Do South Asian women with menopausal symptoms have access to optimal therapy?

Abstract

Background Menopausal symptoms can have a significant impact on a woman's quality of life. Information on availability of menopausal hormone therapy (MHT) in National Essential Medicines Lists (NEMLs) of South Asian (SA) countries has not been widely studied. Objective To review the availability of non-injectable MHT included in NEMLs of SA countries and to assess differences in availability compared to the recommended MHT preparations in the World Health Organization (WHO) model essential medicines list and the list of MHT available to women of a developed country in the Asia Pacific Region, while comparing with the healthcare expenditure and country's economic status. Methods Most recent NEMLs were obtained from all eight SA counties by visiting the Ministry of health/regulatory website of the respective country. Latest WHO model essential medicines list and Pharmaceuticals Benefits Scheme (PBS) schedule from Australia were obtained from the WHO and PBS websites respectively. Per capita health expenditure was obtained from The WHO Global Health Expenditure Database. Two investigators extracted the non-injectable MHT preparations independently from NEMLs and conducted the comparison. Results Except in two countries, in all other SA coun­tries NEMLs were updated within the preceding five years. According to available data, seven SA countries had at least one separate preparation of oestrogen suitable for MHT while all countries had a separate progesterone preparation suitable for MHT. The oestrogen preparations available in the SA NEMLs were limited to either ethinyl estradiol or conjugated oestrogen tablets whilst in the WHO model, oestrogen preparations were not specified. In Australia, estradiol tablets were the only available oral oestrogen while there were four more different dosage forms of oestrogens available through the PBS Scheme. Progesterone preparations found in SA countries, WHO list and PBS schedule were similar, but oestrogen progesterone combination MHT preparations were only available in the PBS schedule. Per capita health expenditure was much higher in Australia compared to SA countries where a wide variation was observed. Conclusions The available evidence suggests that a larger population of SA women have access only to a very limited number of options if in need of MHT. In contrast, importance of MHT is highlighted in PBS Schedule. Although per capita health expenditure was low in SA countries, given that MHT products are relatively low cost and that there is a large proportion of women in menopausal age in this region, it would be imperative to update the WHO model list and NEMLs of SA countries to address the growing need of safe MHT and to improve the quality of life of postlnenopausal women in our region.