This is an urgent petition to increase the awareness and availability of Hormone Replacement Therapy (HRT) for Women in Trinidad and Tobago.

We, a group of Women's health doctors dedicated to the wellbeing of Women in Trinidad and Tobago are signing this petition to express our deep concern regarding the lack of availability of HRT for women experiencing perimenopause and menopause symptoms in T and T.

• Women in TT have no access to the safest forms of modern HRT in the form of Transdermal Estradiol and Micronised Progesterone.
• Women spend on average a third of their lives in the peri and menopause and 85% experience symptoms, 25% severe enough to leave their jobs.
• Afro-Caribbean Women are more likely to suffer with vasomotor symptoms
• Women of East Indian descent are more likely to have an early Menopause.
• Over 70% percent of our population is overweight or obese. Transdermal Estradiol is safer than oral HRT especially in overweight and obese women as it does not increase the risk of clots.
• We know that heart disease is the leading cause of death in our nation, and Women's risk of heart disease increases fivefold after the Perimenopause and Menopause. HRT started within 10 years of the Menopause does NOT increase the risk of heart attacks. In fact, it may do the opposite.

The Ministry of Health's recent guideline on menopause acknowledges the essential role of HRT and yet the availability of HRT in T and T remains severely restricted. We refuse to accept this situation any longer. Women in T and T deserve access to a full range of safe and effective HRT options to manage their health proactively and with dignity.

We urge the Ministry to:

• Negotiate with T and T pharma distributors to ensure consistent supply chains of a range of HRT options including Transdermal and Vaginal Estradiol and Micronised progesterone.
• Expand the T and T formulary of HRT medications available through public health facilities to include a broader range of Estrogen and progesterone options, tailored to individual patient needs.
• Increase training and resources for healthcare providers to prescribe and manage HRT safely and effectively
• Implement public education campaigns to raise awareness about Menopause and the benefits of HRT

Addressing these issues aligns with the Ministry's commitment to improving Women's health and supports the broader goals of equitable, comprehensive healthcare for all citizens. The time has come to prioritise women's hormonal health as a critical component of the National Health Strategy.

We standby ready to collaborate with the Ministry to develop and implement these improvements.

Respectfully,