We are continuing to work closely with the Medicines and Healthcare products Regulatory Agency (MHRA) to ensure safe access to these products. We have reached out to specialist importers who can source unlicensed medicines in order to find alternative sources of both oestrogen and testosterone hormone replacement therapy (HRT) implants, which are not licenced in the United Kingdom. We are aware of a specialist importer who is able to source unlicensed testosterone implants. The decision to prescribe an unlicensed imported medicine sits with the prescriber.

We are also engaging with companies globally to source supplies of HRT implants for UK patients. The MHRA is working closely with current importers of the product and encouraging applications to supply products through the licenced medicines route.

We are continuing to work closely with the Medicines and Healthcare products Regulatory Agency (MHRA) to ensure safe access to these products. We have reached out to specialist importers who can source unlicensed medicines in order to find alternative sources of both oestrogen and testosterone hormone replacement therapy (HRT) implants, which are not licenced in the United Kingdom. We are aware of a specialist importer who is able to source unlicensed testosterone implants. The decision to prescribe an unlicensed imported medicine sits with the prescriber.

We are also engaging with companies globally to source supplies of HRT implants for UK patients. The MHRA is working closely with current importers of the product and encouraging applications to supply products through the licenced medicines route.

Shared care arrangements are voluntary and involve a specialist clinician transferring responsibility for some aspects of a patient’s care, such as prescribing medicines, to a general practitioner. If a shared care arrangement cannot be put in place or is interrupted, responsibility for ongoing prescribing remains with the specialist clinician responsible for the patient’s treatment.

The National Institute for Health and Care Excellence’s (NICE) guideline on the identification and management of menopause includes guidance for healthcare professionals on the prescribing of hormone replacement therapy (HRT). The guideline includes guidance on reviews for women receiving treatment for menopause and recommends that women should be referred to a healthcare professional with expertise in menopause if treatments do not improve their menopause-associated symptoms or they have ongoing side effects.

These NICE guidelines represent best practice and support clinicians in the assessment, management, and treatment of menopause symptoms and associated complications. Healthcare professionals are expected to take these guidelines fully into account in their prescribing decisions. The guideline is available at the following link:

https://www.nice.org.uk/guidance/ng23

HRT is the main treatment for menopause symptoms, and NICE recommends that for most women it is safe and effective. It is important, however, that women are provided with accurate information and are able to make informed choices about their care, including HRT and that healthcare practitioners take a personalised approach when discussing treatments, using evidence-based information tailored to individuals’ circumstances.

We recognise the significant impact that menopause symptoms can have on women’s health, wellbeing, and daily lives. Improving support for women experiencing menopause is an important part of the Government’s wider work on women’s health.

The hormone replacement therapy (HRT) prescription prepayment certificate covers eligible HRT medicines containing oestrogen and/or progesterone that are licensed for the treatment of menopause. It is valid for 12 months, costs £19.80, and can reduce costs for patients who need more than one prescription.

As announced in October, local authorities will be asked to include menopause in the NHS Health Check later this year. This will signpost eligible women in England to information on menopause, including symptom management, support, and diagnosis. Menopause and menstrual health conditions will also be priorities for the National Health Service’s new online hospital, due to launch next year, to improve access to specialist care.

There are over 70 hormone replacement therapy products, and the vast majority are in good supply.

We are aware of ongoing intermittent supply issues affecting Estradot (estradiol) patches due to global supply disruptions of this product. We continue to regularly engage with the supplier to expedite deliveries and stabilise supply where possible. We have issued comprehensive management guidance to healthcare professionals and Serious Shortage Protocols to enable community pharmacists to supply specified alternative estradiol patches, with the patient’s consent and without needing to seek authorisation from the prescriber.

We continue to work with the Medicines and Healthcare products Regulatory Agency and Specialist Importers to source unlicensed estradiol and testosterone implants. We are not aware of supply issues with progesterone 100 milligram capsules which is licensed for hormone replacement therapy.

The Department is closely monitoring the Middle East conflict to assess any potential impact on United Kingdom medical supply chains through disruptions to manufacturing and logistics.

We have limited direct exposure to the Middle East for medical products, and we maintain well‑established contingency arrangements to manage medicine and medical device supply disruptions where these occur. These can include coordination of mutual aid, work to identify alternative products, alternative clinical practices, regulatory easements, and/or use of the Express Freight Service which can provide bespoke global logistics services in the event of critical supply disruption.

The Department is not aware of supply issues impacting codeine and co-codamol as a result of the conflict. The Department is aware of supply constraints affecting co-codamol 30 milligram/500 milligram tablets, which pre-date the conflict and which are due to manufacturing issues. These are in limited supply until early July 2026. We have engaged with National Health Service specialist clinicians and issued comprehensive guidance on how to manage patients during this time and advise on available alternative preparations.

The NHS Business Services Authority (NHSBSA) collects data relating to National Health Service dispensing in the community. Prescriptions do not state the purpose for which they are written. There may be instances where medicines are used for other conditions.

The tables below set out Net Ingredient Costs (NIC). This is the basic price of a product excluding VAT. It does not take account of discounts, rebates, dispensing costs, fees and allowances paid to pharmacists and appliance contractors for the service they provide to the National Health Service, or prescription charge income received, where the single charge or prescription prepayment certificate fee is paid, or foregone where prescriptions are dispensed free of charge.

The following table shows the NIC for prescriptions for medicines eligible for the hormone replacement therapy prescription pre-payment certificate where gender is recorded in NHSBSA data as female, that were prescribed by NHS organisations in England and subsequently dispensed in the community, by year, from 2023 to 2025:

In addition, the following table shows the NIC for prescriptions for testosterone where gender is recorded in NHSBSA data as male, that were prescribed by NHS organisations in England and subsequently dispensed in the community, by year, from 2023 to 2025:

Source: the British National Formulary (BNF)

Note: Testosterone Replacement Therapy is not a named section within the BNF. Data the table is based on the products included in the BNF chemical substances of methyltestosterone, testosterone, testosterone enantate, testosterone propionate, testosterone undecanoate, and testosterone esters.

The Government is committed to improving women’s health outcomes, including through better awareness and support for menopause, and we will continue to work with NHS England and the National Institute for Health and Care Excellence (NICE) to ensure patients and clinicians have access to clear, evidence-based guidance.

NICE guideline on menopause was last updated in November 2024. It provides guidance on best practice that prescribers are expected to take fully into account in the care and treatment of individual patients.

NICE intends to update its recommendations on starting and stopping hormone replacement therapy, including managing unscheduled bleeding. There are no current plans to update other recommendations at this time, including the use of transdermal oestrogen gel and access to testosterone for women with confirmed low blood levels and significant cardiovascular symptoms. This guideline will be reviewed if there is new evidence that is likely to change the recommendations.

We are continuing to work closely with the Medicines and Healthcare products Regulatory Agency (MHRA) to ensure safe access to these products. We have reached out to Specialist Importers who can source unlicensed medicines in order to find alternative sources of both oestrogen and testosterone hormone replacement therapy (HRT) implants, which are not licenced in the United Kingdom. We are engaging with companies globally to source supplies of HRT implants for UK patients. We are aware of a Specialist Importer who is able to source unlicensed testosterone implants. The decision to prescribe an unlicensed imported medicine sits with the prescriber.

We are also engaging with companies globally to source supplies of HRT implants for UK patients. The MHRA has been working closely with current importers of the product and are also looking to encourage other applications for a licenced medicinal product. As oestrogen and testosterone HRT implants are not licenced in the UK, the MHRA is encouraging applications to supply products through the licenced medicines route.

Setting guidance for the treatment of individual conditions falls to the National Institute for Health and Care Excellence (NICE), who produce guidance for the National Health Service and wider health and care system. NICE guidelines are evidence-based recommendations for health and care in England and Wales. They help health and social care professionals to prevent ill health, promote good health, and improve the quality of care and services.

NICE clinical guidelines are intended for health and social care professionals, commissioners, patients, and carers to help them make informed decisions on the appropriate treatment and care.

When put into practice, NICE guidelines have the potential to effectively target health and care resources to significantly improve patient outcomes, in line with the best available evidence of clinical and cost-effectiveness. Although healthcare professionals and commissioners are not legally obliged to follow NICE guidelines, they are expected to take them into full account when making decisions on treatment and care for patients. The most recent guidance, last updated November 2024, is available at the following link:

https://www.nice.org.uk/guidance/ng23

Generally, providers rely on a range of professional organisations to keep their practice up to date, and they need to work within a scope of practice which includes being up to date and which is assessed through appraisal. In addition to NICE, they would look to the British Menopause Society, the College of Sexual and Reproductive Healthcare, the Royal College of General Practitioners, or the Royal College of Obstetricians and Gynaecologists. Further information on the British Menopause Society is available at the following link:

https://thebms.org.uk/

While there are no plans to review the inclusion of hormone replacement therapy (HRT) within the prescription charge exemption list, the HRT prescription pre-payment certificate is available for patients who are prescribed HRT on the National Health Service. The price of the HRT prescription pre-payment certificate (PPC) is the equivalent of two single prescription charges, currently £19.80, and covers all qualifying prescribed HRT medicines for the 12-month period of its validity, representing significant saving for patients compared to the single prescription charge. In financial year 2024/25, approximately 13.3 million HRT items were dispensed without charge, either because they were covered by the HRT PPC or the patient held an exemption from prescription charges.

There are over 70 HRT products, and the majority are in good supply. We are aware of shortages affecting Estradot (estradiol) patches. We are engaging with the supplier to expedite deliveries. We have issued guidance to healthcare professionals and Serious Shortage Protocols to enable community pharmacists to supply specified alternative estradiol patches.

We will also be asking local authorities to include menopause in the NHS Health Check from 2026. This will support eligible women from across England to access high quality information on the menopause, including advice on managing symptoms and where to seek support.

Further data on HRT prescriptions is available via the NHS Business Services Authority at the following link:

https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/hrt/hrt_June_2025_v001.html

While there are no plans to review the inclusion of hormone replacement therapy (HRT) within the prescription charge exemption list, the HRT prescription pre-payment certificate is available for patients who are prescribed HRT on the National Health Service. The price of the HRT prescription pre-payment certificate (PPC) is the equivalent of two single prescription charges, currently £19.80, and covers all qualifying prescribed HRT medicines for the 12-month period of its validity, representing significant saving for patients compared to the single prescription charge. In financial year 2024/25, approximately 13.3 million HRT items were dispensed without charge, either because they were covered by the HRT PPC or the patient held an exemption from prescription charges.

There are over 70 HRT products, and the majority are in good supply. We are aware of shortages affecting Estradot (estradiol) patches. We are engaging with the supplier to expedite deliveries. We have issued guidance to healthcare professionals and Serious Shortage Protocols to enable community pharmacists to supply specified alternative estradiol patches.

We will also be asking local authorities to include menopause in the NHS Health Check from 2026. This will support eligible women from across England to access high quality information on the menopause, including advice on managing symptoms and where to seek support.

Further data on HRT prescriptions is available via the NHS Business Services Authority at the following link:

https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/hrt/hrt_June_2025_v001.html

The Medicines and Healthcare Products Regulatory Agency (MHRA) is an executive agency of the Department which regulates medicine, medical devices, and blood components for transfusion in the United Kingdom, with responsibility for ensuring that medicines meet appropriate standards of safety, quality, and efficacy.

Patient safety is our top priority. The MHRA keeps the safety and effectiveness of all medicines under continuous review, drawing on the latest scientific and clinical evidence.

Hormone replacement therapy (HRT) is an important treatment that helps many women manage menopause symptoms. We continually review emerging data on HRT to ensure that information and guidance in the UK reflects the latest evidence. The MHRA is currently reviewing the available evidence on HRT risks and considering whether updates to the product information are warranted for certain HRT products. This review remains ongoing, and we are currently determining the appropriate next steps based on the evidence.

Women should not make any changes to their treatment plan without first speaking to their general practitioner or healthcare professional, who can provide advice tailored to their individual circumstances.

The hormone replacement therapy prescription prepayment certificate (HRT PPC) was introduced to support women in accessing hormone replacement therapy medicines on the National Health Service as part of their care during menopause. The equalities impact assessment is available at the following link:

https://www.gov.uk/government/publications/hormone-replacement-therapy-prescription-prepayment-certificate-equality-impact-assessment/introducing-the-hrt-ppc-equality-impact-assessment#:~:text=The%20policy%20intention%20is%20that,benefit%20from%20the%20HRT%20PPC%20

Testosterone products are not in scope for the HRT PPC because, even though they can be used "off-label" to treat menopause symptoms, they are not licensed for this purpose. No United Kingdom licensed testosterone products for the treatment of menopause symptoms have been launched in the UK.

Anyone can purchase the HRT PPC if they feel that it is the most appropriate product for them. The three-month or 12-month PPC, which cover all medicines prescribed on the NHS, may be more appropriate for patients who are prescribed medicines not covered by the HRT PPC.

We know that more needs to be done to address the barriers to accessing menopause care experienced by women, and that some groups of women experience these even more acutely. The Government is committed to prioritising women’s health as we reform the National Health Service, and women’s equality will be at the heart of our missions, our 10-Year Health Plan, and the renewal of the Women’s Health Strategy.

In October 2024, the NHS published a healthcare inequalities report into NHS primary care hormone replacement therapy prescribing to treat menopause symptoms. This report provides insights by age, deprivation, region, integrated care system (ICS), primary care network, local authority, electoral ward, and Core20, as well as specific medication level analysts. ICS’s and local authorities should use this information to inform policies, planning, commissioning, and promotion of services.

From 2026 onwards, local authorities will be asked to include menopause in the NHS Health Check which will support up to five million eligible women across England to access high quality information on the menopause, including advice on managing symptoms and where to seek support when they need it the most. To improve access and engagement with the NHS Health Check, a new NHS Health Check Online service is in development, which people can use at home, at a time convenient to them. The new online service is now being piloted in multiple local authorities.

The NHS Business Services Authority releases official statistics on patients prescribed hormone replacement therapy (HRT). The latest available data shows that there were 2.8 million female patients aged 18 years old or over who were prescribed HRT in England, that was subsequently dispensed in the community, from July 2024 to June 2025. Further information, including monthly data to June 2025, is available at the following link:

https://www.nhsbsa.nhs.uk/statistical-collections/hormone-replacement-therapy-england/hormone-replacement-therapy-england-april-2015-june-2025