Pfizer is pulling its hormone replacement therapy Premarin from the Canadian market, a move that one doctor warns will leave women seeking treatment for some menopause-related symptoms in Ontario without a replacement cream that is covered by the government. Pfizer announced it will be discontinuing the sale of Premarin vaginal cream in Canada on Thursday, following an internal review. Pfizer Canada said there has been a shortage of the cream in the country since June and no further batches will be supplied. Dr. Amanda Selk, an obstetrician-gynecologist at Mount Sinai Hospital, said this vaginal cream is generally used for menopausal women to restore moisture and estrogen. But she said that there is some data suggesting it can help with bladder infections as well. With Selk’s clinical practice focusing on dermatologic skin conditions around the vulva, she says a lot of her patients prefer estrogen creams because of its functionality and benefits. “Different drugs work well for different people, so some might prefer what’s there now, and some people might prefer what was there before, and so we lost choices,” Selk said in an interview with CTV News Toronto. “I don’t think one is necessarily way better than the other, but I think that patients, it’s always better for us to have multiple options for people, both for cost, but for how it feels, how it works, because everybody meshes better with a different thing.” The Canadian Pharmacists Association published a list of alternatives amid the menopausal hormone therapy shortage, and with Premarin gone, there is only one other vaginal cream available. However, in Ontario, it is not covered by the Ontario Drug Program, a program covering the costs of more than 5,900 medications. Those with private insurance might have coverage, Selk said, but there are many who don’t have private insurance. “Well that’s the problem, I think that if we only have one cream available in the country, then it really needs to be covered,” Selk said. “In a perfect world, we would have other options. There are other cream options, like different drug formulations in other countries, but that’s a whole other thing, like that’s not a provincial issue.” She says it would be up to the companies themselves to bring the products to the country and get approval from Health Canada, which takes time. “We’re not a big market compared to other countries because of our population and so women in Canada suffer for options for things,” Selk said. A spokesperson for the Ontario Ministry of Health said among the vaginal estrogen products listed by the Canadian Menopause Society as alternatives, there are three covered under ODP: Estring (vaginal ring), Vagifem 10 (vaginal tablet), and Imvexxy (vaginal inserts). Pfizer Canada said existing inventories of Premarin tablets are expected to last midway through 2027, though supply could run out sooner if demand increases. In Ontario, the extended-release tablets are covered by the Exceptional Access Program, meaning coverage is only offered if specific clinical circumstances are met. The patches and gels provide relief for other menopausal issues, Selk says, like hot flashes. There are other hormone therapy products that are facing supply constraints in Canada, like the estradiol transdermal patches made by Bayer and Sandoz. Health Canada said earlier this month that intermittent shortages are expected to last until early next year, adding that patients may find certain strengths of the product are temporarily unavailable at their local pharmacy. The discontinuation of Premarin products, alongside shortages of some estradiol patches, could put a strain on Canada’s menopause drug supply. Selk says the demand for more estrogen products is there, but the supply chain has not been able to keep up. She says this reflects a more general problem regarding women’s health. “Women are very frustrated,” she said. “There’s a lot of talk about ‘Why does this happen to women and women’s health products? Why is there not more dedication and time spent, and would it be different if it was a product for men?’ And I can tell you, there is a lot of discussion and questions about that, and we don’t know because we don’t have a male drug shortage, right?” With files from Reuters
