When Ellen Winn was in her late 40s, she began having night sweats that ruined her sleep and left her feeling depleted the next day. Her doctor prescribed an estrogen patch, and after trying out different doses, the sweats eventually stopped.
Then, earlier this year, her local pharmacy ran out of her patch, along with all the pharmacies in neighboring towns. For months, she scrambled to stay on the treatment by mixing and matching lower-dose patches that were available.
“I’m a busy working mom with three little kids,” Ms. Winn, now 51, said. “It feels truly ridiculous.”
Since January, women across the country have reported difficulty filling prescriptions for estrogen patches, which help treat menopausal symptoms such as hot flashes, sleep issues and brain fog, and preserve bone density. While a few manufacturers reported shortages as far back as 2023, the problem has become more pervasive this year, menopause care providers said.
The Times reported on the shortage in February, when 10 formulations of patches that deliver estradiol, a form of estrogen, were in shortage. As of July 1, that list had doubled, according to the American Society of Health-System Pharmacists, a professional group for pharmacists.
“There is still enormous difficulty obtaining the estradiol patch in a consistent way,” said Hollie Wakelyn, a pharmacist based near Seattle who specializes in menopause medicine. It’s not clear when the shortages will improve, experts said.
A spokeswoman for Sandoz, one of the manufacturers facing a shortage, said it had been working on increasing its global supply, and in the meantime, had “allocated additional quantities” to the United States.
Demand for estrogen to manage symptoms of perimenopause and menopause has surged in recent years, in part because of an increased trust in the safety of menopause hormone therapy: Last year, the Food and Drug Administration removed so-called black box warning labels from products containing estrogen.
While accessing hormone therapy might require more effort right now, there are a few workarounds that can help you continue treatment — though you should consult with your provider before making any changes. “We don’t want you to suffer, we don’t want you to go without medication, and you don’t have to,” Dr. Wakelyn said.
We asked menopause experts to share their most effective strategies for helping patients obtain or stay on estrogen during the shortage.
Get a flexible prescription.
If your local pharmacy is out of your patch, start by calling around to other nearby pharmacies to see if it’s available. “Different pharmacies have different stockpiles of these medications, and so it’s definitely worth checking,” said Dr. Stephanie Faubion, the director of the Mayo Clinic Center for Women’s Health and medical director of the Menopause Society.
You can also ask your provider to write an “open format” prescription, noting that you are open to receiving another brand of the same dose, if they are out of your preferred patch, Dr. Wakelyn said. (Some providers do this regularly, but others will only do it as requested.)
That way, if your pharmacy is out of your first choice, they can fill the prescription without having to go back to your provider for approval. “Most of the time, we can interchange the patches that we have,” Dr. Wakelyn said.
You can also see which products are not in shortage on the website for the American Society of Health-System Pharmacists, and ask your provider to request one of these formulations in their prescription.
Dr. Suzanne Gilberg, an OBGYN and menopause specialist in the Los Angeles area, also suggested asking your doctor to request a 90-day supply, as many pharmacies will default to a 30-day order.
If you can’t find your patch locally, or can’t devote time to traveling to other pharmacies, the experts suggested trying a major online pharmacy. While you’ll have to wait to receive your prescription by mail, these pharmacies often have a larger supply than local retailers.
Cut your patches in half — or wear two.
Depending on the type of estrogen patch you use, you may be able to cobble together your dose by using the patches pharmacies have on hand, said Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine.
If only a higher dose is available, ask your provider whether it is safe for you to cut your patch in half or quarters.
Before you reach for the scissors, though, note that estrogen patches come in two varieties: The most popular type deliver estrogen through a “matrix” of adhesive, but some deliver estrogen through a small “reservoir,” or pocket, of liquid or gel. Only the matrix style patch can be cut.
If only a lower-dose patch is available, you can wear two instead of one.
And if you currently use a patch that requires you to change it twice a week, you could also try switching to one that is changed once a week — or vice versa.
Try a gel, spray, ring or pill instead.
Estradiol patches are popular for a reason: They’re convenient, widely covered by insurance and deliver estrogen through the skin into the bloodstream.
But they are not the only form of estrogen therapy — and none of the other delivery systems are in shortage. For some women, there might be a more effective option that’s easier to find, Dr. Gilberg said.
If you are on a low-dose patch, you can try switching to a daily gel or spray, which you rub or mist on your upper arm or thigh.
You can also try a vaginal ring, a silicone device that you insert into the vagina, which slowly releases estrogen. You switch it out every three months.
There is also oral estrogen, taken as a pill. Oral estrogen isn’t typically recommended for women at risk of blood clots or liver problems, and it can cause more side effects compared to estrogen that’s absorbed through the skin, but it is a safe choice for many women, Dr. Streicher said.
For some women in perimenopause, a low-dose hormonal contraceptive pill can also effectively manage symptoms.
In recent months, some manufacturers of dietary supplements have used the shortage as a marketing opportunity, claiming their products will ease menopause symptoms. But there is little evidence to support their efficacy, Dr. Wakelyn said.
Dr. Faubion also urged caution if you are considering getting estrogen from a compounding pharmacy. Since the Food and Drug Administration does not approve compounded products, their quality can vary, experts said. If you are considering using a compounded medication, ask your doctor to recommend a compounding pharmacy they trust.
Your provider can advise on whether you are a good candidate for a different form of estrogen therapy. “It doesn’t have to be forever,” Dr. Wakelyn said. But some women find that they actually prefer one of the other methods, she added.
Maggie Astor and Nina Agrawal contributed reporting.
