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Is HRT funded in New Zealand?

Updated: 22 hours ago

There are a number of funded HRT or hormone replacement therapy options that are available in New Zealand for women experiencing perimenopause or menopause. HRT is used during perimenopause and menopause to relieve symptoms relating to fluctuating or low hormone levels.


It is the most effective treatment for menopausal symptoms and is recommended as it reduces symptoms and improves quality of life. We do need more funded options for HRT in New Zealand so that all women can access HRT treatment that works for them.


is HRT funded in New Zealand, Otepoti Integrative Health, Dr Deb Brunt

What is HRT?


HRT is hormone replacement therapy, and is also called MHT or menopause hormone therapy in New Zealand. HRT is a prescription medication containing some of the reproductive hormones.


It is used to relieve symptoms caused by low or fluctuating estrogen levels that occurs in perimenopause and menopause.


During perimenopause your hormones are topped up with body identical hormones or synthetic hormones to reduce perimenopausal symptoms.


During menopause your hormones are replaced as ovarian function is now minimal. The hormones however do not reach the same levels they did premenopause.


Depending on your needs, HRT can be prescribed as estrogen alone therapy (in those who have no uterus/womb), combined estrogen and progesterone therapy (in women with a uterus) and, in some situations testosterone is also prescribed.


It is important to fund more types of HRT to ensure equitable access to these important medications.


Common Menopause Symptoms


HRT is a common treatment for the various symptoms faced by women during menopause, such as night sweats, poor sleep quality, vaginal dryness, itchy skin, mood swings, anxiety, depression, poor memory and weight gain. HRT has been proven to help 95% of women with these symptoms.



What are the benefits of HRT?


There are many benefits of HRT and they include:

  1. Reduced symptoms of menopause, such as hot flashes, night sweats, and mood swings

  2. Increased quality of life

  3. Reduced risk of osteoporosis and fractures

  4. Reduced risk of heart disease

  5. Improved sleep, circadian rhythm and energy

  6. Potential benefits of estradiol for cognition and memory


What are the current New Zealand menopause guidelines for hormone replacement therapy?


HRT is be accessible in primary care, and can be prescribed by your GP.


New Zealand menopause guidelines for HRT recommend it's use for menopausal symptoms as it is the most effective treatment for the vasomotor symptoms and urogenital atrophy associated with menopause.


It also refers to international consensus based on the totality of evidence around hormone replacement therapy that;


"the benefits of menopause hormone therapy are likely to outweigh the risks in most women with menopause symptoms affecting their quality of life if they are started aged < 60 years or within ten years of menopause."

It also states that menopause hormone therapy should be initiated in women who experience symptoms that affect their quality of life.


How does funding for HRT work in New Zealand?


A number of types and brands of HRT are funded by the New Zealand government through PHARMAC (Pharmaceutical Management Agency of New Zealand).


Your doctor can prescribe HRT according to your perimenopause or menopausal symptoms, contraceptive needs and risk factors. Because HRT is a prescription medicine it has to be prescribed by a doctor or nurse practitioner in primary health care.


Your pharmacist will dispense your HRT and from 1 July 2023 most forms of HRT do not have a dispensing cost if they are prescribed by your GP, but will have a small charge if prescribed by a menopause or other specialist.


Some HRT products may not be funded in New Zealand, or may only be partially funded. One example is testosterone cream formulated for use in post-menopausal women with low sexual desire. It has to be fully self-funded and is available via section 29. Some HRT products are only available under a section 29. This means a doctor can prescribe the type of HRT but it has not been approved by Medsafe for use in New Zealand.


It is important for women to discuss their options and preferences with a doctor before making any decisions about taking HRT.


Is Natural Hormone Therapy Funded in New Zealand?


Yes! A number of types of natural or body identical hormone therapy is funded in New Zealand

Estradiol is the main estrogen in women's bodies from puberty to menopause. It is available in:

  • patch form that is fully funded and

  • tablet form that is partially funded (Estrofem).

There are different forms of estrogen tablets that are fully funded in New Zealand.


Progesterone is a naturally derived progesterone. It is derived from plants especially yam. It's chemical structure is identical to progesterone in the body so is considered body identical.


It comes in the form of micronised progesterone in a capsule (Utrogestan) and this is fully funded in New Zealand. It also contains soy lecithin and for this reason should not be used if you have allergy or hypersensitivity to soy.


Utrogestan was recently funded by PHARMAC, widening funded access to this form of progesterone (it was previously only funded for some women with recurrent early pregnancy loss).


Is HRT funded in NZ and which types?


It can seem like a complete minefield as to work out what is funded and what is the best hormone therapy for you. The lists below outline HRT that is fully funded and accessible in primary care, partially funded hormone replacement therapies and HRT that is not funded.


Estrogen formulations


Estrogen Tablets

  • Progynova

Estrogen patches are fully funded in New Zealand and can be prescribed as a suitable alternative to tablets.

  • Estradot

  • Climara

Vaginal Oestrogen as cream/pessaries

  • Ovestin cream and pessaries


Progestin formulations (synthetic progestogens)


Tablets

  • Provera

  • Primolut N

Intrauterine Device (IUD)

  • Mirena

Natural progesterone

  • Micronised progesterone.

Selective Estrogen Receptor modulator

  • Evista (often used in estrogen +ve breast cancer)


What types of menopausal hormone therapy (MHT) are partially funded in New Zealand?


When HRT is partially funded, the price of the hormone therapy can vary between pharmacies due to their retail mark-up price. If you want the best price it is wirth enquiring at a few local pharmacies to compare prices.


The following types of HRT are partially funded in New Zealand by PHARMAC.


Combined estrogen + progestin

  • Triquestrens

  • Kliovance

  • Kliogest

Estrogen Tablet

  • Estrofem

  • Premarin


What types of HRT are NOT funded in New Zealand?


Combined HRT (estrogen + SERM = selective estrogen receptor modulator)


Female testosterone cream preparations


No female physiologial dose preparations of testosterone are approved in New Zealand so testosterone has to be prescribed under section 29 by your GP or menopause specialist.


Testogel, a testosterone gel formualted in the male physiological range, is funded and can be used for menopause as a section 29 prescription.


Oestrogen gel for menopause


Estrogen gels are applied to the skin and are absorbed systemically. Estrogen gels are not funded in New Zealand. They are available under Section 29.


PHARMAC currently has a tender out to purchase estrogen gel which is a great safe estradiol alternative for women who have allergy to adhesives in the estradiol patch of cannot use if for other reasons. Hopefully it will be not too far away when we will have access to at least 1 brand of estrogen gel in New Zealand.


Estrogen rings, pellets or implants


These are not available in New Zealand.


Tibolone


Tibolone is a reproductive-like steroid with estrogen, progesterone and weak testosterone effects. It is a form of combined HRT as it provides symptom relief for low levels of estrogen, progesterone and testosterone. It is typically used after periods have stopped as can cause irregular bleeding if used during perimenopause.


Read more about Tibolone.


How do I know if the HRT I want is funded in New Zealand?


Check if the medicine is available in Aotearoa/New Zealand. You can do this by asking your healthcare provider, or by looking online in the New Zealand Formulary (NZF).


Check the Australasian Menopause Society list of HRT available in New Zealand.


Ask your pharmacist or GP for more information.


How do I know if I need HRT and how do I get a prescription?


Hormone replacement therapy is the most effective ways to treat menopausal symptoms.


  1. Learn about perimenopause and menopause.

  2. Research the different hormone therapies available and determine which one could be the best for you.

  3. Consider the benefits and risks of the treatment, as well as any other alternative treatments.

  4. Discuss the treatment with your GP or menopause specialist and ask any questions you might have.

  5. Make a shared decision with your health provider based on your personal symptoms, risks, contraceptive needs and preferences.

  6. Start the treatment and monitor the results to ensure it is working well.

  7. If you feel the treatment is not helping or you have side effects, talk to your doctor about other options.

  8. Remember that hormone replacement therapy is only one part of a larger menopause care strategy, and it should be used in combination with healthy habits for life.


What are the side effects of HRT?


Breast Tenderness


Some women may experience breast tenderness, especially in the first month of HRT, or they may experience it cyclically if on cyclical HRT. If this persists after 1 month, you should discuss it with your doctor.


Mood swings


Hormone replacement therapy (HRT) generally reduces fluctuations in mood and anxiety due to providing more stable hormone support.

If you do have worsening mood symptoms, suicidal thoughts or plans see your doctor for urgent help.


Weight gain


Women do not generally increase weight when using HRT as it supports more stable metabolism and glucose regulation. Using HRT in combination with lifestyle changes such as an anti-inflammatory diet, sprint-interval training and muscle resistance work can improve body composition even more than HRT alone.


Irregular Bleeding

As HRT is topping up your own hormones, it impacts the endometrial lining of the uterus/womb. The dose and type of estrogen and progestogen or an imbalance between the two steroids can cause bleeding. See your health provider to discuss if you have heavy or irregular bleeding during perimenopause and if you have any bleeding once you have had menopause.



What are the actual risks of HRT?


In healthy women, the risks of using HRT are minimal.


1. Breast cancer risk


Most women are worried about breast cancer risk. There are many factors that contribute to an increased and reduced risk of breast cancer.


There is no increased risk of breast cancer in women under age 50 who take HRT for premature menopause.


23 women aged 50-59 per 1000 will develop breast cancer over a 5 year period.


Women who use estrogen-only HRT do not have an increased risk of breast cancer. Some studies such as the womens health initiative found women who use estrogen-only HRT have a reduced risk of breast cancer (ie 19 women aged 50-59 per 1000 would develop breast cancer) (Understanding the Risks of Breast Cancer)


There is a slight increase in breast cancer risk in women who used combined hormone replacement therapy (HRT), ie oral estrogen + synthetic progestin. This combination demonstrated 4 additional breast cancer cases per 1,000 women over 5 years.


Estrogen + micronised progesterone is NOT associated with an increased risk in breast cancer (Unequal Risks for Breast Cancer Associated with Different Hormone Replacement Therapies)


So in summary, wmen who use estrogen-only HRT or estrogen + natural micronised progesterone have NO increased risk in breast cancer.


2. Heart disease risk


The heart disease side effects of HRT vary depending on your age when treatment was initiated. For women aged < 60 years or fewer than 10 years since their last menstrual period, MHT reduces the risk of CHD.


Hormone replacement therapy in women when initiated before age 60 signficiantly reduces heart disease events and death from all causes (MHT & Reduction of All-Cause Mortality and Cardiovascular Disease)


For women using oral conjugated equine estrogen HRT with a synthetic progestin (medroxyprogesterone acetate -MPA) that was started > 10 years since menopause, seven additional women experienced heart attacks compared with women who did not.


We do not have data on body identical estrogen and progesterone on heart disease risk in older women.


Women who smoke have an increased risk of heart disease, one of the reasons that smoking continues to be discouraged.


Blood clot risk


The risk of developing blood clots while taking MHT increases with age and is higher for women who are obese, have severe varicose veins or have a family member who has had a blood clot.


Women who take MHT in tablet form have a small increase in the risk of blood clots in their veins. The increase in risk is between 1 and 2 per 1000 each year for women aged between 50 and 60 years.


Endometrial Cancer


There is an increased risk of cancer of the uterus in women who use estrogen only HRT and have not had a hysterectomy. So women with a uterus who want to use HRT should use combined oestrogen and progestogen HRT.


Women without a uterus can use oestrogen only therapy.


The Takeway


A number of options for menopause HRT is funded in New Zealand but there are still a number of beneficial options that remain unfunded such as estrogen gels and testosterone gels.


Hopefully over the coming years as awareness of the benefits and safety of HRT increases, there will be more unrestricted funding available for more HRT options for women in perimenopause, menopause and post-menopause to provide adequate symptom relief and improved quality of life.



Dr Deb Brunt @ Ōtepoti Integrative Health is committed to supporting perimenopausal and menopausal women's health in Dunedin, Otago and Southland. She offers in clinic appointments and telehealth appointments online throughout New Zealand.


She is a Specialist GP who practices lifestyle and integrative medicine in New Zealand and Health coaching internationally. She has a passion for supporting women's health holistically.


Schedule a free health discovery call or clinic appointment with her online.


Let's connect | Facebook and Instagram.


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