Oestradiol (Estradot) patches: Supply issue

Last Updated: 29 September 2023

Supply issue Active

We continue to monitor supplies of oestradiol patches.

On this page

Updated on 28 September 2023

Supply status updated.

Supply status

We want to acknowledge the stress this supply issue may be causing some people. We are taking every measure to ensure that people can continue to access this treatment.

Schedule listing for all oestradiol patches(external link)

Pharmacists, please check with your wholesaler on availability.

Availability of oestradiol patches 29 September 2023

Stocks in pharmacies and wholesalers may differ from what's shown here. The product is on allocation, which means pharmacies are only receiving a small amount each week. This is to ensure equitable distribution of the limited supplies around the country.

Summary of availability

Strength	Estradot	Estradiol TDP Mylan	Viatris
25 mcg	emergency only	✗	n/a
50 mcg	✓	✗	✗
75 mcg	✓	✗	✗
100 mcg	✓	✗	✓

Detail of availability:

25 mcg

Estradot (pharmacode 2358840) is not available. There is only an emergency supply available.
Estradiol TDP Mylan 25 mcg (Pharmacode 2601583) is not available.

Estimated monthly usage: 8,871 packs

50 mcg

Estradot (Pharmacode 2358867) is available.
Estradiol Viatris (Pharmacode 2661470) is not available.
Estradiol TDP Mylan 50 mcg (Pharmacode 2601591) is not available.

Estimated monthly usage: 12,897 packs

75 mcg

Estradot (pharmacode 2514346) is available.
Estradiol Viatris (Pharmacode 2661489) is not available
Estradiol TDP Mylan 75 mcg (Pharmacode 2605317) is not available.

Estimated monthly usage: 3,780 packs

100 mcg

Estradot brand (pharmacode 2358883) is available.
Estradiol Viatris (Pharmacode 2662418) is available.
Estradiol TDP Mylan 100 mcg (Pharmacode 2661497) is not available.

Some people have mentioned difficulty getting the 100 mcg patch, there is stock - but it supplies may be limited.

Estimated monthly usage: 5,650 packs

Issues with alternate brands

We have heard that people are experiencing issues with the Mylan and Estraderm brands of patches.

Check the relevant information leaflet on the best way to apply the patch. Your pharmacist may also be able to offer more guidance.(external link)

Mylan consumer information sheet - Medsafe [page 3 PDF](external link)

Estraderm consumer information sheet - Medicines UK [page 7 PDF](external link)

The steps for applying the patch for Estradot are not on the consumer information sheet. They are on a separate sheet in the Estradot box. You can read the Estradot consumer information information sheet [PDF](external link) but it doesn't contain application instructions.

Oestradiol gel and other products

Pharmac has issued a Future Procurement Opportunity (FPO) for the supply of transdermal oestradiol products, that is products that deliver oestradiol through the skin. The FPO can be found on the government’s procurement site, GETS(external link)

An FPO is the first step in a procurement process.

We hope this process will alleviate supply pressures and provide people with a greater range of oestradiol presentations. Any funding decisions would be subject to the future bids received from suppliers and available budget.

We will continue to secure supply of oestradiol patches to address this supply issue.

Clinical advice on oestradiol products

Our clinical advice network has said that the gel will be a useful addition to the Schedule. They noted that many people were stressed and frustrated by the ongoing supply issues with the patches.

The advice indicated that demand for oestradiol patches would likely continue to increase. While tablets are available, patches and gel are a better option for many people. Patches and gel deliver the oestradiol through the skin (transdermally).

For some people, especially on a lower dose, patches are the best option. However, clinicians indicated that many people would consider moving to the gel, if it were offered.

Endocrinology Advisory Committee full summary of advice [PDF, 110 KB]

Reproductive and Sexual Health Advisory Committee full summary of advice [PDF, 115 KB]

Who to contact

For patients, if the application information doesn't help, contact Viatris 0800 168 169 or medinfo_anz@viatris.com - they have a team that can help.

For pharmacists, please report any concerns to Medsafe(external link) about efficacy of the patches.

About this supply issue

Demand has sky-rocketed

Over the last 2 years demand has more than doubled, demand has grown from about 1 million patches in 2020 to over 2.3 million patches a year in 2022.

The increasing, rapidly shifting demand means that the supplier needs to continually amend its planning and forecasting to increase orders for delivery to New Zealand, which can take time.

Demand has increased globally

Globally, suppliers are reporting extraordinary increases in demand for oestradiol patches. As a result, they are building up their production capabilities. In addition, to this rapid increase in demand, distribution issues have also complicated supply, due to global and local supply chain disruptions caused by COVID-19.

HRT: inside the complex global supply chain behind a $20bn market - The Guardian(external link)

What Pharmac is doing

Because of the ongoing global supply issues, Pharmac is:

encouraging our supplier to review their forecasting and demand planning for the New Zealand market
funding a range of alternative brands of the patches to ensure continuity of supply of this medication for New Zealanders
exploring if there are other presentations or products we could secure and fund in New Zealand
keeping Estradot stock on allocation, meaning people can only be dispensed one month of patches at a time to ensure equitable distribution of the limited stock
where appropriate, providing support for suppliers to help speed up delivery of stock
prioritising seeking clinical advice on which products would be appropriate for people in New Zealand seeking oestradiol treatment, and
providing regular updates on our website so that people affected by the short supply of this treatment will have the latest information about its availability and alternatives available.

We understand that there will be people in New Zealand experiencing debilitating symptoms. We're exploring every possible option to help New Zealanders to access the medicines they need.

Thank you for your patience

We want to acknowledge the stress this supply issue might be causing some people. We recommend people contact their healthcare practitioner if they have concerns about their medicine.

Other oestradiol products

At this time we are not aware of any supply issues for oestradiol (branded as Estrofem, partially funded) or oestradiol valerate (branded as Progynova, fully funded) but it is important to note that these are different medicines so will require a new prescription and guidance from a healthcare practitioner.

Who to contact

If you are a prescriber or pharmacist with questions about this supply issue, email enquiry@pharmac.govt.nz

If you use the oestradiol patches, contact your health professional. Pharmac cannot give clinical advice about the best treatments for you.

Previous supply issue: October 2021 supply issue 25 & 50 mcg patches

Resupplied

The supplier has advised that Estradot transdermal

25 mcg (pharmacode 2358840) patches are now available
50 mcg (pharmacode 2358867) patches are now available.

The 75 and 100 mcg patches are not affected by this supply issue.

Alternative product

Estradiol TDP Mylan brand patches were available for supply as an alternative. They will be delisted from the Schedule on 1 May 2022.

Pharmacodes:

25 mcg patches 2601583
50 mcg patches 2601591

Check the listing in the Schedule(external link)

The patches are not Medsafe approved, as such they need to be supplied in line with section 29 of the Medicines Act.

Prescribing and supplying a medicine under section 29

Section 29 of the Medicines Act allows for medicines that are not Medsafe approved to be prescribed and supplied to people. The medicine must be prescribed by someone registered with the Medical Council of New Zealand – e.g., doctors.

We know supplying a medicine under section 29 is not ideal. In this case, however, the alternative would be for patients to have no oestradiol patches.

We apologise for any inconvenience this causes.

Prescriber and pharmacist requirements for section 29 medicines – Medsafe website(external link)

What patients need to know about section 29 medicines – Health Navigator website(external link)

Previous supply issue: February 2021 to 6 May 2021

Previous supply issue: August 2020 to January 2021

In August 2020, the 25 mcg and 50 mcg Estradot patches ran out. Both patches were available again by January 2021.

What we did to address the issue

We listed 2 alternatives to ensure people can continue to access the medicine they need. One patch was not approved by Medsafe and one patch had a different dosing regime.

25 mcg patches

Estradiol TDP Mylan 25 mcg per day patches (pharmacode 2601583) were listed on the Schedule from 1 November 2020 to cover the out of stock. They had to be supplied under section 29.

50 mcg patches

To cover the out of stock, we listed:

Climara 50 mcg per day (pharmacode 371114)
Estradiol 50 mcg per day patches (pharmacode 2601591)

Estradiol is an unapproved brand of oestradiol and needs to supplied in line with section 29 of the Medicines Act 1981.

There was a dosing regimen change for Climara.

Dosing regimen difference for Climara

Note that there is a difference in dosing regimen for Climara. It should be applied every 7 days (i.e. once weekly). The other oestradiol patches should be applied twice a week.

Quantity restriction for Climara: 1 patch per week

Due to the dosing difference, we restricted Climara patches to no more than 1 patch per week in the Schedule from 1 July 2020