Global HRT shortage is disrupting treatment for millions of women managing menopause symptoms. Many now endure hot flashes, anxiety, and sleepless nights without relief. Hormone replacement therapy (HRT) is a key treatment for perimenopause and menopause symptoms, yet access is shrinking due to production problems, rising demand, and complex supply chains.
Karen Golden, a Toronto lawyer, knows the impact firsthand. She began HRT to treat anxiety and sleep problems linked to menopause. In 2020, a shortage of her medication forced her to stop. Alternative products caused side effects, so she chose to go without. Her symptoms returned quickly. She resumed her original treatment last year, but the drug went on back order within months. Running out of options, she contacted the manufacturer directly. After repeated requests, they shipped stock to her local pharmacy. She says women should not have to fight for essential medicine.
Drug Shortages Canada lists 92 shortages and four discontinuations of estradiol-based products since 2017. Estradiol, a form of estrogen, is found in HRT patches, pills, vaginal rings, gels, and creams. Without consistent supply, women often experience setbacks in mood, sleep, and focus. Dr. Alison Shea of McMaster University says shortages also strain doctors and pharmacists, who spend extra time finding alternatives. This adds pressure to an already overloaded healthcare system.
Health Canada says most HRT drugs remain available, but estrogen/progestin patches are still scarce. Officials expect supply to stabilise later this summer. Pharmacists and industry experts link the issue to fragile global supply chains. HRT drugs often travel through several countries before reaching pharmacies. Manufacturers must handle sensitive chemical compounds with precision. With only a few producers active, any disruption can delay supply for months.
Manufacturers, including Sandoz Canada, report a sharp rise in demand. Changes in medical guidelines, stronger public advocacy, and the debunking of past health concerns have all driven growth. Manulife insurance data shows HRT use among women aged 45 to 65 rose by 21% between 2020 and 2023. HRT also plays a crucial role in gender-affirming care, so shortages affect both menopausal and transgender patients. Dr. Kate Greenaway of Foria says the impact can be worse for trans and non-binary people, as they have fewer alternative options.
Some experts believe expanded prescribing could motivate manufacturers to increase production. Dr. Michelle Jacobson of the Canadian Menopause Society says every woman of average menopausal age, without major health risks, should be offered HRT if she experiences symptoms. She argues that hesitation and lack of training still prevent many doctors from prescribing it, even though guidelines support its use.
Pharmacist and researcher Mina Tadrous suggests allowing pharmacists to substitute unavailable drugs with equivalent therapies. He warns that shortages will continue without changes to production capacity and supply management.
For women like Golden, the global HRT shortage is more than an inconvenience. It disrupts health, work, and daily life. Governments, manufacturers, and healthcare providers must act together to ensure these medications remain available to all who need them.
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