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Title BMS issues update on HRT supplies
Date 17 April 2020
Full Story

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.


For more information about different types of HRT and when to use what, see our decision tree.

We recognise that many women are likely to experience difficulties in obtaining HRT supplies due to the current coronavirus situation. We also 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 also been put under additional pressure, with consultations and advice prioritised to dealing with serious and potentially life-threatening medical issues.


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 at all 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.

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

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, Manage my Menopause and 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 has been obtained direct 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
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
Imvaggis vaginal 0.03 mg estriol vaginal pessary. Available

Gideon 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.
This is available to order via AAH

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. 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 (update March 2020)
Evorel: UK Stock Update from Theramex:
"Since acquiring the Evorel family of products in October 2019, we have been committed to bringing the products back to patients as quickly as possible.
We have restarted the manufacturing process, fast-tracked supply, shortened timelines and are pleased to be able to say that we have brought both the Evorel 50 and Conti lines back to market six months ahead of what had originally been communicated."

Please note below the most up to date stock availability dates for all Evorel products:


Evorel 50 Available

Evorel Conti Available

Evorel 25 10th April 2020

Evorel 75 17th April 2020 (limited supply)

Evorel 100 17th April 2020 (limited supply)

Evorel Sequi May 2020

Further information:

Patients who have any questions with regards to their treatment options should speak to their GP.

For pharmacists and healthcare professionals who wish to place orders for the Evorel range of products, please contact Alliance Healthcare via your usual channels.


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.


Norgine - Estraderm MX patches

Estraderm MX estradiol 25 patches. Available but low in supplies until July 2020

Estraderm MX estradiol 50 patches. Available but low in supplies until July 2020

Estraderm MX estradiol 75 patches. Available but low in supplies until July 2020

Estraderm MX estradiol 100 patches. Available but low in supplies until July 2020


Mylan HRT products

Supply information as of 14th April 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

Mylan HRT stock can only be obtained through AAH, Alliance and Phoenix.

If you have difficulty obtaining supplies please contact Mylan Customer Service on: productenquiries@mylan.com


Elleste™ Oral Range - currently unavailable

Elleste Solo™ 1mg estradiol Out of stock until second-half 2020

Elleste Solo™ 2mg estradiol 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 up-to-date information about current supply of their HRTs & useful webinars.


- The overview of stock availability page can be accessed on:

https://mywayhub.co.uk/en-gb/range


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.

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


Flynn Pharma Ltd

Blissel50 micrograms estriol vaginal gel. 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. Small amount of remaining stocks 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

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


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