Oestrogel is a popular Hormone replacement therapy (HRT) medication which contains estradiol. In recent months Oestrogel has been going out of stock, intermediately coming back to replenish the backlog of prescriptions with owings, causing further supply issues. Some patients were prescribed Oestrogel alternative medicines. This post summarises Oestrogel alternative medicines.
What is Oestrogel?
Oestrogen is a type of hormone replacement therapy (HRT) prescribed for oestrogen deficiency symptoms in postmenopausal women. Oestrogel comes as a pump-pack product which delivers estradiol in form of a gel (Oestrogel Pump-Pack 750 micrograms/actuation Gel2).
Each pump of Oestrogel gel delivers 1.25 g of gel which contains 0.75 mg of estradiol. In most women, two pumps of Oeastrogel provide effective relief of menopausal or postmenopausal symptoms. If needed the dose can be increased up to a maximum of four pumps a day (Emc, 2021).
Shortage of Oestrogel had a negative effect on the availability of alternative HRT medicines. Generally HRT market has been under the pressure for the last few months with different HRT medicines going out of stock.
In the latest development, the Government has issued serious shortage protocols (SSPs) for three HRT products. SSPs were introduced in the past to allow a pharmacist to supply alternative medication when a drug is out of stock. Each SSP clearly states which medication can be supplied if one is out of stock. Each SSP also have an expiry date, but if needed can be extended by the Government.
The newest SSPs apply to three different HRT products (Oestrogel, Ovestin cream and Premique Low Dose) allow pharmacists to limit the supply of HRT medicines (mentioned above) to 3 months, without needing to seek prescriber’s authorisation. It is common for HRTs to be prescribed to cover a supply of over 3 months, and up to 12 months The newest SSPs are welcome, although introduced very late, since the availability of HRTs including Oestrogel has been problematic for the last few months.
What to do when Oestrogel is out of stock?
Over the last couple of months, Oestrogen intermediately came back in stock 3 times. With a number of owings, the stock did not last long. Patients who have enough stock of Oestrogel to last over a few weeks should wait to see if supply of Oestrogel improves in coming weeks. Trying an independent pharmacy rather than a larger chain such as Boots or Lloyds Pharmacy may bring more luck. Independent pharmacies use additional 1-2 suppliers which Lloyds and Boots don’t. I closely monitored Oestrogel availability recently in three main suppliers. On the last occasion, Phoenix wholesaler (supplying independent pharmacies, Numark and Rowland Pharmacies) was the quickest to resupply Oestrogel. However, this is not a set rule.
What is HRT? (video)
Oestrogen alternative medicines
Different medicines contain estradiol including patches, tables and one alternative medication which comes in a form of a gel.
1. Sandrena gel
Sandrena is a brand of HRT gel which contains estradiol. Sandrena comes in a form of single-dose containers, either as 1 mg or 0.5 mg gel containing containers.
Sandrena is applied once daily to dry and clean the skin of the lower trunk of the right or left thigh, on alternate days.
Unfortunately, Sandrena has been going out of stock in recent weeks due to increased demand caused by supply issues with Oestrogel. 0.5mg Sandrena is less commonly prescribed and so far it has not been affected by out of stock (yet).
2. Lenzetto spray
Lenzetto delivers estradiol to the skin in form of a spray. Each spray delivers 1.53 mg of estradiol. One spray is usually administered once daily to a dry skin of the forearm. Lenzetto has been also going out of stock with supply problems in the last few months.
Oestrogel alternatives – Estradiol patches
HRT patches need to be worn continuously and changed twice or once a week, depending on the brand of the patch. This offers a different method of drug delivery.
4. Evorel patches as Oesrogel alrav
Evorel patches are the most commonly prescribed estradiol containing patches (prescribing statistics for the last 12 months at openprescribing.net). Evorel patches are applied to the skin twice a week. Evorel range includes:
- Evorel 25: 1.6 mg estradiol/patch
- Evorel 50: 3.2 mg estradiol/patch
- Evorel 75: 4.8 mg estradiol/patch
- Evorel 100: 6.4 mg estradiol/patch
Are Evorel patches out of stock?
Last year (2021) all Evorel patches were short in supply due to change of the company which produces them. The situation improved for a while. At this time (March-April 2022) different strengths of Evorel patches have been going out of stock intermediately.
5. Estradot patches
Estradot is another brand of patches containing estradiol. Estradot patches are work continuously and applied twice a week. Estradot range include:
- Estradot 25 (estradiol content: 0.39mg)
- Estradot 37.5 (estradiol content: 0.585mg)
- Estradot 50 (estradiol content: 0.78mg)
- Estradot 75 (estradiol content: 1.17mg)
- Estradot 100 (estradiol content: 1.56mg)
Are Estradot patches out of stock?
A similar situation applies to Estradot patches as with other HRT medicines. Intermediate supply problems affect the availability of Estradot patches.
6. FemSeven patches
FemSeven patches come in two different strengths, FemSeven 50 and FemSeven 75, containing 1.5mg and 2.25mg of estradiol hemihydrate respectively.
7. Estraderm MX patches
Estraderm patches are worn continuously, however twice weekly application is required. Estraderm MX patches include:
- Estraderm MX 25 (estradiol content: 0.75mg)
- Estraderm MX 50 (estradiol content: 1.5mg)
- Estraderm MX 75 (estradiol content: 2.25mg)
- Estraderm MX 100 (estradiol content: 3mg)
8. Progynova® TS patches
Progynova TS patches come in two strengths: 50 ( patch contains 3.8 mg estradiol) and 100 (patch contains 7.6 mg estradiol) micrograms. Progynova TS patches are applied on weekly basis and worn continuously.
Estradiol containing HRT tablets alternative to Oeastogel
Elleste-Solo tablets come in two strengths, 1 and 2 mg tablets. Elleste Solo tablets can be taken continuously in women without a uterus.
10. Zumenon tablets
Similarly to Elleste-Solo, Zumenon tablets come as 1 and 2mg tablets.
Oestrogen alternative drugs – summary
Despite supply issues with Oestrogel, women who need HRT treatment with estradiol, have a good variety of alternative treatments including Sandrena gel, HRT patches and tablets. Unfortunately, the supply of the best alternative option to Oestrogel – Sandrea patches seems to be affected by increased demand.
EMC (2021). SmPC: Oestrogel. Available at: https://www.medicines.org.uk/emc/ Accessed on 03/04/2022
OpenPrescribing.net (2022). Analysis: Evorel. Available at: https://www.openprescribing.net Accessed on 03/04/2022