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

The ongoing challenges brought on by the COVID-19 pandemic have resulted in many women experiencing difficulties in obtaining their HRT supplies. We appreciate that continuing HRT intake is likely to help many women control their often difficult menopausal symptoms, particularly relevant given the additional stress some women may be under in view of the strains of the current situation on society. In addition, General Practitioners’ surgeries have been under ongoing additional pressure as a result of the pandemic.

We recommend that Healthcare Professionals and prescribers follow the joint guidance issued by the BMS, RCOG, RCGP and FSRH which recommends that General Practitioners and healthcare providers consider advising women about menopause issues through telephone and virtual consultations where possible to reduce face to face engagement, and with easy access to repeat prescriptions of HRT supplies (especially to women who have been on HRT and have not been experiencing any problems with their intake). This will help to avoid the need for many women to visit their GP surgery to discuss these issues and assist with obtaining repeat prescriptions. This can be accessed through the following link:https://thebms.org.uk/wp-content/uploads/2020/06/Framework-for-restoration-of-menopause-services-2020.pdf 

The BMS has produced a document on alternative HRT preparations to provide guidance to BMS members and clinical practitioners who may be experiencing difficulties obtaining their HRT preparations. This can be accessed through the following link: HRT Equivalent preparations 28.4.21.

Prescribers should consider equivalent preparations to that which their patients are using. If an exact match is not possible, prescribers can seek guidance available on the BMS document on alternative HRT preparations and 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.

Signposting could also be provided to resources on the BMS website as well as Women’s Health Concern (WHC) website, Menopause Matters and the Primary Care Women’s Health Forum (PCWHF).

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 manufacturing these products. We are not in a position to comment on availability at wholesale suppliers’ level and appreciate that availability from wholesale suppliers may lag behind and thus sometimes vary from the information provided by the manufacturers.

Besins Healthcare (UK) 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

Off-label use for female testosterone replacement (5 mg a day).

Imvaggis vaginal 0.03 mg estriol vaginal pessary. Available

Any pharmacies who are having any difficulty in obtaining stock can contact Besins Healthcare information@besins-healthcare.com with the details of their wholesaler and pharmacy account details.

Gedeon Richter

Lenzetto 1.53 mg/spray, transdermal estradiol spray. Available

Lenzetto is an estradiol metered-dose transdermal spray. The Medicines and Healthcare Products Regulatory Agency granted a marketing authorisation valid throughout the European Union for Lenzetto on 13 August 2015. Gedeon Richter UK launched Lenzetto in the UK on 1st April 2020.

Vagirux 10 micrograms vaginal tablets. Available

Gedeon Richter UK launched Vagirux in the UK in October 2020. This is delivered through a reusable applicator (applicator can be used up to 24 times).

Lenzetto and Vagirux are available to order via AAH

Orion HRT products

Sandrena 0.5 mg estradiol sachet (28x packs). Available
Sandrena 1.0 mg estradiol sachet (91x packs). Available

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

Indivina 1mg estradiol + 2.5mg medroxyprogesterone acetate. Available

Indivina 1mg estradiol + 5mg medroxyprogesterone acetate. Available

Indivina 2mg estradiol + 5mg medroxyprogesterone acetate. Available

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

Product Availability
Bijuve (estradiol/progesterone) Available – Fully in stock
Evorel  
Evorel® Conti (estradiol/norethisterone) Available – Fully in stock
Evorel® Sequi (estradiol/norethisterone) Available – Fully in stock
Evorel® 25 (estradiol) Available – Fully in stock
Evorel® 50 (estradiol) Available – Fully in stock
Evorel® 75 (estradiol) Available – Fully in stock
Evorel® 100 (estradiol) Available – Fully in stock
FemSeven  
FemSeven® Conti (estradiol/levonorgestrel) Available – Fully in stock
FemSeven® Sequi (estradiol/levonorgestrel) OOS. Anticipated to be early 2022
FemSeven® 50 (estradiol) OOS. Anticipated to be available Autumn 2021
FemSeven® 75 (estradiol) OOS. Anticipated to be available Autumn 2021
FemSeven® 100 (estradiol) OOS. Anticipated to be available Autumn 2021
Intrarosa® (Prasterone) Available – Fully in stock
Zoely® (nomegestrol acetate/estradiol) Available – Fully in stock

Theramex will continue to keep health care professionals informed of any changes. We would like to thank both patients and prescribers for their continued patience.

Note to pharmacists

For pharmacists and healthcare professionals who wish to place orders, please contact Alliance Healthcare via your usual channels.

Novartis pharmaceuticals

Supplies of Estradot TTS-75, Estradot TTS-25, Estradot TTS-37.5, Estradot TTS-50 and Estradot TTS-100 are all available. Estradot 37.5mg has been QA released and is now available to order.

If you are a healthcare professional and would like further information, please contact the Novartis Pharmaceuticals UK Medical Information Services by email; medinfo.uk@novartis.com or by phone; +44 1276 698370

Norgine UK – Estraderm MX patches

Estraderm MX estradiol 25 patches. Available

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

Estraderm MX estradiol 100 patches. Available

Viatris HRT products 

Viatris is a new global healthcare company formed in 2020 through the combination of Mylan and Upjohn.

For stock updates on the Viatris HRT range, you can also visit www.mywayhub.co.uk/range

Viatris HRT stock can only be obtained through AAH, Alliance and Phoenix, if you need assistance from us please contact productenquiries@viatris.com.

Femoston® Range – all available 

  • Femoston® 1mg estradiol + 10mg dydrogesterone. Available
  • Femoston® 2mg estradiol + 10mg dydrogesterone. Available
  • Femoston®-conti 1mg estradiol + 5mg dydrogesterone. Available
  • Femoston®-conti ultra-low dose 0.5mg estradiol + 2.5mg dydrogesterone. Available

Zumenon® Range – all available

  • Zumenon® 1mg estradiol. Available
  • Zumenon® 2mg estradiol. Available

Elleste™ oral Range – all available

  • Elleste Solo™ 1mg estradiol. Available
  • Elleste Solo™ 2mg estradiol. Available
  • Elleste Duet™ 1mg estradiol + 1mg norethisterone acetate. Available
  • Elleste Duet™ 2mg estradiol + 1mg norethisterone acetate. Available
  • Elleste Duet™ Conti 2mg estradiol + 1mg norethisterone acetate. Available

Elleste™ transdermal Range – discontinued

  • Elleste Solo™ MX patches 40mcg transdermal estradiol No longer available (discontinued) (contact Viatris for more information)
  • Elleste Solo™ MX patches 80mcg transdermal estradiol No longer available (discontinued) (contact Viatris for more information)

Pfizer

PRODUCT RECALL (as referred to in the previous BMS HRT update): Duavive. Conjugated equine estrogen 0.45 mg + 20 mg bazedoxifene         

In 2018 Pfizer communicated that it planned to discontinue Duavive in the UK. Pfizer have continued to supply Duavive to patients since then but now all remaining supplies have been exhausted.

Doctors and/or Healthcare Professionals are best equipped to advise on alternative options. Impacted patients should follow local GP surgery guidance on the best way to contact them during this time.’’

Please see information on the availability of Pfizer’s other HRT products below:

Premique available

Conjugated equine estrogen 0.3 mg + medroxyprogesterone acetate 1.5 mg. Available

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.  Available

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 0800 023 2573., to guide them to their wholesale suppliers.

Bayer

Progynova 1mg estradiol tablets. Available
Progynova 2 mg estradiol tablets. Out of stock 29 November 2021.

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

Mirena IUS. Available

Qlaira. Out of stock until April 2022

Endo Pharmaceuticals

Testim testosterone gel. 50 mg tube. Available

Off-label use for female testosterone replacement (5 mg a day).

Medical Information Direct Line 0800 069 8421

http://www.endo.com +353 1 268 2000

E-mail medinfoEU@endo.com

Aspen

Ovestin. Estriol topical vaginal cream. Available

Marlborough

Estriol 0.01%. Topical Estriol vaginal cream. Available

Flynn Pharma Ltd

Blissel 50 micrograms estriol vaginal gel. Available

Shionogi BV

Senshio (ospemifene) 60mg 28 tablet pack – Available. No supply shortage

Shionogi UK has decided to discontinue commercial support behind Senshio (ospemifene). However, Shionogi Europe will continue to support existing and upcoming formulary applications through the EU Med Affairs and Senshio remains available to prescribe in the UK for patients who need it.

Any supply issues, medical information enquiries or questions regarding formulary applications should be addressed to the company on 020 3053 4190 or contact@shionogi.eu.

Kyowa Kirin Ltd

Tostran 2% Gel. Available

Off-label use for female testosterone replacement (10 mg per measure to take 2-3 times a week).

If difficulty obtaining supplies, the company suggested contacting their customer care on: medinfo@kyowakirin.com; or telephone 01896 664 000.

Lawley Pharmaceuticals

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

AndroFeme 1 remains available in the UK with no shortages anticipated and the UK ‘specials’ status remains.

On 23rd November 2020 Australia’s regulatory granted AndroFeme 1 full marketing authorisation and registration on the Australian Register of Therapeutic Goods.

The approved indication for the management of hypoactive sexual desire dysfunction (HSDD) in postmenopausal women.

There will be some minor text and colour scheme changes to the tube and carton appearance, but no changes to the formulation. These changes will be implemented in late July 2021.

Merck Sharp & Dohme Limited

Livial (2.5 mg Tibolone)   (x84 packs). Available

Livial (2.5 mg Tibolone)   (x28 packs). Available

 

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

Haitham Hamoda, Chairman, British Menopause Society