The number of hormone replacement therapy (HRT) items prescribed in England in the last year has increased 47% from 2021/22, totalling 11 million items.

They were prescribed to a total of 2.3 million identified patients, with a 29% increase from 2021/22.

The figures were released today by the NHS Business Services Authority (NHSBSA) and include all drugs that are covered by the HRT Prescription Pre-payment Certificate (PPC) and were prescribed in England and dispensed in the community in England, Scotland, Wales, Isle of Man or the Channel Islands.

While the majority of patients prescribed HRT are aged under 60, meaning that they may be likely to pay prescription fees, the NHSBSA said that since the HRT PPC was introduced in April 2023, there has been a reduction in the proportion of HRT items that patients pay for.

Between April 2023 and June 2023, 80.9% of HRT items were exempt from prescription charges, compared to 70% of items in 2022/22.

The analysis suggested patients in less deprived areas were more likely to be able to access HRT – a pattern that the NHSBSA said had ‘remained consistent’ since 2015/16.

In 2022/23, there were an estimated 662,000 patients prescribed HRT medicines in the least deprived areas in England – more than double the 289,000 identified patients that received prescribing from in the more deprived areas.

The integrated care board (ICB) with the highest proportion of patients being prescribed HRT was NHS Gloucestershire ICB, with an estimated 62 patients per 1,000 population being prescribed HRT.

Meanwhile, the lowest proportion of patients being prescribed HRT was NHS North East London ICB, with just 17 patients per 1,000 population being prescribed HRT.

Utrogestan 100mg capsules were the most prescribed HRT item in 2022/23, with 935,000 total items being prescribed and dispensed – more than double the 458,000 items in 2021/22.

The NHSBSA also released the 10 most prescribed HRT items in the last year:

BNF Presentation Name Unit of Measure Total Quantity Total Items
Utrogestan 100mg capsules capsule 67,300,000 935,000
Estradiol 0.06% gel (750microgram per actuation) gram 139,000,000 829,000
Evorel Conti patches patch 15,900,000 751,000
Progesterone micronised 100mg capsules capsule 49,900,000 691,000
Vagifem 10microgram vaginal tablets pessary 15,000,000 631,000
Estradiol 10microgram pessaries pessary 13,900,000 593,000
Oestrogel Pump-Pack 0.06% gel gram 94,700,000 586,000
Estriol 0.1% cream gram 9,970,000 480,000
Evorel 50 patches patch 9,590,000 473,000
Evorel Sequi patches patch 9,480,000 451,000


In terms of BNF categories, the biggest increase in prescriptions in the last year was for female sex hormones and their modulators.

In 2022/23, 8.25 million female sex hormones and their modulators items were prescribed in England, representing a 57% increase from the 5.26 million items prescribed in the previous year.

They were prescribed to an estimated 1.61 million identified patients in 2022/23 – a 39.8% increase from the 1.15 million identified patients in 2021/22.

Prescriptions for items for vaginal and vulval changes increased by 23.5% in 2022/23, with 2.54 million items dispensed compared to 2.05 million items the previous year.

An estimated 833,000 identified patients were prescribed at least one item for vaginal and vulval changes in 2022/23 – a 21.6% increase from the 685,000 identified patients in 2021/22.

Earlier this month, the NHSBSA reported that the total volume of items dispensed by community pharmacies had increased by 3.4% from 2021/22, with 1.08 billion prescription items dispensed by community pharmacies in 2022/23.

But over the same time period, 388 pharmacies closed, while just 297 new pharmacies opened, bringing the total number of active dispensing contractors in England to their lowest level since 2015/16.