One woman's menopausal tale amid Sweden's drug shortage

It's not just hot flushes. The symptoms of perimenopause and menopause range from extreme anxiety, impaired sleep, vertigo, body aches, brain fog, lowered self-esteem and self-confidence, urinary tract infections, new allergies and skin rashes, and irregular menstrual cycles.
It's not just hot flushes. The symptoms of perimenopause and menopause range from extreme anxiety, impaired sleep, vertigo, body aches, brain fog, lowered self-esteem and self-confidence, urinary tract infections, new allergies and skin rashes, and irregular menstrual cycles.

As a drug shortage bites, Donna Richmond, an immigrant to Skellefteå, shares her troubling experience navigating menopausal symptoms and a Swedish healthcare system ill-equipped to address them.

Engelska 31 januari 2024 16:10

I couldn’t quite believe what I was hearing. I asked the nurse from my local hälsocentral to repeat what she’d just said to me on the phone. She did.

– I said, don’t worry, it’s not as if it’s an important drug, such as one you’d take for high blood pressure.

I was speechless. Let me explain the situation. I’m a menopausal woman. My symptoms started in my mid-forties. The Pedro Almodovar movie ‘Women On The Edge of a Nervous Breakdown’ fits my frame of mind perfectly right now. The common tendency to dismiss menopause as a natural life event, and to urge women to simply 'get on with' and 'get through' it, has been known to anger me.

I’d finished my supply of Estradot patches, a patch that contains a synthetic form of the female hormone oestrogen.

Once you apply a patch to the skin, the hormones are slowly released over a number of days. During perimenopause and menopause, both oestrogen and progesterone levels drop drastically.

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It’s almost unfathomable that a drug that is crucial to so many women is out of stock with not a glimmer of light as to when it will be available again.

However, it’s the big drop in oestrogen levels that causes most of the symptoms of menopause. Oestrogen is crucial for many bodily functions, including maintaining healthy and strong muscles and joints, helping your nerves work correctly, improving the way other neurotransmitters (including serotonin) work in your brain, temperature regulation: the list goes on. 

For those unaware (perhaps you're a doctor), the symptoms of perimenopause and menopause range from extreme anxiety, impaired sleep, vertigo, body aches, brain fog, lowered self-esteem and self-confidence, urinary tract infections, new allergies and skin rashes and irregular menstrual cycles. It's not just the stereotypical hot flushes.

Sadly, there’s a global shortage of Estradot, hence my call to the hälsocentral to try to find an alternative. Two weeks prior to my Estradot supply finishing, I’d been scouring the internet looking for pharmacies in Västerbotten that had the elusive plasters in stock.

The result was grim - the shortage was not just countrywide, but almost, but not quite, worldwide, and the back-in-stock date offered by manufacturers was at best vague. 

I’d spoken to a nurse at my local hälsocentral who suggested I try the drug in tablet form. I’d already tried the tablets, but they hadn’t worked, so the nurse's advice was to try the gel version of the drug. 

This I did for two days before abruptly stopping the daily application due to some pretty severe side effects such as abdominal and back pain, and debilitating headaches that woke me every day at 3am leaving me close to tears.

The phone conversation above that so enraged me followed one such sleepless night after I stopped applying the gel. The nurse explained that I could expect a call from a doctor in five days to discuss my options. Five days!

The prospect of five days going cold turkey without any oestrogen filled me with despair. I was just left to figure it out alone.

It’s almost unfathomable that a drug that is crucial to so many women is out of stock with not a glimmer of light as to when it will be available again. This is not an isolated incident - Sweden went through the same problem last year. A few of my non-Swedish newcomer friends here are also suffering.

With approximately 25 million women worldwide hitting the menopause each year, this transformational time affects not only these women, it affects their families, society as a whole, and entire healthcare systems. The lack of awareness and understanding about the menopause appears to be a deep-rooted problem. 

Incredibly, Swedish doctors don't learn about the menopause and perimenopause at med school: how then can we expect them to be able to give women constructive advice? I was told there was no specialist menopause clinics in Norrland, so unless you have the time, knowledge and finances to visit one in Stockholm, you’re at the mercy of your local doctor.

Menopause affects half the population, so how on earth did women cope before now? My mother’s generation ‘just got on with it and didn’t make a fuss’: they had to take the same approach to periods, childbirth and housework. Thankfully, attitudes have moved forward from the 1970s, but the stigma surrounding the menopause is still prevalent. 

Women are lucky to have experts such as Monika Björn fighting our corner. Monika has worked in the health and fitness industry for over 30 years and is on a mission to get Sweden on track with dealing with (or maybe even just acknowledging!) the health issues surrounding the menopause.

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Monika Björn is active trying to get Sweden on track with dealing with (or maybe even acknowledging!) the health issues surrounding the menopause.

She’s written two books, and offers coaching to those who want to learn more about the menopause in order to instruct, coach and support women in their professional roles. 

Monika took to the stage at Sara kulturhus last year, and before her performance I asked her about the problems women face in Sweden regarding menopause.

She said:

 –There is a lack of knowledge, and a lack of interest from the medical profession to learn more and get updated around menopausal issues, symptoms and treatments. That is a HUGE problem because it means that it is increasing inequality. You can look at it from the perspective of money spent on women's health versus money spent on men's health or money spent on research. There is an enormous disparity.

So where does that leave those of us waiting in limbo for Estradot patches? And why are there no patches?

A spokesperson at medical company Sandoz, which makes Estradot, explained in an email to me:

– Due to the complexity of the product, the global manufacturing capacity is very limited, but also vulnerable, as even a small interruption in any part of the production chain affects future deliveries. Unfortunately, we predict that these shortages will occur on and off also during 2024, although we hope to have some more available in late-March. We encourage women to contact their doctor for an alternative treatment.

OK, so you’re sending me back to medical professionals who, I've already discovered, have no real understanding of what happens during the menopause, never mind how to treat it.

So, what to do? I recently learnt from Monika Björn’s Facebook group 'Stark genom klimakteriet’, that it’s possible to buy a similar version of the Estradot patch from Germany, using a Swedish prescription. 

Needless to say, I went straight online and placed my order. So now I find myself not only at the mercy of the drug manufacturer but also of PostNord. I wait impatiently. My family cower in their bedrooms.

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It's not just hot flushes. The symptoms of perimenopause and menopause range from extreme anxiety, impaired sleep, vertigo, body aches, brain fog, lowered self-esteem and self-confidence, urinary tract infections, new allergies and skin rashes, and irregular menstrual cycles.

I cannot help but wonder if this drug shortage would have ever happened if this was a male drug. Would there have been more time and money invested in research into the menopause and drugs? The answer seems obvious.

This lack of knowledge and awareness surrounding the menopause is not unique to the Swedish medical industry, but given the country’s well-regarded medical system and its lauded commitment to gender equality there seems to be a severe deficit in this area. 

As an immigrant to Sweden from the UK, I find it striking that, according to my similarly suffering sister in the UK, Brexit Britain has no acute shortage of oestrogen patches and has better medical and pastoral support for women going through the menopause. How can Sweden be so far behind the UK, when it comes to a critical female health issue? It's baffling.

If you’re patiently waiting in the queue at Apoteket, when the patches come back in stock, and you see an English woman knocking everyone else out the way to get to the front, I apologise. 

I am usually calm and respectful of others. 

But Hell hath no fury like a woman deprived of her oestrogen patches.

This is a column and the views are the author's own.


 
 
 
 
 
 
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