The British Menopause Society has issued this further update on the current availability of HRT products to provide guidance to BMS members and clinical practitioners in response to the ongoing HRT shortages.

There continues to be availability issues with many HRT products 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. The BMS has been in ongoing discussions with the manufacturers as well as the RCOG, FSRH and the Medicines Supply Team at the Department of Health and Social Care to explore this ongoing issue and to provide up to date information on HRT product availability.

In the meantime, prescribers can continue to consider equivalent preparations that provide a similar dose to that which their patients are 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.

The BMS has produced a document on alternative HRT preparations in response to the ongoing HRT shortages to provide guidance to BMS members and clinical practitioners who may be experiencing difficulties with HRT supplies. This can be accessed through the following link: https://thebms.org.uk/wp-content/uploads/2019/11/HRT-alternatives-04.11.2019.pdf

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 estradiol gel. Available

Utrogestan (micronised progesterone) 100 mg in continuous combined regimen and 200 mg in sequential regimens. Available

Testogel 50 mg, gel sachet. Available

Orion HRT products

Sandrena 0.5 mg estradiol sachet Available
Sandrena 1.0 mg estradiol sachet (91x packs). Available

Sandrena 1.0 mg estradiol sachet (28x packs). Available

Indivina 1mg estradiol + 2.5mg medroxyprogesterone acetate Out of stock until end of February 2020
Indivina 1mg estradiol + 5mg medroxyprogesterone acetate Out of stock until end of February 2020
Indivina 2mg estradiol + 5mg medroxyprogesterone acetate Out of stock until end of February 2020

Tridestra 2mg estradiol + 20mg medroxyprogesterone acetate Available

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

Theramex HRT products

Theramex acquired the Evorel family of products from Janssen Pharmaceutical Companies of Johnson & Johnson on 23rd October 2019 at which point many individual products were out of stock.

Theramex have issued the following update on the Evorel HRT product line:

‘’Evorel: UK Stock Update from Theramex:

  • Theramex have re-started manufacturing and increased output.
  • Qualified and invested in an additional manufacturer to accelerate supply.
  • Invested in additional packaging equipment to increase production volumes and improve speed to market.
  • Worked in partnership with the UK Health Authorities to shorten timelines.

Theramex have fast-tracked supply, shortened manufacturing timelines and have announced they are bringing the product back to market, more than 6 months earlier than originally planned.

Below the most up to date stock availability dates:

Evorel Mono 50                        14th February 2020 

Evorel Conti                             21st February 2020

Evorel Mono 25                        March 2020      

Evorel Mono 75                        March 2020      

Evorel Mono 100                      March 2020      

Evorel Sequi                            End March 2020

Theramex plan to bring Evorel back to market over the coming months and will continue to build on stock levels across all lines to restock the market fully.

Theramex will continue to provide regular updates on stock availability on their website and to UK Health Authorities.

Theramex appreciates the impact this has had on women‘s lives and continue working towards a continuous and stable supply chain.’’

FemSeven Mono Out of stock until Quarter 4 2020

FemSeven Conti Out of stock until Quarter 4 2020

FemSeven Sequi Out of stock until Quarter 1 2021

Further information

For patients with questions regarding current or alternative HRT therapies, please speak to your GP or healthcare professional.

For pharmacists and healthcare professionals who require further information around supply of the  Evorel range of products please contact your usual wholesale providers.

Novartis pharmaceuticals – Estradot patches

Estradot estradiol 25 / 37.5 / 50 / 75 / 100 micrograms Available. No supply shortages

All Estradot stock is being distributed through AAH & Alliance, please ask your pharmacist to contact their preferred wholesaler to source a supply. Please call Novartis Customer Care on 08457 419 442 or e-mail novartis.customercare@novartis.com if you need any further assistance.

Estraderm MX patches (Norgine)

Estraderm MX estradiol 25 patches. Available

Estraderm MX estradiol 50 patches. Available
Estraderm MX estradiol 75 patches.
Available

Estraderm MX estradiol 100 patches. Available

Mylan HRT products

Supply information as of 23rd January 2020
Femoston® 1mg estradiol + 10mg dydrogesterone. Available
Femoston
® 2mg estradiol + 10mg dydrogesterone. Available
Femoston
® conti 1mg estradiol + 5mg dydrogesterone. Available
Femoston
® conti low dose 0.5mg estradiol + 2.5mg dydrogesterone. Available
Zumenon
® 1mg estradiol. Available
Zumenon
® 2mg estradiol. Available

Elleste Solo™ MX patches 40mcg transdermal estradiol Available
Elleste Solo™ MX patches 80mcg transdermal estradiol Available
Elleste Solo™ 1mg estradiol Out of stock until second-half 2020
Elleste Solo™ 2mg estradiol. Very limited stock available, then out of stock until second-half 2020

Elleste Duet™ 1mg estradiol + 1mg norethisterone acetate. Out of stock until second-half 2020
Elleste Duet™ 2mg estradiol + 1mg norethisterone acetate. Out of stock until second-half 2020
Elleste Duet™ Conti 2mg estradiol + 1mg norethisterone acetate. Out of stock until second-half 2020

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

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

Novo Nordisk HRT products

No shortage of supplies of any of their HRT products:

Kliovance 1mg estradiol + 0.5mg norethisterone acetate. Available
Kliofem 2mg estradiol + 1mg norethisterone acetate. Available

Novofem 1 mg estradiol + 1 mg norethisterone acetate. Available

Trisequens 2mg/2mg/1mg estradiol + 1mg norethisterone acetate. Available

Vagifem 10mcg topical vaginal estrogen. Available

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.

Bayer

Progynova 1mg estradiol tablets. Available
Progynova 2 mg estradiol tablets. Available

Progynova TS estradiol 50 patches. Available
Progynova TS estradiol 100 patches. Available

 Mirena IUS. Available

Aspen

Ovestin. Estriol topical vaginal cream. Available 

Merck Sharp & Dohme Limited

Livial (2.5 mg Tibolone)   (x84 packs) Available

Livial (2.5 mg Tibolone)   (x28 packs) Available

Marlborough

Oestriol 0.01%. Topical Estriol vaginal cream. Available

Kyowa Kirin Ltd

Tostran 2% Gel. Available.

AAH low in in stock, Alliance in supply, Phoenix in supply   

If difficulty obtaining supplies, the company suggested contacting their customer care on: medinfo@kyowakirin.com; or telephone 01896 664 000, to guide them to the process of obtaining emergency supplies until stocks back in supply.

Lawley Pharmaceuticals

AndroFeme 1 testosterone 1% cream (Specials unlicensed supply). Available

Pfizer

Premique low dose. Conjugated equine estrogen 0.3 mg + medroxyprogesterone acetate 1.5 mg. Available

Duavive. Conjugated equine estrogen 0.45 mg + 20 mg bazedoxifene. Discontinued August 2018. Stocks expected to be available into early 2020

Premarin conjugated equine estrogen 0.625 mg and 1.25 mg. Available

Estring estradiol 7.5 micrograms/24 hours. Available 

Provera 5 mg tablets. Available

Provera 10 mg tablets.  Pack of 10 low stock.

                                       Pack of 100 out of stock. Expected back week ending 6th March 2020

 

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

Haitham Hamoda
Chairman, British Menopause Society