The latest wave of an ongoing shortage of estrogen patches has some Alberta women scrambling to track down supplies or find alternatives.
Health Canada’s drug product database shows there were shortages of the three different strengths of the Estradot patch, as well as two forms of the Estradiol Derm patch, as of Monday morning. Both of them are manufactured by Sandoz Canada.
“I’m kind of stuck here,” said Diane Reid, 59, who spent years trying to find the right treatment for her menopause symptoms, which include hot flashes, difficulty sleeping, brain fog and fatigue.
Reid, who lives in Edmonton, eventually ended up using an Estradot patch and found relief.
But she hasn’t been able get the right dose through her pharmacy due to the latest supply problems.
“What do I do? Do I just literally live with this? For a lot of us it’s not an option, because the symptoms are so bad you just can’t function,” Reid said.
Reid said alternatives either don’t work as well or cause side effects. She’s now using a combination of a weaker patch strength and an estrogen gel to try and get by until the shortage ends.
Dr. Shafeena Premji became aware of the latest round of shortages about a month ago.
“Patients are calling our clinic asking, ‘What else can I take? Is there a substitute?’ Pharmacies are asking for an adaptation to the prescription,” said Premji, a Calgary family physician specializing in menopause care.
“This really does put a barrier for that woman to be able to feel she can get her medication in a timely and appropriate way.”
Premji is also a board member with the Canadian Menopause Society.
She said in addition to the patches produced by Sandoz, Climara patches, manufactured by Bayer, are also sold in Canada. While there have been supply problems with Climara in the past, no shortages of that brand are currently reported.
There are also other forms of hormone therapy, including pills and gels that can be applied to the skin.
Switching to a different delivery system isn’t always ideal, she said.
“The dosing is not always perfectly aligned,” Premji said. “That can cause havoc with respect to her response and her symptoms.”
Problems can include breakthrough bleeding, she said.
Heba Elbayoumi, owner of Heathers Pharmacy in Calgary, said she’s getting several calls a day from women who are not her usual customers, trying to track down stock.
“Over the last couple of years we’ve noticed that they’re on cycles of being available and then not available,” she said.
“Unfortunately I think this round, the shortages are really beyond what I personally anticipated.”
Demand surges
Sandoz Canada said fluctuations in demand, including surges over the last several years, are the primary driver of the current supply problems and it planned to increase production by more than 20 per cent this year.
The database lists end dates in March and April for the current shortages, including one shortage expected to end on Monday.
According to a spokesperson, these dates indicate when stock is expected to return to “predictable and manageable” levels.
But manufacturing for this type of medication is very complex, the statement said, and ramping up capacity is difficult.
“Given the sustained and elevated demand for these products, normalization does not occur overnight,” said Christian Ouellet, vice-president of corporate affairs.
“Even once the formal shortage period ends, supply levels, inventory rebuilding, and order fulfillment may continue to stabilize progressively over the course of the year.”
Health Canada said it knows how important hormone replacement therapies are for Canadians who use them and is actively monitoring supplies.
“While individual formats may go into shortage, alternatives remain available,” a spokesperson said in an emailed statement.
Health Canada is urging patients to talk to their health care provider or pharmacist if they’re impacted by the shortage.
The Alberta government said it is also aware of the supply problems and is monitoring the situation, noting some strengths of the Estradot patches remain available, along with other estrogen products.
“It just puts a spotlight on the challenges we have in getting good menopausal health care to patients,” said Dr. Fiona Mattatal, a Calgary-based obstetrician-gynecologist who has been guiding her patients through similar shortages for several years.
“We started to hear about pharmacies kind of stockpiling patches for patients in Calgary … I think everybody’s trying to do their best for patients in a very frustrating situation.”
Awareness on the rise
According to Mattatal, awareness about menopause is growing and she’s not surprised to see an increase in demand.
“Menopause is having its moment, finally,” she said.
For example, British Columbia recently signed onto the national pharmacare program, giving residents free access to menopausal hormone therapy.
“So that might increase demand as well for the whole category of medications.”
Meanwhile, Elbayoumi said it’s important that patients work with their physician and pharmacist to find the alternatives that work best for them.
Although it’s not ideal, she said patches can often be cut or doubled up, if needed, to get the right dose.
According to Elbayoumi, compounding pharmacies can also create gels or creams to fit a patient’s needs.
“We are not out of options.”
