As menopausal women struggle to get their prescriptions filled, the FDA told USA TODAY it is in discussions with the five largest manufacturers of estrogen patches to ensure all companies are at production capacity.
It’s time to talk about menopause and menopause
The hormonal and physical changes associated with menopause are rarely discussed publicly. Why not?
Alexis Dunn always plans the best treatment for her patients’ perimenopausal and menopausal symptoms.
A Chicago-area doctor hopes the hormone replacement therapy he prescribes will improve night sweats and brain fog, ensuring long-term bone health for his patients.
But these days, you have to do more, like have a backup plan in case your estrogen patch runs out of stock.
Some days I feel like I have to choose the solution to my adventure. Estrogen patches are still in short supply, so Dan is troubleshooting.
If the patch is not available and the patient can take oral estrogen, Dunn prescribes it.
However, if a woman cannot take estrogen pills, she may try estrogen gel or spray.
But the gel costs $300 per month instead of the $35 per month patch.
So she might try two .025 patches instead of the .05 patch that most of her patients are looking for. In emergencies, patients can also cut the high-dose patch in half, she says.
“Women don’t have to skip treatments or wonder if they can get their medications,” says Dunn, who specializes in menopause care. “They can’t sleep, they’re having hot flashes again, and they’re in a dire situation. The main message I want to give them is, ‘Don’t worry. We can try other methods. We can help you.'”
Estrogen patches, which are popular among people suffering from menopause, have been in short supply since the beginning of the year. USA TODAY first reported the case in February.
Now, the Food and Drug Administration tells USA TODAY that the organization is consulting with the five largest patch manufacturers to ensure all companies are up to the task. FDA officials said they would not classify the difficulty in finding patches as a shortage, but if the situation deteriorated further, they would work with manufacturers and compounding facilities to ensure their needs were met.
According to the Menopause Society, hormone replacement therapy (often a combination of estrogen and progestin) is the preferred treatment for menopause.
It’s also personal
Dan understands scarcity. Her pharmacy also doesn’t have .05 patches applied. Instead of scrambling every month to find a pharmacy that has it in stock, she’s now considering taking oral estrogen temporarily.
She jokes, “If the government doesn’t step in and fix the estrogen patch shortage soon, there will be a political coup and an enraged woman near menopause will be in the Oval Office.”
She encourages patients to call her if they can’t get their medication, rather than skipping a dose.
“Even a month off of hormones can have negative effects,” she says.
Patches do more than just relieve symptoms like night sweats and irritability. Estrogen helps protect against osteoporosis and can also help improve mood, memory, and sex drive. It is also used by transgender men and women as part of gender-affirming care.
Since the Food and Drug Administration removed the black box warning label last fall, prescriptions for estrogen have increased, further exacerbating the shortage.
This warning has kept many women away from hormone replacement therapy for more than two decades, ever since a 2002 Women’s Health Initiative study linked it to an increased risk of breast cancer, heart attack, and stroke in postmenopausal women. This later-recognized risk was primarily seen in women who were older when they started hormone therapy.
The impact of this study has affected millions of women, and over the past two decades, the use of hormone replacement therapy has fallen from 40% to 5%, as many doctors stopped prescribing it, and even if they did, women were reluctant to take it.
Prescriptions for estrogen-based hormone replacement therapy more than doubled from 2018 to 2026, according to health and data analytics company Truveta. One of the biggest jumps occurred in patches.
Monthly Scramble – Patch Trading and Endless Calls
Many women struggle with menopause and menopause symptoms for years before getting help. According to a study by Bonafide, a women’s health care company, one in five women experience menopause a year before their doctor diagnoses it.
So when women finally find a solution, they often feel exhausted and frustrated when they can’t get their medication.
At the beginning of this year, Jenny Carrick thought it couldn’t get any worse.
Each month, when she had two patches left and was allowed to reorder, she called her local pharmacy. She and her pharmacist then called more pharmacies to see if they had them in stock.
A marketing and communications director in Sacramento, Calif., is talking with her doctor about temporarily switching to oral estrogen after four months of stress.
“It’s very frustrating and I don’t understand why they can’t figure this out,” she says.
Some manufacturers say they are working to help women who are forced to use different brands of estrogen each month, which often leads to inconsistent care and higher prices for drugs not covered by insurance. Women have driven 45 miles to pick up coveted boxes containing tiny plastic patches that are placed near their belly buttons and replaced twice a week. One woman offered an unused patch (her doctor had increased her dose of estrogen) to a friend who couldn’t find it.
Sandoz, one of the leading manufacturers of estrogen patches, is working to expand its global production capacity.
A company spokesperson said the patch is more complex and time-consuming to manufacture than other medicines. In the meantime, the company is allocating additional quantities to patients in the U.S. to meet demand.
What to do if you can’t find your estrogen patch
Sharon Malone, an obstetrician-gynecologist and Alloy medical consultant, says women need to keep talking to their doctors and not skip their treatments. “We want them to remain asymptomatic,” she says.
Her suggestions for patients suffering from ongoing shortages are:
- Inventory fluctuates, so try different local and mail-order pharmacies.
- Try an estrogen spray. You can also apply it to your arms and thighs.
- Try estrogen gel. You can also apply it to your arms and thighs. Both sprays and gels allow health care providers the flexibility to change doses without changing prescriptions.
- If a woman can take estrogen by mouth (some women with blood clots or other health problems cannot), it is a good temporary solution.
Laura Trujillo is a national columnist focused 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.
