Aila Morgan Guthrie was put into medically induced menopause at just 23 years old.
Menopause is when the ovaries stop releasing eggs, and make less of the reproductive hormones oestrogen and progestogen.
In simple terms it’s when someone’s periods stop for good and happens on average between the age of 50 and 52.
Aila says she can’t live without Estradot, a hormone replacement therapy patch which helps alleviate menopausal symptoms such as hot flushes, anxiety, insomnia and mood swings.
However due to a global shortage, sometimes she has to.
What is Estradot?
Estradot is the brand name for oestradiol and releases oestrogen the way ovaries would have prior to menopause – this significantly helps with symptoms.
The Pharmaceutical Management Agency, better known as Pharmac, is a crown entity that makes decisions on which medical products are subsidised for public hospitals and the public.
Pharmac funds the prescription patches which come in 25, 50, 75 and 100 mcg doses but currently there is a worldwide shortage and it’s expected to continue well into 2025.
According to Health NZ figures, there were 85,865 people in New Zealand with an oestradiol prescription between January 1 2024 and August 31 2024.
What’s being done
Last month Pharmac announced it was changing the main funded brand of oestradiol patch from Estradot to Estradiol TDP Mylan to try and help improve supply in New Zealand.
Pharmac’s Director Equity and Engagement Dr Nicola Ngawati said Pharmac understands the Mylan brand of patch or other funded alternatives might not be clinically suitable for everyone.
“Pharmac are actively working to put in place a process for accessing other brands if needed.”
The shortage is in part due to increasing demand, Pharmac says.
At the time ACT Party leader David Seymour, who is responsible for Pharmac, said he was asking questions over the switch.
In a statement Seymour said he had written to the Pharmac Board to understand the decision made and asked them to consider whether appropriate levels of consultation were undertaken, and patient voice was properly considered.
“They have advised me that they are going to review the consultation for this decision, and how they consult for future decisions. Though I cannot make any guarantees that Pharmac’s review will affect the outcome of their decision, or how long the review will take.”
The Pharmac website states there were 1.3 million patches dispensed in 2020/21 and in 2023/24 that skyrocketed to more than 4.7 million patches.
“Supply of all oestradiol patches is limited. The availability of patches can change rapidly and varies around the country. We anticipate that some people may not be able to get oestradiol patches,” the website states.
“We want to acknowledge the stress this supply issue may be causing. We are taking every measure to ensure that people can continue to access this treatment.”
Dr Ngawati said they also fund a range of medicines other than the patches to treat symptoms of menopause including tablets and gels.
“Each person’s health journey and experience of menopause is different. Medicine is a part of the support available to people through their health journeys.
“People should speak to their clinician about the best treatment options for them.“
Menopause better than the alternative for some
Aila wears one patch of the highest dose which lasts her two-and-a-half days.
She says they help significantly with all her symptoms.
At 17, Aila discovered she has adenomyosis, which she describes as “the evil sister” of endometriosis.
Adenomyosis causes the tissue that normally lines the uterus to grow into the muscular wall of the uterus.
The condition saw Aila having two periods a month which would last 12 – 14 days and using 10 tampons a day.
She only got two days off a month from bleeding.
Then there was the pain, which she describes as “hell on earth” and like having a butcher’s knife inside you consistently turning.
Treatments for adenomyosis are limited and include self-care methods such as heat packs and pain relief medicines, and then there are hormone treatments and contraceptive devices.
Aila says she tried everything to help the pain or ease the bleeding, and going into menopause was the final option.
While it’s common to hear people complain about their struggles with menopause, Aila says it’s changed her life and in the best way.
“It’s wonderful. I was desperate for any relief from the pain so I felt quite comfortable going into menopause because it couldn’t get any worse.
“It’s been brilliant, I really appreciate menopause.”
She will stay in menopause, by way of a two-monthly injection, until she has a hysterectomy next year.
A hysterectomy is a surgery to remove her uterus and is used in severe cases like Aila’s when no other treatments work.
It’s not recommended to stay in menopause for a long time, especially when young, as it affects bone density and puts you at risk of osteoporosis.
Because of this, and because she has private health insurance, she has regular bone density scans, and is under the care of two gynecologists and an endocrinologist.
Grieving what you missed out on
Aila says while she has a great mindset about what she’s going through, there’s definitely been times of grieving and feeling lonely.
“I felt like a failure, and like my problems meant I wasn’t enough of a woman. But I don’t think it’s something I should be ashamed of or any woman should be ashamed of.
“Getting into relationships was tricky and explaining what it is and getting them to understand.”
She says people need to be better supported in the process and a lot more research is needed, especially for people going through menopause earlier in life.
Menopause has been manageable for Aila because of Estradot.
Estradot has also been a gamechanger for Melissa Nicholson who also relies on it after going through premature ovarian failure when she was just 16.
The 36-year-old is also on the highest dose, but often the 100mcg patches aren’t available so she has to use four of the 25mcg and that lasts her three days.
“I have to order in advance and even then they can’t guarantee. When you don’t have the patches, it kicks you out of sync. It’s so frustrating.”
Melissa got her first period at 13 and freaked out, as she says most young people do.
Her mother reassured her though that it meant “everything is working”.
But then her periods started to become few and far between and it was her mum who realised.
“My mum said ‘I haven’t bought you any sanitary products in a while, when was your last period?’ and I said ‘8 months ago’ so she first raised it.
“She took me to the doctor who referred me to a gynecologist and found I had premature ovarian failure and my hormone levels were postmenopausal.”
Melissa says she doesn’t think she ever would have recognised symptoms as menopausal and would have put them down to puberty.
Initially she was put on a contraceptive pill to help with her oestrogen levels.
But when she got a new GP two years ago she was told this was an issue with her hormones so she should see an endocrinologist.
That’s when she was told about and put on Estradot.
Because of the premature ovarian failure at 16, Melissa’s decision on if she wanted to have kids or not was made for her at a very early age.
“I’d rather not have this disorder at all obviously but I always feel lucky that I got it so young so I had a lot of time to grieve the life I thought I would have as a kid.”
Research on women’s health is limited
Please note: The rest of this article uses the term ‘women’ because the interviewees and research included specifically referred to women. However we acknowledge that people who menstruate who do not identify with the term may also relate to this issue.
Professor Andrew Shelling, of the Department of Obstetrics, Gynaecology and Reproductive Sciences at the University of Auckland, has spent 20 years of his life trying to understand menopause and especially what causes early menopause or premature ovarian failure.
He says the average age of a woman going through menopause hasn’t changed from 50 – 52 for thousands of years.
Early menopause figures show 1 in 100 women will go into menopause under 40 and 1 in 1000 women under 30, he says.
“Thankfully women are realising that hormones can help and so there’s been an uptake which has fed the shortage.”
Andrew says women had previously been scared to take HRT due to studies that came out claiming links to cancer.
However, he says these have since been strongly debunked.
He says research on women’s health is pretty poor and more support, knowledge, training and funding is needed.
“Menopause hormonal therapy can make an enormous change in people’s lives.
“Symptoms for menopause will get so bad for some women that more than 40% will present to their GP with significant symptoms.
“It’s something very significant in a woman’s life.”
