT are sponsored by pharma,” it said.
The women’s health research program at Monash University added to the voices saying menopause management in Australia is poor,with GPs and gynaecologists lacking confidence.
“Pharmacists and GPs often recommend complementary therapies known to be ineffective before prescribing menopausal hormone therapy,” it said in a submission.
It said women were consuming vast quantities of therapies that were known to be ineffective but promoted on social media,while hormone therapies were not consistently or appropriately prescribed.
“While some women are being inappropriately denied therapy,others are being treated with excessive doses that lack established safety,or compounded hormones that are not[Therapeutic Goods Administration]-approved.”
Loading
Pharmaceutical company Bayer said most accessible hormone therapies in Australia were older medicines that had been on the PBS for more than 15 years. Only seven PBS submissions for women’s health products were considered between March 2018 and November 2023,it said,and none was specifically for menopause.
Bayer said few pharmaceutical companies applied to the PBS because the way the scheme worked meant their products were assessed against older,cheaper medicines,and they did not meet the scheme’s cost-effectiveness test in comparison –a similar issue to that which exists for the contraceptive pill and which means newer and more innovative medicines for women are often not subsidised.
The Society of Hospital Pharmacists said most oral hormone therapies were not subsidised in Australia after 2009,meaning women need private prescriptions and pay full-price,“creating further inequities in medicines access,especially for women who are already disadvantaged”.
“The current low number of subsidised treatments under PBS also forces clinicians to rely on off-label prescribing,” it said. This restricted treatment options for doctors,reduced their confidence,led to higher out-of-pocket costs for patients,and disincentivised pharmacies to carry stock – all combining to reinforce the reduced use of hormone therapies in Australia.
Cut through the noise of federal politics with news,views and expert analysis.Subscribers can sign up to our weekly Inside Politics newsletter.