I’ve not been down Patch Road myself (my hormone misadventures took me down Birth Control Boulevard instead and it wasn’t a pretty journey), but for many, hormone therapy patches can be life-saving. And when they’re not available consistently, as is currently the case with the US’ estradiol patch shortage, life-harming. (For clarity, there are also birth control patches, which I also did not try.)
Estradiol Patch Shortage
In February, the US Food and Drug Administration (FDA) approved drug labeling changes to some menopausal hormone therapy (MHT, also known as hormone replacement therapy or HRT) products, related to risks for cardiovascular disease, breast cancer, and dementia.
The shortage is being attributed to these label changes and subsequent increased demand, supply chain challenges, and tariff impacts, according to nonprofit newsroom, The 19th.
Hormone Therapy’s Challenging Past
For a little history lesson, MHT (HRT) has had a complicated past, largely due to poor conclusions drawn and publicized as a result of the Women’s Health Initiative (WHI) study that started in 1991 and was abruptly halted a few years early in 2002. While not a new article, University of Rochester Medical Center has a good writeup, “Was The Women’s Health Initiative Good Or Bad For Women’s Health?” Patient Care also has a strong summary and helpful timeline of events in, “Hormone Replacement Therapy After the WHI: Clinician’s Evidence Timeline (2002–2025).”
The gist of the study’s problems are well stated in the American Society for Reproductive Medicine’s Fertility and Sterility journal. “The WHI hormonal replacement study had major design flaws that led to adverse conclusions about the positive effects of hormone therapy.” (Klaiber E, Vogel W, Rako S A critique of the Women’s Health Initiative hormone therapy study Fertility and Sterility, 84, 1589-1601)
What You Can Do About It
What follows is not medical advice. These are practical steps. The clinical decisions belong with a provider who knows your history.
If you can’t fill your prescription right now
Start with your pharmacist, not your doctor. Pharmacists often know which locations have stock before your provider does. Ask them specifically to check other branches, partner pharmacies, or distributors — not just their own shelves.
Call independent pharmacies. Chain shortages don’t always reflect what independent pharmacies have. A local or regional pharmacy may have inventory that CVS and Walgreens don’t.
Also try online pharmacies. Online options including GoodRx, Cost Plus Drugs, and The HRT Club have been mentioned as alternatives during the shortage.
Refill earlier than you think you need to. Don’t wait until your last patch. Build in a few weeks of search time before you run out. If your provider will authorize a 90-day supply, request it. You may only be able to fill 30 days at a time right now, but having the authorization gives you flexibility to fill wherever stock appears.
Check the ASHP shortage bulletin directly. It is publicly accessible and updated regularly. It lists which manufacturers have which doses on backorder and estimated resupply dates. It’s dry reading but it’s the authoritative source.
If you’re considering switching formulations
Talk to your provider before making any change. This is the one tip that matters more than all the others. Dose equivalencies between patches, gels, sprays, and oral estradiol are not 1:1, and what works for someone else may not work for you.
Ask specifically about transdermal alternatives. Estradiol gel (EstroGel, Divigel) and spray (Evamist) use the same active ingredient as patches and carry the same lower clot risk as transdermal delivery. They currently have better availability than patches — though as more people are switched to them, that gap is narrowing. Dose equivalencies between patches and gels are not 1:1, so any switch needs to involve your provider, not just a pharmacist swap. Insurance coverage varies — worth asking about the generic estradiol gel as a lower-cost option.
Don’t self-substitute based on what a friend found. What works for someone else’s body, dose, and symptom profile may not translate to yours.
A note on compounded hormones
You may see compounding pharmacies promoted as a solution during the shortage. Some people find them helpful. What’s important to know: compounded hormones are not FDA-regulated for safety, efficacy, or consistency. Quality varies significantly between pharmacies. If you’re considering this route, do it with a provider who knows compounding well and can guide dosing — not independently, and not based on social media recommendations.
Also keep in mind the American College of Obstetricians & Gynecologists’ Clinical Consensus on “Compounded Bioidentical Menopausal Hormone Therapy.”
“Compounded bioidentical menopausal hormone therapy should not be prescribed routinely when FDA-approved formulations exist. Clinicians should counsel patients that FDA-approved menopausal hormone therapies are recommended for the management of menopausal symptoms over compounded bioidentical menopausal hormone therapy.“
Finding a knowledgeable provider
This shortage makes something that was already true more urgent: having a provider who actually understands MHT is essential. Most general practitioners haven’t had significant training in menopause care. The Menopause Society (menopause.org) maintains a directory of certified practitioners.
Menopausey is building a patient-friendly natural language search for perimenopause and menopause-informed healthcare practitioners across disciplines (counselors and therapists, doctors, nurse practitioners, physical therapists and beyond). It’s currently available in private usability testing. Email hello@menopausey.com for an access code.
A few things not to do
Don’t cut patches in half unless your provider specifically tells you that your formulation can be cut. Not all patches can. Some use a reservoir delivery system where cutting disrupts the dose. Ask before trying this.
Don’t abruptly stop without a plan if you can avoid it. Going off MHT suddenly can bring symptoms back faster and more intensely for some people. If you’re running low, contact your provider proactively so you can plan a managed taper or bridge if needed, rather than just running out.
Don’t panic-stockpile if you do find supply. It depletes stock for others in the same situation.
Notes from Menopausey
Most of the articles linked here speak only to experiences of women. Menopausey welcomes and honors that anyone with (or who previously had) ovaries is impacted by this life phase, whether or not you identify as a woman.
Menopausey is seeking perspectives from community members for a new blog series. If you have directly experienced challenges re/filling your estradiol patch prescription (or want to share your peri/menopause journey more broadly), please send a note to hello@menopausey.com.
Learn/Read More
- The Menopause Society’s Menopause Topics: Hormone Therapy
- Patients scramble to find estrogen patches as shortage worsens after US FDA champions use | Reuters
- Estrogen patch shortages are getting worse and could last for years | NBC News
- Why the ‘mad scramble’ to fill hormone therapy prescriptions for menopause | NPR
- Impacted by the estrogen patch shortage? Here are your options | The 19th
- HHS Fact Sheet: FDA Initiates Removal of Black Box Warnings from Menopausal Hormone Replacement Therapy Products
- The Menopause Society: MenoNotes — patient-facing fact sheets on hormone therapy, hot flashes, and bioidentical hormones
- Cleveland Clinic: Perimenopause overview
- ASHP Drug Shortage Detail: Estradiol Transdermal System
Photo by Valdhy Mbemba on Unsplash
