Information on the HRT Shortage

We have been contacted over the past few weeks by many patients who have been impacted by the ongoing shortage of Hormone Replacement Therapy (HRT). We understand that the uncertainty has caused significant anxiety and are grateful to Dr Orna McGinn for providing the following information.

What is behind the shortage?

Several factors are involved, including worldwide increased demand and issues with the global supply chain. Shortages have affected all countries where women use HRT to alleviate the symptoms of menopause.

Why has demand for HRT increased?

Over the past 5 years, research has proven that for most women HRT is a safe and effective way to ease vasomotor symptoms (sweats, flushes) and compounding issues such as brain fog, libido decline, muscle aches and fatigue. In the long-term, HRT has beneficial effects on bone density, muscle mass and possibly brain function. We now know that most women can use HRT safely for many years – so more women are using HRT for longer periods.

What are the particular issues in New Zealand?

Between 2017 and 2022, prescriptions for HRT in New Zealand rose from approximately 1.2m per year to 3.5m. At the same time, the proportion of patches prescribed as opposed to tablets for HRT rose from 45% to 85%. Also, only a very number of options are funded by Pharmac compared with other countries. Until shortages became acute, just one brand of patches were funded (Estradot). Pharmac have now approved the funding of a second brand of Estradiol patches, Lyllana. These should also be available going forwards.

I have been advised to cut my patches in half (quarters, thirds); is this safe?

Yes, this is safe and has been a way of mitigating supply issues.

Is it dangerous to stop HRT suddenly if I run out of patches?

There are some medicines (for example medication for anxiety or depression) which we do not advise patients to stop suddenly due to withdrawal effects which can be very unpleasant. However, this is not the case with HRT. There may be a gradual (or less gradual) return in menopausal symptoms, but it is not dangerous to stop it.

I have been advised to switch to oral oestrogen tablets while patches are unavailable. Is that safe?

When advising a substitution, your doctor will first check your records to ensure that there are no reasons why you should not take oral oestrogen. This is a safe and effective option for the majority of women and was in fact the only option available funded in NZ until 2017.

Will any other formulations become available?

Pharmac issued a request for proposals from suppliers of oestradiol gel in April 2024. This suggests that the gel will be available funded at some point, but as yet we have no information. The gel is available unfunded at a cost of approximately $150/month.

And we’re excited to announce that Dr McGinn will be offering a free, evening session on menopause a bit later in the year. We’ll be sure to share all the details in our newsletter and on social media!

Why are Primary Care Prices Increasing?

From Monday, 5 August ’24, Ostend Medical Centre will be increasing fees for most patients. This doesn’t include children under 14 and patients who have Community Services Cards. In doing this, we are joining most other clinics in the country, as our sector continues to be underfunded by Health NZ. The new fee schedule will be emailed to patients this week and shared on our website and in the clinic.

Capitation is the government’s way of providing primary care with a predictable, set amount of money for each patient enrolled with them. In the last 19 out of 20 years, capitation has failed to meet inflation, a problem that is continuing to snowball this year.

While Health NZ suggested to Dr Shane Reti in January that there was a 14% capitation shortfall in 2024, only a 4% increase was announced this month. We have been told that to make up for this shortfall, we should increase our patient fees. Ostend Medical Centre joins the larger primary care community in feeling deeply distressed by this decision at a time when many of our patients are already struggling with cost-of-living increases.

You can use this QR code to email Dr Reti directly to share your disappointment in Health NZ’s decision. The code will provide you with an email template which you can send as it is or personalise to fit your concerns. For instance, you may want to remind Dr Reti that NZ government funding into primary care is already amongst the lowest in the OECD. OECD countries spend an average of 14% of their health budget on primary care, whereas in NZ it is a pitiful 5.4%, even though we know that every $1 spent in primary care saves $14 in the hospital system.

A Warm Welcome to Dr Dawn Davis!

Ostend Medical Centre and Waiheke Health Trust are thrilled to announce that GP Dr Dawn Davis will be joining the Medical Centre staff full-time in November. Dr Davis is relocating to Waiheke from the US, where she has worked as a physician in hospital, family medicine and corrections settings. She has also taught for many years at the Saint Louis University School of Medicine.

Dawn has a strong interest in minor surgery and skin clinic work and also specialises in caring for those with diabetes. In her current role, she focuses on both A&E care and supporting the medical centre’s sexual health clinic and has just completed additional training in substance abuse treatment. Dawn and her family love being in and around the water, whether it be swimming, scuba diving or stand-up paddle boarding. They also love to travel, so are very excited for their next adventure on our beautiful Waiheke Island!

And a reminder that Ostend Medical Centre is now accepting new patients, so if you’d like to join us and Dr Davis, give our friendly reception team a call on 372 5005.

Celebrating Mindfulness Month

Mindfulness techniques can be helpful in reducing worry and anxiety. To celebrate ‘Mindfulness Month’, our Health Improvement Practitioner Rozanne has provided two techniques that you can try if your mind starts racing or dwelling on anxious thoughts.

Being aware of unhelpful thoughts is the first step to managing them. To catch your anxious thinking and worrying at the earliest possible opportunity, you can try the ‘S.T.O.P‘ technique:

Stop whatever you are doing and pause momentarily. You might even see a stop sign in your mind and recognise you are taking back control of your thinking.
Take a breath and re-connect with your breath. The breath is the anchor to the present moment.
Observe and notice what is happening both inside and outside of you.
Proceed and continue what you are doing.

And if you have a bit more time, a very simple technique for mastering anxiety and worry is the 5,4,3,2,1 technique. Once you have stopped the ‘spiral’ to catastrophic thinking, simply ask yourself:

What are 5 things I can see right now (name them and give a simple description)?
What are 5 things I can hear right now (name them and give a simple description)?
What are 5 things I can feel right now (name them and give a simple description)?

There is no rush, take your time. You are bringing yourself firmly back into the here and now where you feel safe and where all is well. Once you have done a round of 5 things you can see, hear, and feel, reassess where you are at. Is there still a negative story running or any anxiety at all? If so, do another round, this time asking for 4 things you can see, hear and feel. At the end of that round, assess again and if necessary, do 3, then 2, then 1.

When to practice this?

Both these techniques work really well in the moment when you notice your mind start racing or when you feel anxiety in your body. You can also do them as a daily practice, to reset your anxious “set point’ and teach your system how to do this, so that when you need a source of calming, it is easy to drop into the routine.

And don’t forget these simple grounding techniques which Rozanne has provided previously. If you would like to book in with Rozanne for further FREE support in managing anxiety, our reception team would be happy to make an appointment for you.