For almost a year, women have struggled to find estrogen patches to treat their menopausesymptoms. They’ve called dozens of pharmacies to find them in stock, driven to neighboring cities to pick them up and even procured them from friends who had extras.
And for almost a year, the U.S. Food and Drug Administration has told women there is no shortage of patches, even as the American Society of Health Care Pharmacists documents that there are almost 20 estrogen patch formulations impacted by the shortage, double the number from earlier this year.
Now the FDA has acknowledged that many women are not able to get their estrogen patches and its leaders are working with six manufacturers to increase supply. This includes companies adding manufacturing
shifts, increasing batch sizes, and prioritizing production of estradiol patches.
In the meantime, the FDA is telling women to talk to their pharmacist or doctor about options.
Women aren’t ready to applaud the announcement, saying the FDA should have declared a shortage which could incentivize manufacturers to increase production faster.
“When we met with representatives at the FDA in April, they made it clear they knew women weren’t able to get patches. It took four months to issue what amounts to a lukewarm statement with advice ‘Talk to your pharmacist!’ that we’ve already exhausted,” says Jennifer Weiss-Wolf, author of the upcoming "When in Menopause: A User's Manual & Citizen's Guide," and part of a group of health care leaders who met with FDA leadership earlier this year.
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Women say they are frustrated that they still are struggling to get access to the medication they need. In some cities, women have also struggled to get progesterone capsules, which often are used with estrogen patches for hormone replacement therapy. The American Society of Health Care Pharmacists, which represents more than 65,000 pharmacists, also says there is a shortage of different types of progesterone.
Why is there an estrogen patch shortage?
The FDA says the shortage stems from women themselves.
Agency leaders say since they removed the “black box” warning on products last fall, more women have sought access to estrogen. That’s created a run on the medication that companies weren’t prepared for. Some drug manufacturers also have blamed the shortage on the increased use of the patches.
For more than 20 years, the warning has kept many women away from hormone replacement therapy after a 2002 Women’s Health Initiative study linked it to a higher risk of breast cancer, heart attacks and strokes in postmenopausal women. The risks, recognized later, were mostly found in women who were older when they started hormone therapy.
The study's ramifications affected millions of women, with the use of hormone replacement therapy dropping from 40% in 1999 to 5% in 2020 as most doctors stopped prescribing it.
But some advocates for women’s health say that reasoning alone that doesn’t sit well with them.
The use of hormone replacement therapy has been steady for the past six years with around 5% of women in menopause or perimenopause using it. So while there has been an increase in use of the patch since November due to the change in labeling, it hasn’t been large enough to cause the shortage, Kathleen Jordan, the chief medical officer and cofounder of Midi a women’s telehealth menopause provider, told USA TODAY earlier this year. “The problem isn’t an increase in demand of the patch, the problem is the manufacturers. The demand is only going up as access to care is improving.”
How did we get here?
Almost half of all women who are on hormone replacement therapy said they are having difficulty filling their estrogen patch prescriptions, according to a May Midi survey of more than 8,000 women.
Amy Heavener has been on HRT since 2022 when perimenopause left her exhausted and with hot flashes that she couldn’t manage on her own. The city clerk who lives in Northern California credits twice weekly .05 estrogen patches with helping her feel like herself again.
But for the past six months, her pharmacy has been out. Her hot flashes returned and she felt depression creeping in. A friend gave her some .025 patches to double, but they aren’t working for her.
Her physician switched her prescription to an estrogen gel, but her insurance company won’t pay for it because it already approved the patch prescription. Now she is waiting as her physician tries to get one prescription canceled to allow for the new one.
Estrogen gel without insurance coverage can cost from $150 to $300 a month.
One third of the women surveyed said the estrogen patch shortage is affecting their health.
Hormone replacement therapy − estrogen often coupled with progesterone − is the preferred treatment for menopause, according to The Menopause Society. Estrogen helps protect against osteoporosis and can help with menopause symptoms including hot flashes and depression.
What to do if you can't find estrogen patches
Sharon Malone, an obstetrician and gynecologist and medical adviser for Alloy, says women should not skip treatment, but also not panic. “We want them to remain symptom free,” she says.
Here are her suggestions for patients grappling with the ongoing shortage:
- Try local and mail-order pharmacies as stock varies.
- Try estrogen spray or gel, which also can be applied on the arm or thigh. Both spray or gel allow providers the flexibility to change doses without changing the prescription.
- If women can take oral estrogen (some women with blood clots or other health issues cannot), it is a good temporary solution.
Laura Trujillo is a national columnist focusing on health and wellness. She is the author of "Stepping Back from the Ledge: A Daughter's Search for Truth and Renewal" and can be reached at ltrujillo@usatoday.com.
This article originally appeared on USA TODAY: Doctors told women to use this medicine for menopause. Pharmacies can't keep it in stock
