Your Patient Needs Endometrin — and Their Pharmacy Doesn't Have It

As a fertility provider, you've likely fielded more calls about medication availability than you'd like over the past couple of years. Endometrin (Progesterone vaginal insert, 100 mg) has been among the more challenging fertility medications to source consistently since the late-2023 recall and subsequent shortage.

While supply has improved in 2026, your patients may still encounter pharmacies that are out of stock — especially those using retail chains rather than specialty fertility pharmacies. This guide provides practical steps your practice can take to help patients find Endometrin and maintain uninterrupted luteal phase support.

Current Availability

As of early 2026, the Endometrin supply picture is considerably better than it was in 2024:

• Brand-name Endometrin (Ferring Pharmaceuticals) is being manufactured and distributed. Specialty fertility pharmacies generally report consistent stock.
• Generic Progesterone vaginal insert (Xiromed, 100 mg) launched in September 2025 as the first FDA-approved generic equivalent. Distribution is expanding through both specialty and retail pharmacy channels.
• Retail pharmacy availability remains less reliable than specialty channels, as Endometrin is not a high-volume item for general pharmacies.

For current market conditions, the provider shortage update offers additional detail.

Why Patients Can't Find It

When a patient calls to say their pharmacy doesn't have Endometrin, the issue is usually one of the following:

• Retail pharmacy doesn't stock it routinely. Endometrin is a specialty product. Many chain pharmacies don't carry it as a regular inventory item and would need to special-order it.
• Timing. The patient's prescription was sent at the last minute, leaving no time for the pharmacy to order.
• Regional distribution gaps. While overall supply has improved, some geographic areas may have fewer pharmacies carrying the product.
• Generic confusion. The patient or pharmacy may not realize the generic Progesterone vaginal insert is available and interchangeable.

What Providers Can Do: 5 Practical Steps

Step 1: Partner with Specialty Fertility Pharmacies

If your practice doesn't already have established relationships with specialty fertility pharmacies, now is the time. Pharmacies like Freedom Fertility, Encompass Fertility, Village Fertility Pharmacy, and Alto Pharmacy specialize in fertility medications and maintain more reliable Endometrin inventory.

Benefits of specialty pharmacy partnerships:

• Priority access to fertility drug inventory
• Coordination with your clinical team on timing and protocol changes
• Patient support services (insurance verification, financial assistance enrollment)
• Delivery directly to the patient's home

Step 2: Use Medfinder to Locate Stock

Medfinder for Providers offers real-time pharmacy availability search for hard-to-find medications, including Endometrin. Your nurse coordinators and pharmacy liaisons can use it to quickly identify which pharmacies in your patients' areas have stock — saving time and reducing patient anxiety.

Consider integrating a Medfinder check into your workflow whenever a patient reports difficulty filling their prescription.

Step 3: Allow Generic Substitution

Unless you have a specific clinical reason to require brand-name Endometrin, writing prescriptions that allow generic substitution increases the likelihood of a successful fill. The Xiromed generic Progesterone vaginal insert is AB-rated by the FDA and therapeutically equivalent.

Pharmacies are more likely to have the generic in stock, and it typically costs less for the patient — an important consideration given the financial burden of fertility treatment.

Step 4: Send Prescriptions Early

Encourage your team to send Endometrin prescriptions as early as feasible in the treatment cycle. A few extra days of lead time allows pharmacies to order the product if it's not on their shelf, reducing the chance of a last-minute scramble.

For patients with known insurance complications (prior authorization requirements, step therapy), early prescription submission gives time to resolve these issues before the medication is urgently needed.

Step 5: Educate Patients Proactively

Include medication availability as a topic in your cycle orientation or patient education materials. Let patients know:

• Endometrin may not be available at every pharmacy
• Specialty pharmacies are often the best source
• A generic version exists and is clinically equivalent
• They should contact the clinic early if they're having trouble filling the prescription
• Tools like Medfinder can help them search availability independently

Proactive education reduces panicked phone calls and gives patients a sense of control during an already stressful process.

Alternatives to Recommend

When Endometrin is unavailable, having pre-established alternative protocols allows quick pivots. Recommended alternatives include:

• Generic Progesterone vaginal insert (Xiromed): Same medication, same format. First-line substitute.
• Crinone (Progesterone vaginal gel, 8%): Well-studied alternative with comparable efficacy. Some patients find the gel residue uncomfortable.
• Prometrium/generic Progesterone capsules (vaginal use): Off-label but widely practiced. Very affordable (under $35 for 90-day supply). Note: contains peanut oil.
• Progesterone in oil (PIO): Intramuscular injection. Reliable and widely available. Patient compliance can be an issue due to injection discomfort.

For a patient-facing comparison, you can direct patients to our guide to Endometrin alternatives.

Workflow Tips for Your Practice

Based on lessons learned from the shortage, consider implementing these workflow improvements:

• Medication availability check at cycle start: Before initiating a cycle, verify that the patient's pharmacy can source the prescribed luteal phase support medication.
• Backup protocol documentation: Maintain written alternative protocols so any provider in your practice can quickly switch a patient to an available product.
• Pharmacy liaison role: Designate a team member responsible for medication availability issues. This person can build relationships with specialty pharmacies, monitor shortage databases, and serve as the point of contact for patient medication concerns.
• Patient resource sharing: Provide patients with links to Medfinder and relevant educational content (like the posts in this series) so they can take action independently when needed.

Final Thoughts

The Endometrin shortage underscored the importance of supply chain awareness and clinical flexibility in fertility practice. While the acute shortage has resolved, the operational lessons are worth retaining.

By partnering with specialty pharmacies, allowing generic substitution, sending prescriptions early, and educating patients proactively, your practice can minimize disruptions to treatment cycles and reduce patient stress.

Medfinder for Providers is here to help your team locate hard-to-find medications quickly. And for financial assistance resources to share with patients, see our guide on helping patients save money on Endometrin.