In response to the ongoing HRT shortages, the British Menopause Society has produced this further update on the current availability of HRT products. This provides guidance to BMS members and clinical practitioners who may be experiencing difficulties with HRT supplies.

There continues to be availability issues with many HRT products, either related to manufacturing shortages or supply issues. The BMS has been informed that these are temporary shortages which pharmaceutical companies and their suppliers are addressing.

In the meantime, prescribers can continue to consider equivalent preparations that provide a similar dose to that which their patient is using. If an exact match is not possible, prescribers can seek guidance available on the practical prescribing chart on the BMS website and Menopause Matters website, to clarify equivalent doses.

Consideration could also be given to prescribing estrogen and progestogen separately to make the closest match or find a suitable alternative.

Different brands for the same medication may vary in appearance or excipients. However, they would provide equivalent amounts of hormones when used in similar doses.

BMS members can post prescribing queries on the BMS forum if any clarifications are required.

The information on stock availability and supplies below was obtained from the pharmaceutical companies producing these products.

Besins Healthcare (UK) HRT products

No shortage of supplies of their HRT products:

Oestrogel systemic oestrogen gel.
Utrogestan (micronised progesterone) 100 mg in continuous combined regimen and 200 mg in sequential regimens.

Orion HRT products

Sandrena 0.5 mg sachet Available.
Sandrena 1.0 mg sachet Shortage of supplies until mid September 2019.
Indivina 1mg oestradiol + 2.5mg medroxyprogesterone acetate Available.
Indivina 1mg oestradiol + 5mg medroxyprogesterone acetate Available.
Indivina 2mg oestradiol + 5mg medroxyprogesterone acetate Shortage of supplies until end of August 2019.

Tridestra 2mg oestradiol + 20mg medroxyprogesterone acetate Available but there is currently 2 week delay in delivery of orders.

If difficulty obtaining supplies, the company has suggested contacting their customer care on 01635520300 to guide them to the wholesale suppliers.

Evorel patches (Janssen)

Janssen have provided the following update on their Evorel patch products:

Janssen has issued the following update regarding their Evorel patch supplies:

There is an interruption of supply for Evorel®, Evorel® Sequi and Evorel® Conti that will result in shortages to patients. The product range will stockout at the end of October 2019. The company anticipates that pharmacies will be out of stock until mid-2020.

For further questions or additional information, please contact: Janssen Medical Information Department: email: medinfo@its.jnj.com, telephone: 0800 731 8450 or 01494 567 444.

Estradot patches (Novartis pharmaceuticals):

Available. No supply shortages.

If difficulty obtaining supplies, the company has suggested contacting their customer care to guide them to the wholesale suppliers, on 08457 419 442; E-mail novartis.customercare@novartis.com. Frimley Business Park, Frimley, Camberley, Surrey, GU16 7SR.

Merck Sharp & Dohme Limited

Livial (2.5 mg Tibolone) Available.

Mylan HRT products

Supply information as of 21st August 2019:

Elleste Solo™ 1mg oestradiol. Available.
Elleste Solo™ 2mg oestradiol. Available.
Elleste Duet™ 1mg oestradiol + 1mg norethisterone acetate. Available.
Elleste Duet™ 2mg oestradiol + 1mg norethisterone acetate. Available.
Elleste Duet™ Conti 2mg oestradiol + 1mg norethisterone. Shortage of supplies.
Femoston® 1mg oestradiol + 10mg dydrogesterone. Shortage of supplies.
Femoston® 2mg oestradiol + 10mg dydrogesterone. Available.
Femoston® conti 1mg oestradiol + 5mg dydrogesterone. Available.
Femoston® conti low dose 0.5mg 0estradiol + 2.5mg dydrogesterone. Available.
Zumenon® 1mg oestradiol and 2mg oestradiol. Shortage of supplies.
Elleste Solo™ MX patches 40mcg transdermal oestradiol. Available.
Elleste Solo™ MX patches 80mcg transdermal oestradiol. Available.

Mylan’s manufacturing partner continues to experience interruptions in the production of certain strengths of Elleste™, their Hormone Replacement Therapy (HRT). They have informed us that they will continue to provide updates on timing for resolution, as they receive them; to the British Menopause Society as well as to healthcare professionals via their sales team. Mylan understands the challenges this situation poses to women and is working closely with their manufacturing partner to expedite deliveries when possible.

Mylan has a dedicated website for healthcare professionals, which has LIVE information about current supply of their HRT. The overview of stock availability page can be accessed on: https://mywayhub.co.uk/en-gb/range

It is important to note that Mylan HRT stock can only be obtained through AAH, Alliance and Phoenix

If you have difficulty obtaining supplies please contact Mylan Customer Service on: mguk_customer.services@mylan.co.uk

Estraderm MX patches (further update pending)

Estraderm MX 50 patches pack of 24. Available.
Estraderm MX 75 patches pack of 8. Available.
Estraderm MX 100 patches. Available.
Estraderm MX 50 patches pack of 8. Shortage of supplies.

Novo Nordisk HRT products

No shortage of supplies of any of their HRT products:

Kliovance 1mg oestradiol + 0.5mg norethisterone acetate.
Kliofem 2mg oestradiol + 1mg norethisterone acetate.
Novofem 1 mg oestradiol + 1 mg norethisterone acetate.
Trisequens 2mg/2mg/1mg oestradiol + 1mg norethisterone acetate.
Vagifem 10mcg topical vaginal oestrogen.

If difficulty obtaining supplies, the company suggested contacting their customer care on: customercare@novonordisk.com; or telephone 0845 600 5055, to guide them to their wholesale suppliers.

GPs and Pharmacists should be able to provide guidance on suitable alternatives.

Haitham Hamoda
Chairman, British Menopause Society