For months, hundreds of thousands of women in Spain have struggled to obtain hormone replacement therapies (HRT) to manage menopausal symptoms. What began as a shortage of a single product—Lenzetto, a transdermal estradiol spray—has cascaded into a broader crisis affecting other estradiol-based medicines across the country and elsewhere in Europe.
The initial disruption led to a surge in demand for alternative formulations such as patches and gels, which were not prepared to absorb the influx. Spain's medicines regulator, Aemps, has recorded supply issues with products like Evopad, Estradot, and Bijuva. The result: months of empty shelves, patients searching from pharmacy to pharmacy, and authorities scrambling for solutions.
November may bring some relief, but doubts remain
Spain's Secretary of State for Health, Javier Padilla, told Euronews on the sidelines of the European Health Forum Gastein in Austria that the situation should begin to ease from November. However, Aemps cautions that forecasts from Lenzetto's manufacturer, Gedeon Richter, "have not always been accurate."
Gedeon Richter confirmed to Euronews that Lenzetto should be back in Spanish pharmacies in the second half of November. Yet the company acknowledges it may not fully meet demand throughout 2027 due to global supply constraints, though it expects to gradually catch up starting in the second half of that year.
A European problem, not just Spanish
The issue extends beyond Spain. Padilla noted that a sharp rise in demand has outstripped manufacturers' production capacity in several European countries. Aemps also views this as an international supply problem affecting various EU member states to differing degrees.
The European Medicines Agency (EMA) has confirmed it has been informed about the Lenzetto supply issues and is considering coordinated EU-level measures. The matter will be discussed in upcoming meetings of the European group responsible for medicine supply issues. EMA also notes recent supply problems with other estradiol-based medicines in the EU, though these have not been deemed critical at the European level and are being managed by national authorities.
The crisis primarily affects women using these therapies for menopausal symptoms, but estradiol is also used to prevent osteoporosis and in gender-affirming hormone treatments for trans women.
How the crisis unfolded
The problems were brewing for months. Aemps began receiving reports from users about difficulties finding Lenzetto in February and contacted Gedeon Richter. Initially, the company insisted it was meeting demand normally. Soon after, the laboratory reported a surge in demand it could not immediately meet, plus problems with the device used to administer the medicine. Weeks later, it announced it had run out of stock and that the issue would affect all its markets throughout 2026.
Aemps also maintains that Gedeon Richter failed to notify in advance of incidents that could disrupt supply. Consumption of Lenzetto had risen rapidly: in Spain, distributed units jumped from around 13,000 in 2018 to about 123,000 in 2024.
Gedeon Richter explained that demand had outstripped its manufacturing capacity and that the availability of the applicator could not keep pace. The company stresses the shortage is unrelated to any quality or safety issues. To increase supply, it is maximising current capacity, developing new manufacturing options and suppliers, and establishing a new plant and production line.
Government measures fall short
The Spanish government has tried various approaches. One was raising the regulated price of these medicines to attract more supply to the Spanish market. But Padilla stressed that the difficulty goes beyond price: manufacturers simply do not have enough capacity to cope with the sharp rise in demand.
The Health Ministry then contacted manufacturers of alternative treatments that are not reimbursed by the National Health System, signalling a willingness to consider funding them to widen options for patients. According to Padilla, this route has also not delivered the expected results. Companies told the government they lacked production capacity to increase supply, even if their products were publicly funded. Aemps confirms talks have been held, but no reimbursement requests have been formalised yet.
Patients mobilise
While authorities search for solutions, patients have begun to organise. More than 25,000 people have signed a petition in barely three weeks calling for urgent government action. Its organiser, 49-year-old Rebeca Marín, who uses HRT, was due to submit the signatures on Tuesday, 6 October, at the Health Ministry.
The petition urges authorities to act preventively against future supply problems and to ensure that when a medicine is unavailable, accessible alternatives exist for patients regardless of where they live. The financial aspect of the crisis remains unresolved, and women across Spain—and increasingly across Europe—continue to face uncertainty.
