Women across the United States are reporting that there’s a shortage of the transdermal estrogen patches they use to manage the symptoms of menopause.
USA Today wrote: “Doctors told women to use this medicine for menopause. Pharmacies can’t keep it in stock.”
On Reddit, one recent post says: “FDA says there’s no estrogen patch shortage. We know better. Here’s how to make them listen.“
Oprah even got into the topic: “What to Know Before Freaking Out About the Estrogen Patch Shortage.”
In August, five of the six major manufacturers reported hormone replacement therapy (HRT) shortages, according to the American Society of Health System Pharmacists, bringing havoc to women’s lives as they search for patches or try to go cold turkey from a medication that has been providing them with relief from menopausal symptoms and a measure of equilibrium.
The causes
Why did this happen? Well, three issues. There’s an increased demand from increased publicity and prescribing. And also, there are supply chain problems. Finally, the Food and Drug Administration “black box” warning on serious consequences from this medication was removed in November.
If it’s a crisis, Oprah Winfrey will get into the topic: “If you’re a woman of a certain age, your social media algorithm might be feeding you video after video of other women struggling to get their hormone therapy (HT) prescriptions filled — particularly if they use estrogen patches. ‘This message is for CVS: I’m so sick of back-ordered estradiol patches,’ shared New Hampshire–based family physician Noor Al-Humaidhi, MD, way back in December. For months, women have flooded social media with stories about waiting for weeks to get their patches, or only getting half of their usual order because the pharmacy had so little to spare. Maybe you’re among these frustrated, fed-up patients just trying to get your prescribed medication.”
USA Today reported: “For almost a year, women have struggled to find estrogen patches to treat their menopause symptoms. 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-System Pharmacists documents that there are almost 20 estrogen patch formulations impacted by the shortage, double the number from earlier this year.
“Now the F.D.A. 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.”
Not a trans issue
There’s a great deal of conversation online with people accusing transgender women of taking estrogen supplies away from women undergoing menopause. There’s no evidence to suggest that. And in fact, the use of estrogen for transition does not include estrogen patches in most cases. Trans women seldom use patches, while menopausal women do; also, the number of trans women compared to the number of menopausal women is vanishingly small.
It is also true that estrogen is made in a lab, and when demand sagged, then labs stopped making it. Now that demand is up, labs are more interested in making it, but supply needs to catch up with demand.
Meanwhile, it is scary out there. Don’t go on Reddit and search on “estrogen patches” — or on Twitter either.
What you can do
Call different pharmacies. Mail-order ones might have patches. Also, sometimes a small independent pharmacy might have stock while a big chain does not.
Try a hospital pharmacy. They may have supplies the chains do not.
Talk to your doctor. It’s possible that you can try estrogen spray or gel, or an oral pill. But note that there are also shortages in progesterone and vaginal estradiol cream.
Go overseas. An acquaintance tweeted from Tijuana, Mexico: “Prescription drugs are 1/3 the price or less in Tijuana, Mexico and you can just walk right up to an open market. My albuterol is $5 here. Estrogen patches that are $75-90 in US are $25-30!”
Network. Sometimes a social media group, a neighborhood group, or a friend over email can offer you opportunities beyond your normal prescription-filling path.
Cutting your patches in half might work. “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, according to The New York Times. “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.”
Think about changing your dosage. “Weekly patches are somewhat more available than twice-weekly patches, but not by much,” PhillyMag reported. “Patients can switch to other methods, such as daily gel, daily oral pill, or the vaginal ring (Femring). They can also sign up for annual-fee memberships like The HRT Club — you pay out of pocket for prescriptions from those.”
Do you need to continue? “For people who wish to stay on it long-term, I recommend yearly evaluations of their medical situation and overall health,” PhillyMag added. “Have they developed cardiac disease, liver disease, or cancer? If so, they wouldn’t continue. If they’re in good health, we’d probably lower their dose over the years because the body doesn’t need the same level of hormones over time. …
“The questions doctors should be asking patients is, ‘Why are you on hormone therapy — and why do you want to stay on it?’ If you’re using it to manage perimenopause or menopause symptoms, then you don’t need to be on it forever — those symptoms eventually go away. But if you’re taking it for a long-term health benefit, like preventing osteoporosis, then that’s something to consider.”
