The menopause medication crisis worsens: "They are starting to run out of all kinds"

BarcelonaAfter months of shortages in Spanish pharmacies, the Spanish Agency of Medicines and Medical Devices (AEMPS) has given the green light to the importation from abroad of Lenzetto, an estradiol spray used in hormone replacement therapy to treat the symptoms of menopause and which is also prescribed to trans women and non-binary people. The measure, however, is not a general authorization to access the medication, but rather, for the moment, only a limited number of units have been imported, which is why the supply will be reserved, as the organization specifies in a statement, for "those patients who most need the drug and cannot use other available treatments".

But the lack of Lenzetto since April in pharmacies has caused a domino effect that has affected the rest of the transdermal hormone therapies, which are the most used because they have a lower cardiovascular risk than the oral ones, in pill form. "Now all hormonal drugs are starting to run out," acknowledges Camil Castelo Branco, senior consultant of gynecology at the Hospital Clínic. "Although the situation is not catastrophic, it is very worrying, especially for certain groups of women," he adds.

María Pancorbo, a gynecologist specializing in menopause at the Vall d'Hebron Hospital, agrees: "Every day we have between three and five patients who call us distressed because they cannot find the drugs. They have gone to many pharmacies and have not found a single box." This physician warns that, if the shortage situation continues to drag on, a solution will have to be found. "These women have symptoms that incapacitate them in their day-to-day lives," she states.

In Catalonia, according to data from the Department of Health, there are more than 3,000 women with a Lenzetto prescription pending dispensation. However, they are not the only ones affected by the shortage of these transdermal preparations, as was reported by ARA. Currently, there are 12,892 Catalan women who have hormone replacement therapy prescribed –around 9% of women between 45 and 65 years old–, of which 62% in the form of a patch, 24% in the form of a spray, and 14% in the form of a gel.

Impact on health

Regarding the Lenzetto units that will arrive from abroad, the Department of Health is categorical: "The import is reserved exclusively for patients who cannot use the marketed alternatives, such as patches or gel," explains the director of the Medication Area of the Catalan Health Service (CatSalut), Anna Clopés. "When that is the case, the patient, by medical criteria, will be referred to the reference hospitals" where she will be able to access the drug, she adds.

From the gynecology department of the Clínic, it is indicated that, for the moment, priority will be given to young women with premature ovarian insufficiency; with early menopause (before 45 years of age); as well as patients with very intense symptomatology with a high impact on their quality of life, which translates into social and work absenteeism, and entails a serious impact on their physical and mental health. Also those women with a high risk of suffering from osteoporosis, as well as trans women and intersex and non-binary people.

Not all women in menopause need to follow a hormone therapy treatment. Right now, it is only reserved for those for whom this transition from the fertile to the non-fertile stage, marked by the drop in sex hormone levels, such as estrogen and progesterone, causes symptoms that negatively impact their quality of life. For example, brain fog, irritability, muscle and joint pain, hot flashes and intense sweating, vaginal dryness, or insomnia. Furthermore, hormone therapy has also been shown to provide benefits for bone and cardiovascular health, and there are several studies underway to evaluate its impact on the prevention of dementias, such as Alzheimer's, where two out of every three patients are women.

Although the AEMPS indicates that the forecast is for the situation to begin to resolve within approximately a month or a month and a half, and that, at the same time, both the Spanish government and the Department of Health claim to have urged manufacturing companies to increase production, for the moment the situation in Catalan and Spanish pharmacies remains the same: there are no preparations available. This odyssey-like situation has even caused many women to choose to travel abroad to try to obtain them, as they report through their social media.

In fact, this shortage of hormonal drugs can also be verified in real time both on the platform launched by the Spanish Association for the Study of Menopause, which collects notifications from pharmacies, healthcare personnel, and patients regarding supply shortages; and on the website of the Online Information Center for Authorized Medicines (CIMA) of the AEMPS, where most transdermal preparations carry the alert of "supply problems".

A crisis that goes back a long way

The Lenzetto crisis is a shortage of product that had already been announced. At the end of 2025, the Hungarian-based multinational Gedeon Richter—which manufactures it—began to experience difficulties in producing the quantity of product necessary to supply the global market. At that time, the company already claimed as an excuse that demand had increased exponentially in a short time and that manufacturing forecasts had fallen short.

And, in fact, there has indeed been a demand for these products, after numerous scientific studies have demonstrated their safety and benefits for cardiovascular and bone health, as well as signs of protection against dementia. That is why it is now prescribed much more than a few years ago. Added to this is the prescription of this drug to trans women and non-binary and intersex people.

To the increase in demand, added Gedeon Richter, was the fact that they were experiencing supply problems with the dispensers they use to release the estradiol doses, in spray format. While the lack of stock, in principle, would have affected all European countries, Spain was one of the most affected. Sources consulted by ARA point to the price, set by the Spanish government and much lower than what is sold in other states, as one of the main reasons. Faced with production problems, the company would have prioritized distributing it in those countries with higher profit margins.

In an attempt to alleviate this situation, the Ministry of Health already accepted an increase in the sale price in April to try to guarantee its supply, although, for the moment, it has not resulted in a return of stock. Recently, the company announced that it is already increasing production, and that from November onwards units could start arriving in Spain and a return to "normality" could occur by early 2027. Both the ministry and the Department of Health value this announcement very positively.

However, the member of the Pharmacy Office of the College of Pharmacists of Barcelona, Mercè Barau, approaches it with skepticism: "The price of Lenzetto in Spain is the same as that of countries like Greece, but up to three times cheaper than in Germany." Therefore, she considers, "it is clear that Spain will not be the first place where they will come to sell. Perhaps units will arrive, but in no way will it stabilize the market. Believing that this will happen is an act of faith."

From the Ministry of Health, they explain to ARA that they have also maintained contacts with other manufacturers of other hormonal treatment alternatives currently not funded with the aim of incorporating them into the portfolio of funded products. However, so far there has been no progress. Likewise, both the AEMPS and the General Directorate and the Department of Health have urged the manufacturing companies of hormonal preparations to increase their manufacturing capacity. In some cases, the response has been, as is the case with Estradot patches, that they are ceasing to market them in the Spanish state.

In other cases, such as the EVOPAD preparation, normality should be recovered very soon, says the AEMPS. Non-subsidized alternatives, such as the Oestraclin gel, have already increased production and, according to the Spanish agency, there is no shortage. Bijuva pills, which are also not funded, are also reportedly returning to pharmacies. Since these treatments have a monthly cost of around thirty euros, they represent a barrier for many women. "We should not reach a situation in which access to the appropriate treatment for menopause depends on each woman's economic capacity," considered Elisa Llurba, director of the Gynecology and Obstetrics Service at Sant Pau Hospital, in statements to ARA.

The Association of Pharmacists continues to argue that pharmacies can make magistral formulas with the same active ingredients as Lenzetto and demand that they be covered by CatSalut. In this regard, Clopès confirms that the Health Department is evaluating this option, although she qualifies that it must be the last resort, provided there is no other transdermal alternative.

In addition to hormone replacement therapies, there are also difficulties in accessing testosterone treatments, prescribed to women in menopause who experience exacerbated fatigue and apathy. "Would the same have happened with a medication necessary for men's health, such as Denafil or Viagra, used to treat erectile dysfunction?", asks Barau, from the Association of Pharmacists.