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.
