Most strengths of Elleste tablets and all strengths of FemSeven Conti and Sequi patches are currently unavailable, and shortages of Evorel patches are anticipated to begin in September. Prescribers can find suitable alternatives using the MIMS HRT comparison table, and follow the latest stock updates with the live MIMS drug shortages tracker.
Mylan, which produces Elleste, told MIMS: "Our manufacturing partner continues to experience interruptions in the production of certain strengths of Elleste, Mylan’s HRT. We will continue to provide updates, including timing for resolution, as we receive them.
Mylan is working closely with our manufacturing partner to stay informed of deliveries and we are maintaining a regular dialogue with the Department of Health and Social Care and the British Menopause Society to provide frequent updates on supply.
We offer a website for healthcare professionals, called MyWay HRT Hub & Treatment Navigator that includes a dedicated section showing the latest stock constraints and alternative choices from Mylan’s HRT portfolio."
Janssen, the manufacturer of Evorel, says shortages of other products have increased demand for Evorel. Evorel Conti (estradiol/norethisterone) patches and Evorel (estradiol) 100 patches are expected to be out of stock from September; Evorel Sequi (estradiol/norethisterone) and Evorel 50 and 75 patches from October; and Evorel 25 patches from March 2020.
Both FemSeven Sequi and FemSeven Conti (estradiol/levonorgestrel) have been out of stock in the UK since the end of 2018 and have been removed from MIMS until they are relaunched. Manufacturer Theramex says they are unlikely to be available again before early 2020.
The FemSeven shortage relates to a quality issue with the adhesive that keeps the patches attached to the skin. Theramex says it is evaluating other sources of adhesive from alternative suppliers but it will need to conduct experimental testing to confirm that the new adhesive meets its quality standards, and this process can be time consuming.
Theramex says there is no other HRT with precisely the same composition as FemSeven Conti and Sequi and so it is unable to suggest any alternative treatments.
Match hormone components
The British Menopause Society said in May that it was aware of supply issues with many HRT products but was "reassured that some are only temporary". It advises prescribers to find equivalent types by looking at the oestrogen and progestogen component and matching it as closely as possible to another brand - for example Kliofem can be prescribed instead of Elleste Duet Conti.
The society acknowledges that an exact match is not always possible. Sometimes it will be necessary to prescribe the oestrogen and progestogen separately to make the closest match. The society also highlights that different brands of the same medication may vary in appearance or excipients.