Menopause drug shortage in Spain: hospitals pay triple, some women up to 20 times more

Spain's shortage of menopause hormone treatments is now hitting wallets as well as pharmacy shelves. Hospitals are importing medicines at up to triple the usual price, and some women have had to switch to a far more expensive alternative.

What happened?

A month ago, Catalonia opened the door to compounded medicines (formulación magistral, made-to-order preparations) in community pharmacies. It looked like a possible way out. Now the main response across Spain is a different one: exceptional imports from other European countries, channelled through hospitals.

Spain's medicines agency, the Aemps, now authorises hospitals to turn to foreign products. Patients pay nothing extra, but the health system pays up to three times more for drugs such as Lenzetto, one of the transdermal estradiol products hit hardest by the shortage.

Supply is thin. Germany is one of the markets being tried, but demand there is high too. Catalonia first centralised imports at the Clínic and Vall d'Hebron hospitals, then opened them to any hospital service. Mercè Barau, of the Barcelona pharmacists' association, says some hospitals have received barely one unit.

Why are some women paying 20 times more?

Lenzetto is covered by Spain's public health system, and a patient at the maximum co-payment pays about 0.85 euros. With stock short, a common substitute is Oestraclin, an alcohol-based gel sold in pharmacies but not covered. It costs around 17.38 euros. That is up to 20 times more for a similar treatment.

The cost can weigh even more on people who need higher doses of estradiol, such as some trans women.

Pharmacists also describe women going from pharmacy to pharmacy. Barau recalls a 33-year-old woman, whose uterus and ovaries were removed after gynaecological cancer, who found one of the last units after searching across the city. Finding it this month does not guarantee it next month.

Compounding is no quick fix either. It is designed for one patient's individual needs, and pharmacies cannot make equivalents of some sprays or transdermal patches, which are among the most requested formats.

What's next?

The problem is not only Spanish. Regulators have reported Lenzetto supply problems in France, Italy, Sweden, Norway, the Czech Republic, Portugal, Denmark, Poland, Ireland, Greece and Finland. The European Union treats it as a critical supply needing coordination between member states.

The Aemps is talking to other European authorities and drug companies to bring in other estradiol products, and is drafting a consensus document with scientific societies on using available treatments wisely.

Gedeon Richter, which markets Lenzetto, expects supply to start recovering in mid-November. Full normalisation would come gradually through 2027.