CPhA Flags Estrogen Patch, Premarin Vaginal Cream Supply Gaps
The Canadian Pharmacists Association (CPhA) currently lists menopausal hormone therapy among active Canadian supply challenges, specifically naming estrogen patches and Premarin vaginal cream, while noting that alternative products remain available.
What CPhA is reporting
According to CPhA's active shortages page, there are currently supply challenges affecting some estrogen products in Canada, including patches and Premarin vaginal cream, with Health Canada in contact with manufacturers and monitoring the supply situation. CPhA attributes the intermittent shortages to increased demand for menopausal hormone therapy products combined with manufacturer disruptions.
CPhA has published a clinical resource dated March 13, 2026 to support pharmacists helping patients navigate the shortage and available alternatives. The association also notes that at any given time, there are between 1,500 and 2,000 active drug shortages in Canada.
Why hormone supply chains break
The raw-materials picture behind menopausal hormone therapy helps explain why shortages recur. The starting ingredient for semi-synthesis of estradiol and progesterone is stigmasterol, derived from soybeans, with soybean supply for hormone production concentrated in China and India. The same two countries dominate the world market in converting stigmasterol into hormone active pharmaceutical ingredients (APIs), with Israel and the Netherlands also producing hormone APIs at large scale.
About 94% of APIs that eventually become medications in the United States come from China or India, according to the vajenda analysis. When most companies rely on two countries for an API, a single environmental or factory-related issue can trigger a worldwide supply gap. The same stigmasterol feedstock is also used to manufacture hormones for birth control pills, patches, rings, hormone IUDs and testosterone, meaning API producers may prioritize the products with the better profit margin.
US data cited in the analysis show that when a hormone shortage occurs, it typically lasts approximately 1,201 days. As of February 13, 2026, 194 drugs were reported as impacted by shortages in the United States.
Health Canada's shortage framework
Health Canada defines a drug shortage as any situation in which a manufacturer cannot supply enough of a drug to meet all Canadian orders on time, and requires manufacturers of certain drugs to report anticipated and actual shortages on the drug shortage reporting website. When a shortage has the potential to pose a significant risk, the Health Product Shortages Directorate assembles a Tier Assignment Committee, with Tier 3 representing the most serious level.
Available federal mitigation tools include using regulatory powers to allow drugs labelled and approved for other markets to be imported into Canada, fast-tracking regulatory reviews, and extending the shelf life of a drug when suitable supporting data exist. The CPhA notice does not indicate that menopausal hormone therapy has been assigned Tier 3 status.
Pricing context for tracked products
Consumers comparing costs during intermittent supply gaps can review current Canadian provider pricing on WomensHealthPrices.ca. Tracked categories affected by the CPhA notice include estradiol patch pricing, estradiol gel pricing, oral estradiol pricing, Premarin pricing, progesterone pricing, and vaginal estrogen pricing.
Additional coverage of ongoing Canadian supply developments is available on our women's health news feed and via the general price comparison tools. Provincial coverage information is available for Ontario coverage.
Key facts
- Products flagged by CPhA: estrogen patches and Premarin vaginal cream
- Alternative products: remain available per CPhA
- Clinical resource date: March 13, 2026
- API sourcing: hormone APIs concentrated in China and India
This article is for informational purposes only and does not constitute medical advice.
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