Availability and Acceptability of Hormone Replacement Therapy for Menopause in Sri Lanka: Insights of Pharmacists.

Abstract

Hormone Replacement Therapy (HRT) remains underutilized and insufficiently studied in many low- and middle-income countries (LMICs), despite its recognized potential to alleviate menopausal symptoms and improve quality of life. This study aimed to examine pharmacists’ perspectives on the use, cost, and availability of HRT in Sri Lanka, a setting where structured menopause care services are still emerging. A cross-sectional survey was conducted from 1 January to 31 March 2025 as part of the Global Menopause Project. Pharmacists employed in community, hospital, and private-sector settings were invited to complete an anonymous online questionnaire. The instrument, piloted prior to dissemination, assessed the availability of HRT products, pricing patterns, and perceived barriers to access and use. A total of 58 pharmacists participated. Of these, 23.1% (n=32) worked in private community pharmacies, while 13.8% (n=15) were employed in government hospital pharmacies and 3.6% (n=2) in private hospitals. The remainder represented government community pharmacies and specialized areas such as clinical or regulatory pharmacy. The sample consisted of 37 females (63.8%) and 21 males (36.2%), with 66% practicing in urban areas. Participants held diverse professional qualifications, including Certificate of Proficiency or Efficiency (n=28), BPharm (n=20), Higher National Diploma (n=6), BSc Pharmacy (n=2), and postgraduate qualifications (n=2). Pharmacists reported that only Femoston (1 mg and 2 mg) were reliably available as HRT options in Sri Lanka. The Mirena coil was the most expensive HRT-related product (US$101). Notably, 72.4% (n=42) of pharmacists incorrectly identified oral contraceptive pills or emergency contraceptive pills as HRT formulations. Major barriers included low public health literacy, financial constraints, and limited access to menopausespecific healthcare services. Findings highlight significant disparities in HRT availability, affordability, and awareness. Pharmacists’ perspectives underscore the urgent need for integrated, equitable strategies to strengthen menopause care and women’s health policy in resource-limited settings such as Sri Lanka.