Provider Briefing: The Progesterone Shortage in 2026

The ongoing Progesterone shortage has moved from an intermittent inconvenience to a persistent challenge affecting clinical workflows across OB/GYN, reproductive endocrinology, primary care, and endocrinology. As of early 2026, three distinct Progesterone formulations remain on the ASHP drug shortage database, and the situation requires proactive management from prescribers.

This briefing covers the current state of the shortage, its clinical implications, and practical resources to help you keep your patients on therapy.

Timeline: How We Got Here

Progesterone supply issues are not new, but they've intensified over the past several years:

• 2011-2019: Intermittent shortages of Progesterone injection, largely driven by increased demand for preterm birth prevention following the FDA approval of Makena (Hydroxyprogesterone Caproate) and subsequent supply gaps.
• 2023: Progesterone capsule shortages emerged as multiple generic manufacturers experienced production disruptions. The injectable shortage persisted.
• 2024: Endometrin (vaginal insert) was added to the ASHP shortage list. American Regent exited the Progesterone injection market, further constraining supply.
• 2025-2026: All three formulations — capsules, injection, and vaginal inserts — remain on shortage. Aurobindo has not provided availability updates. Amneal and Virtus (Prometrium) continue supplying capsules, but intermittent gaps persist. AuroMedics and Hikma supply injection, with variable availability.

Prescribing Implications

The multi-formulation nature of this shortage complicates clinical decision-making in several ways:

Menopausal Hormone Therapy (MHT)

For patients on combination estrogen-Progesterone therapy for endometrial protection, oral micronized Progesterone (Prometrium, 200 mg at bedtime for 12 days per cycle or 100 mg continuous) remains the preferred regimen. When unavailable:

• Medroxyprogesterone acetate (Provera) 2.5-5 mg daily continuous or 5-10 mg for 12-14 days per cycle is the most established alternative for endometrial protection.
• Norethindrone acetate (Aygestin) 2.5-5 mg for 12-14 days per cycle is another option.
• Note that switching from bioidentical Progesterone to a synthetic progestin may concern patients who specifically chose Prometrium for its bioidentical profile. Discuss the evidence on comparative risks and benefits.

Amenorrhea

For progestin withdrawal to induce menses, Medroxyprogesterone 10 mg for 5-10 days is a well-established alternative to Progesterone 400 mg for 10 days.

Fertility and ART

This is where the shortage has the most significant clinical impact. Vaginal Progesterone (Endometrin inserts, Crinone gel) is standard of care for luteal phase support in IVF cycles. Options when commercial vaginal products are unavailable:

• Compounded vaginal Progesterone suppositories (typically 100-200 mg twice daily) — requires identifying a reliable compounding pharmacy.
• Intramuscular Progesterone in oil (50-100 mg daily) — effective but also on shortage and associated with injection site pain.
• Switching between vaginal formulations — if Endometrin inserts are unavailable, Crinone gel (8%, daily or twice daily) may be substitutable, and vice versa.
• Oral Progesterone is generally not recommended as a substitute for vaginal Progesterone in ART due to lower uterine tissue concentrations and inferior outcomes in some studies.

Preterm Birth Prevention

For patients with a history of spontaneous preterm birth or short cervix, vaginal Progesterone (200 mg suppository or Crinone 8%) is evidence-based. With the FDA's 2023 request for voluntary withdrawal of Makena (17-alpha Hydroxyprogesterone Caproate), vaginal Progesterone has become even more central to preterm birth prevention. Supply constraints in this setting are particularly concerning.

Current Availability Picture

Based on ASHP data and manufacturer communications:

• Oral capsules: Amneal (generic) and Virtus (Prometrium) — available but with intermittent supply gaps. Aurobindo — status unknown.
• Injection (50 mg/mL): AuroMedics — available. Hikma — available with constraints. American Regent — no longer marketing. Fresenius Kabi — shortage due to increased demand and manufacturing delays.
• Vaginal inserts (Endometrin): Listed on shortage. Check with Ferring Pharmaceuticals for current allocation.
• Vaginal gel (Crinone): Not separately listed on ASHP shortage but may have local availability issues.

Cost and Access Considerations

Cost varies widely by formulation, which may affect patient adherence and access:

• Generic oral capsules: ~$14-$30 with coupon (GoodRx, SingleCare); retail ~$79 for 30 capsules. Covered by most plans, Tier 1-2.
• Prometrium (brand): $200-$422 for 90 capsules without insurance.
• Crinone 8% gel: $200-$350 per box. May require prior authorization.
• Endometrin inserts: $300-$600 per cycle. Often covered under fertility benefit or pharmacy benefit with PA.
• IM Progesterone: $50-$150 per vial.
• Compounded products: Variable; typically $30-$100 per month. Rarely covered by insurance.

For patients struggling with cost, discount programs and patient assistance are available. Point patients to resources like NeedyMeds, RxAssist, and pharmacy discount cards. A patient-facing guide is available at how to save money on Progesterone.

Tools and Resources for Your Practice

• Medfinder for Providers: Real-time pharmacy stock lookup for Progesterone and other medications. Helps your team quickly identify where patients can fill prescriptions.
• ASHP Drug Shortage Database: Monitor shortage status updates for all Progesterone formulations.
• Compounding pharmacy networks: Establish relationships with 1-2 reliable compounding pharmacies that can prepare Progesterone suppositories or creams when commercial products are unavailable.
• Prior authorization templates: For practices prescribing brand-name or vaginal formulations, pre-built PA templates can reduce administrative burden.

Looking Ahead

The Progesterone shortage is unlikely to resolve overnight. With manufacturer exits, ongoing production challenges, and steadily growing demand, providers should plan for continued intermittent supply disruptions through 2026 and potentially beyond.

Key actions to future-proof your practice:

1. Establish formulary alternatives for each indication (MHT, amenorrhea, ART, preterm birth prevention)
2. Build relationships with compounding pharmacies as a backup supply source
3. Educate patients about the shortage proactively — don't wait for them to discover it at the pharmacy counter
4. Use tools like Medfinder to streamline the process of finding in-stock pharmacies
5. Monitor ASHP shortage updates regularly

Final Thoughts

The Progesterone shortage requires a multi-pronged approach from prescribers: awareness of which formulations are affected, familiarity with alternatives for each clinical indication, and practical tools to help patients find available supply. By building shortage contingencies into your clinical workflow now, you can minimize treatment disruptions for your patients.

For a provider-focused guide on helping patients locate Progesterone, see how to help your patients find Progesterone in stock. For patient-facing resources you can share, see our patient shortage update and alternatives guide.