Pfizer discontinues Premarin in Canada, raising concerns about alternatives and costs

TORONTO — American company Pfizer's decision to stop marketing one of its hormone therapies in Canada has raised concerns about whether women will continue to have access to the medications they need to relieve menopause symptoms, particularly in Ontario, where questions have emerged about the cost of alternatives and government drug coverage.

The company announced it was discontinuing Premarin, which is used to relieve some symptoms linked to lower estrogen levels.

The decision covers the vaginal cream and the oral tablets. Pfizer said that withdrawing the products from the Canadian market is not linked to any new concerns about their safety, effectiveness or quality.

The decision comes amid shortages of other hormone therapies, which is adding pressure on patients and pharmacies.

Premarin cream permanently discontinued in Canada

Pfizer Canada confirmed it will not supply new batches of Premarin vaginal cream, which has been in short supply on the market since June.

The cream contains a mix of estrogen hormones and is used to treat symptoms that include vaginal dryness and pain during sexual intercourse caused by hormonal changes after menopause.

Canadian drug shortage records show the cream's discontinuation was logged in November 2026.

This means patients who have been using it will need to consult their doctors or pharmacists to discuss suitable alternatives.

The company said the decision followed an internal review and did not announce detailed commercial reasons.

Premarin tablets may remain available until mid-2027

The decision is not limited to the vaginal cream. It also covers Premarin tablets, which are available in three strengths.

The company said current stock of the 0.3 mg, 0.625 mg and 1.25 mg tablets may last until mid-2027.

However, it warned that supplies could run out sooner if demand rises.

These estimates indicate that the discontinuation will not necessarily make every form of the drug disappear from pharmacies immediately.

By contrast, the intravenous treatment Premarin Intravenous, which is used in hospitals to treat some cases of abnormal uterine bleeding, is not covered by the announced withdrawal.

Single alternative to the hormone cream raises concerns in Ontario

The disappearance of Premarin cream poses a particular problem for women who prefer topical treatment with a cream.

One available alternative is Estragyn cream, which contains estrone, a type of estrogen.

However, this treatment is not identical to Premarin in its active ingredient, so switching to it requires a medical review to determine whether it is suitable and what dose is appropriate.

Government coverage of alternatives is also not equal in Ontario.

The government drug list shows that Premarin vaginal cream was listed among the drugs covered for eligible beneficiaries, while Estragyn does not appear on the same public coverage list.

This difference could mean some patients bear additional costs when switching to the alternative, depending on the type of insurance they have.

Are there treatments other than cream?

Although options for hormone creams are limited, other forms of vaginal estrogen therapy are available in Canada.

They include the Estring vaginal ring, Vagifem vaginal tablets and Imvexxy vaginal inserts.

These products differ in how they are used, their active ingredient, dose and drug coverage.

Their availability on the market also does not mean they are suitable for every case, or that they are a direct substitute that can be used without a prescription or medical assessment.

Information from Canadian pharmacists indicates that the choice of treatment depends on the nature of the symptoms, the patient's health history and her preferences.

Shortages of other treatments add to the problem

Pfizer's decision comes at a time when Canada is facing a shortage of some estrogen patches used to treat menopause symptoms.

Health Canada announced on Nov. 4 that some strengths of patches marketed by Bayer and Sandoz are experiencing supply disruptions.

The affected products include some versions of Climara, Estalis, Estradot and Sandoz Estradiol Derm.

The department expects intermittent shortages to continue until early 2027.

It attributed the situation to global supply challenges, including higher demand and manufacturing disruptions.

It said it is in contact with companies, provinces and health authorities to help manage the shortages and provide suitable alternatives.

Concerns about added financial burden on women

The importance of hormone therapy lies not only in relieving physical symptoms but also extends to the effect those symptoms have on sleep, comfort and daily life.

Some women may have to try different products when their usual treatment is interrupted, which could require additional medical visits or costs that insurance does not cover.

Drug coverage in Ontario varies depending on the government program and eligibility conditions, as well as on whether a person has private insurance.

As a result, the discontinuation of a covered drug could leave some patients facing more expensive treatment options.

What should patients do?

Health Canada advises people affected by drug shortages to contact their doctor or pharmacist before changing treatment.

It also stresses the need to buy medications from licensed pharmacies and to avoid unreliable websites that may sell unapproved products.

For Premarin users, it is important to review their treatment plan before available supplies run out, especially as there is no expected date for the cream's return to the market.

Choosing the most suitable alternative remains a medical decision that depends on each patient's health condition, not simply the choice of another product from the same hormone category.