Last updated: 3 May 2022

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

Besins have reported ongoing insufficient supplies of Oestrogel in the UK caused by the increased demand for HRT in the UK. Besins have indicated they are receiving deliveries of this product on a regular basis, and acknowledge that the current supply is sometimes insufficient to meet the continuing extraordinary demand. Besins have delivered significant volumes of Oestrogel into wholesalers recently, which is approaching double the amount supplied in the same period January to April last year. The company is working to increase and expedite supplies to wholesalers and pharmacies across the country. In addition to the increases described above, Besins Healthcare plans to further increase production capabilities to enable further supplies of this product into the UK market in the longer term.

The BMS advises women who are experiencing difficulty in obtaining Oestrogel to consider equivalent alternative HRT preparations. This could include Sandrena gel (0.5mg or 1mg) or Lenzetto spray preparations.

Prescribers should consider using equivalent preparations to those that their patients are currently using. If an exact match is not possible, prescribers can seek guidance available on the BMS website to clarify equivalent doses:

BMS HRT preparations and equivalents

BMS HRT – practical prescribing

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

Besins have recently released a new Testogel sachet (40.5mg/2.5 ml). The current 50 mg/5ml sachet will be available until the end March 2022.
The new 40.5 mg/2.5ml sachet could be administered off-label over 8 days (1/8th of a sachet will deliver 5 mg) and this is contained in a smaller volume of gel.

Alternatively, Testim (off-label use), Tostran (off-label use) or Androfeme could be prescribed as referred to in the update.

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:

Framework for restoration of menopause services in response to COVID-19

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.

Statement for the public from Besins Healthcare (UK) Ltd regarding Oestrogel® (estradiol) Pump-pack supply:

We regret the continuing situation regarding insufficient supplies of Oestrogel into the UK which is caused by the increased demand for HRT in the UK. While we are receiving deliveries of this product on a regular basis, we acknowledge that the current supply is sometimes insufficient to meet the continuing extraordinary demand we are experiencing.

We have delivered significant volumes of Oestrogel into wholesalers recently, which is approaching double the amount we supplied in the same period January to April last year. With demand continuing to increase we are doing everything we can to manage, increase and expedite supplies to wholesalers and pharmacies across the country.

In addition to the increases described above, Besins Healthcare plans to further increase our production capabilities to enable us to supply even more of this product into the UK market in the longer term.
Besins are acutely aware of the impact this situation is having on patients and understand that they are worried about fulfilling their prescription. We advise patients who are concerned to discuss their needs with their doctor or pharmacist.

We are committed to communicating any significant changes of supply with patients, healthcare professionals and other stakeholders.

Utrogestan (micronised progesterone) 100 mg in continuous combined regimen and 200 mg in sequential regimens. Available
Testogel 50 mg, gel sachet (sachet over 10 days to provide 5 mg a day). Available
Testogel 40.5 mg gel sachet – a new sachet preparation – is now available. Sachet over 8 days to provide 5 mg a day.
Off-label use for female testosterone replacement (5 mg a day).
Imvaggis vaginal 0.03 mg estriol vaginal pessary. Available

Gedeon Richter

IMPORTANT NOTIFICATION IMPACTING SUPPLY OF LENZETTO (ESTRADIOL HEMIHYDRATE) 1.53 MG/SPRAY, TRANSDERMAL SPRAY, SOLUTION FROM GEDEON RICHTER

Gedeon Richter is the Marketing Authorisation holder of Lenzetto 1.53 mg/spray, transdermal spray, solution, MA number PL 04854/0130.

Lenzetto is available in the UK, in both a x1 and x3 pack. After a period of unusually high demand, we are experiencing a temporary shortage in supply with the x1 pack, which we expect to be resolved at some point in April 2022.

The x3 pack remains in full supply, with good levels of stock.

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

Due to unprecedented demand over recent months, we have experienced some supply issues with Sandrena Gel. We are sorry about this situation and understand how distressing this situation is for patients unable to obtain supplies of our products. We continue to receive regular supplies of all HRT products from our European parent company and are doing everything we can to manage and increase supplies for the UK.

We anticipate that all products will be back in stock by the end of May 2022. We are sorry for the impact this situation is having and are endeavouring to minimise inconvenience to pharmacies and patients.

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

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) Expected June 2022
FemSeven® 50 (estradiol) Available – Fully in stock
FemSeven® 75 (estradiol) Available – Fully in stock
FemSeven® 100 (estradiol) Expected May 2022
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 UK Healthcare (previously Mylan)

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

Due to a short delay in our supply chain, there will be a short period of out of stock on Premique Low Dose. Estimated resupply will be week commencing 16th May.

Currently there are no supply issues with other Pfizer HRT products.

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. low stock, but available after 28.03.2022
Progynova 2 mg estradiol tablets. low stock but currently available, improvement after 11.04
Progynova TS estradiol 50 patches. Available
Progynova TS estradiol 100 patches. Available
Mirena IUS. Available
Qlaira. Available

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
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
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.

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