Menopause patients left without treatment: what is happening in Spain?
Hormone therapy shortages leave patients across Spain searching for treatment
Poinews.com – Women in Spain who rely on hormone therapy for menopause symptoms have faced months of uncertainty as supplies of several estradiol medicines have become difficult to obtain. What first appeared to be a shortage of one product, the transdermal estradiol spray Lenzetto, has affected the wider market for hormone replacement therapy.
For many patients, the disruption has meant visiting multiple pharmacies, changing prescriptions or going without the treatment they normally use. Estradiol medicines are often prescribed to help manage symptoms linked to menopause, but they also have other medical uses, including osteoporosis prevention and gender-affirming hormone treatment for trans women.
A shortage that spread beyond one medicine
The immediate issue centred on Lenzetto, a spray applied to the skin that delivers estradiol. As access to that product became more limited, demand shifted towards alternatives such as patches and gels. Those medicines were not prepared for the sudden increase in requests, creating pressure throughout the supply chain.
Spain’s Medicines and Medical Devices Agency, Aemps, has recorded availability problems involving products including Evopad, Estradot and Bijuva. The situation has therefore become more than a single-brand disruption: it has exposed how quickly shortages can spread when patients and prescribers must turn to a limited group of comparable treatments.
Hormone replacement therapy is not identical from one product to another. Delivery methods, doses and combinations can differ, so switching medicine may require medical advice rather than a simple pharmacy substitution. That can add further strain for patients who are already trying to locate a treatment that works for them.
Signs of relief expected in November
Javier Padilla, Spain’s Secretary of State for Health, has said conditions should begin improving from November. Gedeon Richter, the manufacturer of Lenzetto, expects the medicine to return to Spanish pharmacies during the second half of that month.
Yet a full resolution may take much longer. The company has indicated that global constraints could prevent it from completely covering demand through 2027. It anticipates progressively being able to satisfy demand from the latter half of 2027.
Aemps has urged caution over the timetable, noting that forecasts previously communicated by Gedeon Richter have not always proved accurate. For patients, that means a return of stock does not necessarily guarantee that every pharmacy will immediately have a reliable supply or that the wider estradiol market will quickly stabilise.
Demand rose sharply over recent years
The pressure on Lenzetto developed after a rapid increase in use. In Spain, the number of units distributed rose from roughly 13,000 in 2018 to approximately 123,000 in 2024. That growth left production capacity struggling to keep pace.
Gedeon Richter has linked the shortage to demand exceeding its manufacturing capability, as well as difficulties ensuring enough availability of the applicator device used for the spray. The manufacturer has stressed that the problem is not related to the medicine’s quality or safety.
“Have not always been accurate”
Aemps used those words in reference to supply forecasts provided by the manufacturer. The agency says it began receiving complaints from users unable to find Lenzetto in February and contacted the company at that stage. Initially, Gedeon Richter maintained that demand was being met normally.
That position changed shortly afterwards. The company later said it was dealing with a demand increase it could not immediately absorb, alongside problems involving the administration device. It subsequently announced that stocks had been exhausted and that markets throughout 2026 were affected.
Aemps has also said the company did not meet its duty to provide advance notice of incidents that could interrupt the continuous supply of the medicine. Early notification is important because it gives health authorities, doctors and pharmacies more time to consider alternatives and communicate with affected patients.
A European supply problem
Spain is not alone in facing the consequences of constrained estradiol supplies. Padilla has described a sharp increase in demand that has exceeded manufacturers’ capacity in several European countries. Aemps similarly views the problem as an international supply issue that is affecting European Union member states to different degrees.
The European Medicines Agency has been informed about the difficulties involving Lenzetto and is considering whether coordinated action at EU level could lessen the impact. The issue is expected to be discussed by the European group responsible for medicine supply problems.
The agency is also aware of recent disruptions involving other estradiol-based medicines within the EU. Those cases have not been classified as critical at European level and remain under the management of national authorities.
Why price changes did not solve the problem
The Spanish government has attempted several measures to improve access. One option was to increase the regulated price in the hope of encouraging more supply into the Spanish market. That step did not resolve the shortage.
Padilla has argued that the challenge cannot be reduced to price. If manufacturers lack the production capacity to make enough medicine, higher prices alone cannot create the additional stock patients need. The case highlights a broader vulnerability in medicine supply: when demand accelerates quickly, expanding manufacturing and securing specialised components can take far longer than changing commercial conditions.
For people affected by the shortage, the practical priority remains continuity of care. Patients should discuss any difficulty obtaining prescribed treatment with their pharmacist or clinician, particularly before stopping or changing a hormone medicine. As supply begins to recover, the pace and consistency of that recovery will determine whether months of uncertainty finally give way to dependable access.
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