Emily Padgett has been on quite the journey trying to find estrogen patches, spending months hopping from one pharmacy to another, transferring her prescriptions, and even switching brands multiple times. It’s been, well, a bit of a hassle.
In January, she had a particularly tough couple of weeks where she had to go without the patches, which was far from easy.
“I definitely noticed some symptoms coming back after stopping the patch, and they haven’t really gone away since,” she shared. Padgett is currently in perimenopause and those symptoms can be challenging.
Thankfully, she finally found a small independent pharmacy nearby where she could get her patches. However, each time she goes to refill her prescription, anxiety creeps in. Will they be “out of stock” again?
Many women in the U.S. experiencing severe night sweats, hot flashes, and fatigue have turned to estradiol patches for relief. But finding them has become increasingly difficult, and there’s a worry that shortages might worsen.
Manufacturers attribute this shortage to a surge in demand linked to a growing awareness of menopause care and recent regulatory actions that clarified hormone therapy risks and benefits.
Even though the estradiol patch is inconspicuous—a small square worn on the skin—its benefits are significant. It provides a steady stream of estrogen that is absorbed through the skin. As women age, estrogen levels naturally decline, especially during menopause, triggering those pesky symptoms.
Padgett, a 49-year-old mother from Atlanta, explained that she had to endure those two weeks in January without her patches because she simply couldn’t find any in stock.
“It’s really more of an inconvenience than anything else,” she remarked.
During that period without her medication, her symptoms like irritability, brain fog, and insomnia flared up. She suspects that the stress from the shortage didn’t help, either.
“I was certainly anxious about not getting my patches, which in turn led to my primary symptoms worsening, like waking up feeling stressed,” she said. “It feels like my symptoms have lingered since then.”
After trialing various CVS locations and even checking Amazon, she finally hit the jackpot with her local pharmacy but had to settle for a brand she wasn’t accustomed to using. “Now I’m on my third different brand,” she mentioned, still apprehensive about future availability.
Estrogen patches are available strictly through prescriptions, but it’s becoming more common for those prescriptions to take longer to fill amidst dwindling supplies.
A spokesperson for CVS, Amy Thibault, explained in an email that some manufacturers have been unable to maintain adequate supplies of hormone replacement therapies recently. Their pharmacy teams are working to ensure patients receive the medications they need and, when possible, find alternatives.
Doctors report that many women are now scrambling to adjust their brands or dosages. Others are left contemplating whether they can go without treatment altogether.
Dr. Timberly Butler, a board-certified ob/gyn in Marietta, Georgia, noted that for the past six months, she’s encountered more patients struggling to procure their estradiol patches due to ongoing shortages.
While there are various patch brands available, Butler emphasizes that switching patients to a different product can sometimes lead to higher costs.
She stated, “Depending on insurance, some alternative brands might not be covered, which could impose extra costs on the patient. Additionally, switching might mean different application schedules than what they’re used to.”
Dr. Kathleen Jordan, chief medical officer at a telehealth company focused on women’s health, pointed out that intermittent shortages have persisted throughout the U.S. for several years now.
Jordan mentioned that her organization has been actively helping patients find available estrogen patch options and has seen delays in supplies since 2022—this current crisis has been more severe than before.
“We’ve received more reports of delays recently, especially in January. The overall pharmacy supply has seen very little increase,” she said. “I believe demand is only going to rise.”
Systemic estrogen therapy has been recognized as the “best treatment” for managing menopause symptoms such as hot flashes and night sweats, according to the American College of Obstetricians and Gynecologists. While it can be delivered via patches, estrogen can also come in pills, gels, injections, and vaginal inserts.
Recent FDA actions may change how women access menopause treatments. This month, they formally approved changes to drug labels for menopause hormone therapy products, including estrogen, by removing longstanding warnings about risks associated with the therapy. This represents newer research that offers a more balanced view of risks and benefits for women.
The FDA had begun the process of removing these warnings back in November, a move that could open up more treatment options and result in a sharp increase in prescriptions.
Leading up to this, Butler observed at least a “50% increase” in her patients interested in hormone therapies, including estrogen patches.
“Many women used to be told to just deal with it—that the risks of hormone therapy outweighed any benefits. But we’ve learned that’s not necessarily true, and many women can safely undergo hormone replacement,” she said, emphasizing the importance of estrogen for overall health, including heart and bone health.
With changing labels and growing demand, the supply issues may take longer to resolve, according to Jordan.
“There’s heightened awareness regarding menopause and its impact on women. As awareness grows, so does the demand for hormone therapy, and if we keep doing our jobs well, we’ll see that increase continue,” she said. “It’s crucial for pharmaceutical companies to respond with higher supplies.”
Trying to meet demand
Several main pharmaceutical companies involved in producing estradiol transdermal patches in the U.S. include Amneal, Sandoz, Noven, Viatris, and Zydus.
As of Thursday, reports indicated that products from Sandoz and Amneal are currently in shortage, per the latest data from the American Society of Health-System Pharmacists.
Amneal’s executive vice president noted that they were aware of reports concerning patient access difficulties but emphasized a surge in demand at pharmacies in recent months.
Boyer added, “These transdermal systems are complex and require specialized manufacturing, which limits production capacity. We are still meeting our supply commitments and are continually looking to support patients.”
Sandoz acknowledged the seriousness of the estradiol patch shortage, indicating they were working to increase their product shipments to match demand.
They commented on the unprecedented demand created by recent changes in prescribing behavior resulting from the removal of boxed warnings, admitting it hasn’t been easy to keep up.
Sandoz also noted they’re aiming to boost global capacity while shipping additional supplies specifically to meet the rising demand in the U.S.
Noven Pharmaceuticals stated they have managed to fulfill all orders even amidst the increased demand and remain committed to supporting healthcare providers’ choices regarding their products.
Viatris commented on their commitment to ensuring that patient access to estradiol patches is maintained and are planning for future demand increases.
In the U.S. and Canada, concerns linger about how ongoing shortages may affect patients’ health. Dr. Lindsay Shirreff, an ob/gyn in Canada, highlighted the potential consequences of short interruptions in estrogen therapy, which can lead to the return of debilitating symptoms.
“Even small breaks in treatment can bring back hot flashes and mood changes, which can stress patients and push doctors to discuss alternatives,” she advised.
Shirreff recommended discussing potential alternative treatments like estrogen gels or sprays, while noting the importance of consulting healthcare providers to ensure correct dosing when switching formulas.
Many doctors may prefer to prescribe estrogen patches as a primary treatment option for menopausal symptoms, given their favorable safety profile compared to other estrogen forms.
“Generally, we find estrogen patches to be the safest method of delivering estrogen for post-menopausal patients. They carry a lower risk of cardiovascular side effects,” Butler clarified.
However, if a particular patch isn’t covered by insurance, alternative oral options are available, though they come with their own set of risks.
Oral estrogen might not be suitable for some patients due to an increased risk of blood clots and strokes, which differs from transdermal options.
“The way the body processes these medications plays a role. Oral forms must go through the liver, which can increase certain risks,” Butler explained, reaffirming that the benefits of both options generally outweigh the downsides.
“There’s definitely a growing demand,” she added. “People are increasingly interested in hormone replacement than they used to be.”
