A month ago, Catalonia became the main focus of attention in the crisis of shortage of hormonal treatments for menopause. The decision to open the door to compounding in community pharmacies was received as a possible solution to a problem that affects thousands of women and that threatened to spread to the rest of Spain. The president of the General Council of Pharmaceutical Associations, Jesús Aguilar, then defended that the measure made "common sense" and considered that it could serve as a reference for other autonomous communities.
However, now, the solution on which the health response throughout Spain pivots is not the master formulation, but the exceptional importation of medicines from other European countries. A much more expensive alternative that does not guarantee supply either because a good part of Europe faces similar difficulties.
The importation of these treatments is channeled through hospitals. Although it does not represent an additional cost for patients, for the health system it means paying up to three times more to resolve the lack of medications such as Lenzetto, one of the products most affected by the supply problems of transdermal estradiol.
The situation is especially complex because the countries where this medicine usually has a lower price, and which would be the natural candidates to supply units to Spain, are also registering high demand. One of the markets being turned to is Germany, although the expectations of obtaining large quantities are limited by the existing demand in that country.
The Catalan community initially decided to centralize these imports through the Clínic and Vall d'Hebron hospitals. Later it expanded the possibility to any hospital service. However, the arrival of units is being scarce, as in the rest of the country. According to Mercè Barau, member of the pharmacy office of the Official College of Pharmacists of Barcelona, some hospitals have barely received one unit or quantities considered insufficient to meet the existing demand.
A problem that also increases the patient's bill
The economic impact is not limited to health administrations. The lack of certain treatments is forcing many women to resort to more expensive and unfunded alternatives.
This is the case of Lenzetto, financed by the National Health System, whose cost for a patient with the maximum contribution is around 0.85 euros. Given the shortage of this product, one of the most frequent substitutions is Oestraclin, a hydroalcoholic gel available in pharmacies, but not financed, whose price is around 17.38 euros.
In practice, this means that some women end up paying up to 20 times more to continue a similar treatment. The problem becomes especially relevant in groups with greater needs for estradiol, such as some trans women, for whom the expense can become an additional economic barrier.
Pharmacists also describe increasingly frequent scenes of seeking treatment between different pharmacies. Barau recounts the recent case, which she experienced in her own pharmacy, of a 33-year-old woman who had had her uterus and ovaries removed after gynecological cancer and who managed to locate one of the last units available after a search of pharmacies throughout the city. Uncertainty, however, persists: finding the medication this month does not guarantee access to it the next.
From the hope of master formulas to an exceptional measure
The master formulation was presented weeks ago as a possible safety net if shortages continued to worsen. The Spanish Agency for Medicines and Health Products (Aemps) supported this possibility as a last resort when there was no other therapeutic alternative available and it was necessary to ensure the continuity of treatments.
Pharmacies even prepared for that eventuality. However, the sector always warned of its limitations. Pharmacists remember that master formulas are designed to respond to the individual needs of a specific patient and not to replace the industrial production of medicines.
Furthermore, this option has important restrictions. Although estradiol is among the active ingredients authorized for formulation, pharmacies cannot reproduce all the formats available on the market. For example, they are not authorized to produce preparations equivalent to some sprays or transdermal patches, precisely some of the most in-demand presentations.
For this reason, the professional organizations themselves insist that the master formulation could only resolve very specific cases and not the general demand of thousands of affected patients.
A crisis that transcends Spain
Although Catalonia has become the main testing laboratory for this crisis, the problem is far from being exclusively Catalan. Supply problems affect all of Spain and are repeated in much of the continent.
Regulatory agencies have identified supply difficulties with Lenzetto in countries such as France, Italy, Sweden, Norway, Czech Republic, Portugal, Denmark, Poland, Ireland, Greece or Finland.
The dimension of the problem has even led the European Union to consider it a critical supply that requires coordination between Member States. The Aemps maintains contacts with other European authorities and with pharmaceutical companies to facilitate the arrival of new presentations of estradiol available in other markets and increase the therapeutic offer.
At the same time, the organization works with scientific societies to prepare a consensus document that allows optimizing the use of available treatments while supply difficulties persist.
Normalization is still far away
According to the forecasts conveyed by Gedeon Richter, Lenzetto's marketing company, the restoration will begin to occur in mid-November. However, complete normalization of supply will occur gradually throughout 2027.
