When, after her intervention at ASISA WeLife Menopause A Coruña, Dr. Diana López Freire opened the floor to questions, one attendee asked a fairly frequent question. “In the Social Security system you don’t get hormonal treatments. What can we do?” It is a common doubt among women as they reach this stage, and a myth that must be dispelled. Because yes. Our public health system covers menopausal hormone therapy through the classic co-payment system (the patient bears part and the State, the rest).
Another thing is how to reach that prescription and what kind of treatments are included in that funding. But to get in, it does.
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It is confirmed by Dr. Jesús Presa, spokesperson for the Spanish Association for the Study of Menopause (AEEM). “The public system funds many of the hormonal treatments for menopause. Especially the more classic guidelines. Now, and this is one of the challenges and also important to communicate, there are many treatments that are introduced, new preparations or different doses that are not covered”.
The first step: appointment with Primary Care
As described in the Guide for the Management of Menopause in the National Health System, published in 2022 by the Ministry of Health, “Primary Care, within the framework of Social Security, plays an essential role in the diagnosis and management of menopausal symptoms“.
Therefore, the first step to access any medical solution is to make an appointment with the Primary Care physician. Depending on the case, the professional will decide whether to prescribe any type of treatment or refer the patient to the specialist (in this case, to the gynecologist).
The flip side: it does not cover all treatments
And here the obstacles begin. As Dr. Presa reminds, The Social Security does not cover all types of hormonal treatments. But it does cover the most common ones. So a medication that can range between 15 and 30 euros per month —the average price of most— would be obtained, approximately, for less than half (between 5 and 12 euros).
“It is true that the prescription and financing of these products helps many women access it. However, from AEEM, we still make certain demands,” emphasizes the expert.
The other side of public funding
Among those demands is to broaden the range of hormonal treatments covered by public healthcare. “On one hand, financing only some ends up creating unequal access to the existing therapies. So only women with a higher economic level can access the most novel treatments through private healthcare.”
Selective financing acts as a bottleneck “and in the end one always ends up using the same treatments. This somewhat causes the essence of understanding hormone therapy as a tailor-made suit to be lost.”
This implies that new solutions aimed at advancing comfort for the patient and opening therapeutic alternatives, such as non-hormonal treatment for hot flashes or novel dosing schedules, like certain transdermal patches or estrogen gels (not the ones intended to treat genitourinary syndrome, but vasomotor symptoms), are not yet funded by the Social Security.
What if my doctor doesn’t prescribe it for me?
Returning to the attendee from A Coruña, she complained that her doctor denied that public health would cover it. She also refused to even consider the treatment, clinging even to the old myth that ‘it causes cancer’, a notion that persisted for more than 20 years and has been denied by the FDA. In this situation, still too frequent in our consultations, the woman feels she is at a dead end.
But it is not. As a patient she has rights and it is the time to exercise them. “The only thing the patient can do in that situation, if she really feels that her symptoms are important, is to ask to be referred to a specialist. It is her right,” recommends Dr. López Freire, coordinator of the microbiota and menopause group of AEEM.
The other route, followed by many other women, is to turn to private consultations.
Professional updates
Medicine is a life science that advances year after year. Hormone therapy is no exception. Hence the need for Primary Care professionals to have the training and updating in hormonal health and menopause.
However, Jesús Presa acknowledges that “in many occasions, we overburden this route. We cannot expect these doctors to prescribe antidepressants, manage migraines and design a hormone therapy. And to do so, moreover, comfortably.”
What is essential — and both AEEM members agree — is that the gynecological referral and to menopause units be increasingly dynamic and effective.
What if my medicine isn’t in the pharmacy?
Finally, and although not directly related to public funding, it is important to remind those on hormone therapy that, on occasions, supply problems occur. This has recently happened with the transdermal estradiol spray.
From AEEM they insist that a treatment cannot be swapped for another lightly. “The first thing is to avoid confusion: a stock-out is not synonymous with any safety or technical issue,” clarifies the association’s spokesperson.
Women who find themselves in this situation must consult their doctor to prescribe the appropriate alternative. Because, as experts in this stage always remind, each woman, each menopause, and each hormonal treatment, must be understood as something unique.
