By Mrinalika Roy and Sriparna Roy
June 17 (Reuters) - U.S. supplies of progesterone are coming under strain, with patients, clinicians, and pharmacists reporting recent intermittent shortages of oral versions of the hormone used in many fertility and menopause treatments.
The supply concerns come as women going through menopause across the country are already facing difficulties filling prescriptions for estrogen patches, another commonly used hormone therapy.
Demand for hormone replacement therapy,
or HRT, has climbed sharply since the U.S. Food and Drug Administration removed a longstanding safety warning from many such therapies in late 2025. Doctors have also become more comfortable prescribing HRT, while women's health and menopause experts on social media platforms have encouraged its use.
That has combined to produce tight supplies of progesterone, often prescribed to reduce the risk of uterine cancer, alongside estrogen for relief of menopause symptoms such as hot flashes, mood changes and osteoporosis.
Robin Wilson, 64, director of operations for the Iowa State wrestling program, said progesterone capsules became more difficult to get about a year ago after nearly nine years without supply issues.
Her local pharmacy in Ames, Iowa, recently could not fill her usual 90-day prescription, offering instead a smaller supply while awaiting a shipment. "This is the first time this has happened," Wilson said.
SUPPLIES TIGHTEN WITH DEMAND SURGE
Progesterone-containing HRT prescriptions for women aged 45 and older have more than tripled since January 2021, to about 12 women per 1,000 in May of 2026, according to health analytics company Truveta, whose electronic health record database covers more than 130 million patients in all 50 states.
Prescribing rates have increased more than 19% since the FDA's label change, the data showed.
"While estrogen patches are incurring the biggest supply challenges, progesterone supplies are beginning to be stretched too," said Dr. Kathleen Jordan, chief medical officer of telehealth provider Midi Health.
The American Society of Health-System Pharmacists lists certain oral progesterone capsule products from Amneal Pharmaceuticals and Hikma Pharmaceuticals in its shortages database.
"We have seen increased demand for progesterone capsules in recent months," said Amneal, adding that it is increasing manufacturing capacity at its New York facility and continues to meet contracted supply commitments.
Hikma did not respond to requests for comment.
A spokesperson for CVS Health, one of the nation's largest pharmacy chains, said manufacturers have been unable to provide sufficient HRT supplies for several months.
According to an FDA database, nine companies manufacture oral progesterone, including Teva and Dr. Reddy's. Teva did not respond to a request for comment, while Dr. Reddy's said the product has not been part of its U.S. portfolio since 2022 and the company does not manufacture or market it.
The FDA does not list progesterone as being in shortage.
A spokesperson for the U.S. Department of Health and Human Services, which oversees the FDA, said one manufacturer is experiencing delays but others have product available. The agency is working with manufacturers to help ensure supplies meet demand, the spokesperson said.
COMPOUNDING CAUTION
Clinicians say progesterone shortages have been milder than those affecting estrogen patches, though some patients still face delays getting prescriptions filled.
This is partly because women who have had a hysterectomy do not need progesterone with HRT, and because alternatives like combination patches, progestin-releasing IUDs, and oral progestins reduce reliance on any single formulation.
Manufacturers have not disclosed a specific cause for shortages, said Michael Ganio, senior director of pharmacy practice and quality at ASHP, the pharmacists' trade group.
"Without a reason, it can be difficult to know whether there is disruption due to manufacturing or other delays, or an increase in demand that the available market supply cannot meet," Ganio said.
Some have turned to compounding pharmacies for progesterone and estrogen, said Valerie Richards, director of clinical services at Strive Compounding Pharmacy.
"Providers are not waiting for the commercial supply chain to sort itself out," she said.
Compounding pharmacies do their own preparation of pharmaceutical ingredients, which is allowed when the FDA has declared a drug in shortage or for personalized doses not otherwise available.
Dr. Gillian Goddard, adjunct assistant professor of medicine at the NYU Grossman School of Medicine, said compounded products not subject to the strict regulatory process of FDA-approved drugs "could contain too much or too little progesterone," leading to health issues and potentially costly ultrasounds and biopsies.
"I always caution against using compounded products," she said.
(Reporting by Mrinalika Roy and Sriparna Roy in Bengaluru; Editing by Caroline Humer and Bill Berkrot)
