Alexis Dunne always plans how to best treat her patients’ perimenopause and menopause symptoms.
The Chicago-area physician wants to ensure that the hormone replacement therapy she prescribes helps night sweats and brain fog and sets patients up for long-term bone health.
Lately, however, she must do more: Make a backup plan if estrogen patches are out of stock.
Some days, it feels like a choose-your-own-adventure solution. With estrogen patches still in short supply, Dunne is troubleshooting.
If patches aren’t available and the patient can take oral estrogen, Dunne prescribes that. But if a woman can’t take an estrogen pill, she might try an estrogen gel or spray — which can cost $300 a month instead of the $35 monthly patches.
So she might try two .025 patches instead of .05, which is the dose most of her patients are searching for. In a pinch, sometimes patients can also cut a higher-dose patch in half, she says.
“Women shouldn’t have to skip treatment or wonder if they can get their medicine,” says Dunne, who specializes in menopause care. “They’re not sleeping, they’re having hot flashes again and they’re miserable. My main message to them is: Don’t fret. We can try other ways. We can help you.”
Estrogen patches — popular for those in menopause — have been in short supply since the start of the year. Now the Food and Drug Administration says it is talking with the five biggest patch manufacturers, ensuring all companies are running at capacity. FDA officials won’t categorize the situation as a formal shortage, but say if it gets worse, they will work with manufacturers and compounding facilities to ensure the need is met.
Hormone replacement therapy — estrogen often coupled with progestin — is the preferred treatment for menopause, according to The Menopause Society.
It’s Also Personal
Dunne understands the shortage firsthand. Even her own pharmacy is out of her .05 patches, and she is now considering switching to oral estrogen temporarily.
She encourages her patients to call her if they can’t get their medication, rather than simply skipping doses. “Even one month off your hormones can take a toll,” she says.
The patches do more than lessen symptoms such as night sweats and irritability. Estrogen helps protect against osteoporosis and can help with mood, memory and libido.
The shortage has been exacerbated by a surge in prescriptions after the FDA removed estrogen’s black-box warning label last fall. For more than 20 years, that warning kept many women away from hormone replacement therapy following a 2002 Women’s Health Initiative study that linked it to higher risks of breast cancer, heart attacks and strokes in postmenopausal women. Those risks, recognized later, were mostly found in women who were older when they started therapy.
The study’s ramifications were sweeping: use of hormone replacement therapy dropped from 40% to just 5% over the past 20 years. Prescriptions of estrogen-based HRT more than doubled from 2018 to 2026, according to Truveta, a health data analytics company — with one of the largest jumps coming in patches.
The Monthly Scramble
Many women spend years suffering with perimenopause and menopause symptoms before they get help. One in five women go a full year before a doctor diagnoses their menopause, according to a survey by women’s health company Bonafide.
So when a woman finally finds a solution and the medication disappears from shelves, the frustration can be overwhelming.
Jenny Carrick, a marketing and communications director from Sacramento, California, spent the first months of the year calling her pharmacy the moment she had two patches left. She and her pharmacist then called additional pharmacies to track down stock. After four months of that cycle, she is now talking with her doctor about switching to oral estrogen temporarily.
“It’s so frustrating and I don’t understand why they can’t figure this out,” she says.
Some women have been forced to use a different brand of estrogen each month, leading to inconsistent care and often higher out-of-pocket costs. Women have driven 45 miles to pick up a coveted box of the tiny plastic patches they apply near their belly button and change twice a week.
Sandoz, one of the larger patch manufacturers, says it is working to increase global capacity. A company spokesperson says patches are more complex and time-consuming to manufacture than other medicines and that the company is allocating additional quantities to U.S. patients in the meantime.
What to Do If You Can’t Find Estrogen Patches
Sharon Malone, an OB-GYN and medical advisor for Alloy, urges women to keep talking with their clinicians and not skip treatment. “We want them to remain symptom free,” she says.
Her suggestions for patients navigating the shortage:
- Try varied local and mail-order pharmacies, as stock levels vary by location.
- Ask about estrogen spray or gel, both of which can be applied to the arm or thigh and allow providers to adjust doses without a new prescription.
- If you can take oral estrogen (some women with blood clots or other health conditions cannot), it is a good temporary solution.
Reporting by Laura Trujillo, USA TODAY.
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