Increased awareness of menopause hormone therapy (MHT) benefits has driven a surge in demand, leading to supply shortages. New Zealand's drug-funding agency Pharmac temporarily rationed supplies.
Most women are prescribed body-identical hormones, including transdermal estradiol (patch or gel) and progesterone capsules. Estrogen relieves symptoms; progesterone protects the uterine lining and may aid sleep.
Two main drivers: greater confidence in MHT following reassuring long-term data from the Women's Health Initiative (WHI) trial and other studies; and more open dialogue about menopause. Midlife women are more aware of therapies and their bone health benefits.
Changes in MHT over time
The initial WHI trial (2002) found increased risks of breast cancer, stroke, and blood clots with combination therapy, reducing MHT use. Long-term follow-up (18-year data) found no difference in overall mortality between women taking five years of MHT versus placebo. Studies of transdermal estrogen found little to no association with stroke and blood clots.
Current recommendations: use dose required for full symptom relief; duration personalized; decision to continue or stop made annually. MHT is now considered a first-line therapy to prevent menopause-related bone loss.
Improving menopause care
Prescriptions dropped after the 2002 trial, leading to a gap in training. Some doctors lack experience in menopause management. Four out of ten UK medical schools lack mandatory menopause education; a US survey found most obstetrics and gynecology programs lack menopause modules.
In New Zealand, a short online training course on menopause care for nurses, nurse practitioners, and doctors has been developed, along with new content for medical students. Advocacy for more funded MHT options is ongoing.
Research gaps
Up-to-date data on who uses MHT in New Zealand, what women want from health practitioners, and how symptoms affect families, workplaces, and communities is lacking. Most studies include women already in menopause (12+ months without menstruation); no long-term, high-quality trials focus on perimenopause or contemporary MHT regimens (estrogen patches and progesterone capsules affected by shortages). Counseling relies on older studies of outdated therapies in demographics not reflecting New Zealand's population.
New Zealand's women's health strategy (2023) prioritizes better support for menopause, but women continue to report being dismissed by practitioners.