This story originally reported by Jennifer Gerson of The 19th, and republishing via Rewire News Grouphis collaboration with the 19th News Network.
One of the most commonly used forms of menopause hormone therapy is hard to come by right now.
This is true of estradiol patches, as two of the largest manufacturers report being in want. Estradiol is a form of estrogen and these patches are a way to release the hormone transdermally or through the skin. Transdermal estrogens are often prescribed by menopause specialists because the delivery prevents the liver from processing estrogen and therefore does not increase the risk of blood clots or heart attacks.
The reasons for the shortage aren’t entirely clear, though it’s likely a combination of pre-existing supply chain issues, the impact of tariffs on overseas drugmakers and increased demand for the patches following a regulatory change. In November, the Food and Drug Administration lifted up the 20-year-old black box warning on estrogen products used in menopausal hormone therapy warns of serious side effects, which likely made these drugs feel more accessible.
Systemic estrogen—the form of hormone therapy used through a patch—treats some of the best-known and most bothersome symptoms of menopause: hot flashes, night sweats, palpitations and mood swings.
But experts say if you can’t find the patch prescribed to treat these symptoms, there are other options.
Dr. Lauren Streicherprofessor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and author of a forthcoming AARP book on menopause, said there is no need to panic.
“It doesn’t matter how it gets there, it’s going to help your hot flashes, it’s going to help your symptoms,” Streicher said.
Patches aren’t the only form of transdermal estrogen available—and in fact, all transdermal estrogens use the same drug, often made by the same company and then distributed to pharmaceutical companies. So some end up being transdermal patches, but there are also gels, creams, and sprays that go on your skin that have the same active ingredient.
Transdermal estrogen isn’t the only form of estrogen available for hormone therapy, Streicher explained.
Oral estrogen – taken via pill – is also a safe form of estrogen for many people, depending on their medical history. For someone who doesn’t have a history of blood clots, it can be a great option. It has also been proven in lower cholesterol levels and lower lipidsboth excellent for heart health.
Some patients may switch to oral estrogen because transdermal options without patches are often not covered by insurance.
Streicher advises against going to pharmacies to bridge the gap, as it’s impossible to know the exact dose you’re getting in the products dispensed there.
As the systemic dose of estrogen leaves your body, any symptoms you’re experiencing will return—how long will vary from person to person—but Streicher assured that the effects of removing the patch won’t be more severe than that.
“Your brain is not going to start eating itself,” he noted.
But other than discomfort, there is no inherent danger in stopping hormone therapy for a period of time. Likewise, there’s no risk of going back on when you have access to the hormone therapy of your choice – and yes, your symptoms will go away again once you’re back on your estrogen.
In view of the shortage, Streicher advised that those wishing to continue hormone therapy seek the care of a gynecologist who is well-versed in menopausal care and is very familiar with the different forms of estrogen used in menopausal hormone therapy and its dosage. Seeing someone who specializes in menopause care can help ensure you have options if you want to continue hormone therapy, even if you can’t find pads. (Can’t find a menopause specialist near you? There are also many telehealth services that specifically focus on hormone therapy and connect patients with menopause specialists who can prescribe it.)
“These are nuanced things,” Streicher said. “It takes a specialist to be able to help someone with that. And most people out there, especially if you have someone who only prescribes patches, they’re going to scratch their head and say, ‘I don’t know how to help you.’ So keep looking. Keep looking until you find a doctor who has expertise in hormone therapy.”
Because whether that means finding a brand versus a generic, another form of transdermal application, seeing if you’re a candidate for oral estrogen, or just waiting something out – there are options and care.
