Estrogen Patch Shortage: What to Know and Which Alternatives Work

Women across the country are hearing the same frustrating news at the pharmacy counter: their estrogen patches are on backorder.

According to Reuters, the shortage affects major manufacturers and could stretch on for up to three years. Estrogen patches are a common form of hormone replacement therapy (HRT), also called menopause hormone therapy (HT), alongside pills and other delivery methods.

Right now, a mix of surging demand, supply chain issues, and limited production capacity has left many women calling different pharmacies, switching brands and dosages, and in some cases going without treatment, Reuters reported.

With more than 1 million U.S. women entering menopause each year, according to the National Institutes of Health (NIH), the shortage has the potential to affect a large number of people.

Here is what is driving the shortage, why menopausal women benefit from estrogen patches, and what alternatives can help manage symptoms.

Why are estrogen patches so hard to find right now?

Demand for estrogen patches has outpaced supply, and manufacturers are struggling to keep up.

Prescriptions for estrogen-based HRT have surged, according to an analysis by health data company Truveta. Patch use specifically more than tripled between 2018 and early 2026.

Among women ages 45 to 54, prescribing rates jumped 184%. In February 2026, about 1 in 20 women in that age group had an estrogen-based HRT prescription, the Truveta data showed.

Several factors drove that growth. In November 2025, the FDA began removing some of the strongest safety label warnings from certain HRT products. These warnings had been in place for more than two decades, following the 2002 Women’s Health Initiative study, which raised concerns about heart and cancer risks.

The FDA said it made the labeling changes after a full review found the warnings overstated the risks for many women, especially those who start therapy near the start of menopause.

“We removed the black box warnings on hormone replacement therapy to tell women the truth about the short-term and profound long-term public health benefits of hormone replacement therapy,” FDA Commissioner Dr. Marty Makary said in a presentation to FDA employees on April 1.

“Demand for hormone replacement therapy has surged since our announcement,” Makary said.

Dr. G. Thomas Ruiz, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, said the shift has been dramatic in his own practice.

“As soon as the FDA changed its black box warning… I got so many patients who are no longer fearful,” Ruiz told Healthline. He added that the biggest concern holding women back had been breast cancer risk — a fear rooted in the original Women’s Health Initiative findings.

Dr. Sarah Prager, an OB-GYN at University of Washington Medical Center, said she has seen the same trend.

“I have seen a huge uptick in patients requesting estrogen as part of menopausal hormone therapy,” Prager told Healthline, adding that she has noticed patients are having a hard time getting patches.

“Our field is starting to catch up on how helpful estrogen can be, how safe it generally is, and how early we could/should be starting mHT for patients to help with symptoms,” she said.

Estrogen patch manufacturers face hurdles

On the supply side, manufacturers are dealing with challenges.

A spokesperson for manufacturer Sandoz told Reuters that the FDA’s November decision “created unprecedented demand that cannot fully be met at present,” and that the company has shipped extra supplies to the United States to help ease shortages. Amneal and Viatris also told Reuters they are working to boost supply.

The U.S. Department of Health and Human Services (HHS) told Healthline the FDA is not yet at the point of declaring an official shortage.

In a statement, HHS said, “currently all 5 manufacturers are reporting they are continuing to manufacture at full capacity, and they are working to keep up with the increased demand that’s occurred. We are working with all of the manufacturers on ensuring that supplies meet demand and will continue to offer our assistance on anything they need to increase supply.”

HHS added that if the product falls into a national shortage, the FDA will post availability information on its website, along with planned timelines from the companies, and that compounders could make the product in line with all applicable laws.

“Currently, it is not in shortage,” HHS said. “We continue to monitor supply and are offering our assistance to the manufacturers with anything needed to increase supply.”

Estrogen patch alternatives

Ruiz said that while hot flashes and other vasomotor symptoms return quickly without estrogen, longer-term benefits like bone density protection take months to be affected.

Going off the patch temporarily brings discomfort, but symptoms will improve once estrogen resumes in any form, he said.

Ruiz said several alternatives remain available, noting that oral estrogen tablets and estradiol creams and gels can all treat menopause symptoms effectively. The gels and creams, he noted, are “a little less convenient in that you have to do a daily application.”

Experts recommend the following options, all of which a healthcare professional can help evaluate:

– Try other pharmacies: Independent pharmacies may have different supply chains than large chains. The FDA explains that chain pharmacies negotiate directly with distributors, while most independent pharmacies negotiate through buying groups that bid their distribution needs to distributors.

– Ask your doctor about a different patch: Doctors may also be able to prescribe a different patch brand — such as a once-weekly option instead of a twice-weekly one — as a short-term bridge. Ruiz noted the weekly patch “seems to be available,” but cautioned that “it often falls off before seven days,” which can create refill timing issues with insurance.

– Estrogen gels or sprays: Products like EstroGel, Divigel (gels), and Evamist (spray) also deliver estrogen through the skin and bypass the liver. They carry a similarly lower risk of blood clots as patches.

– Oral estrogen tablets: These are widely available and affordable. They effectively treat hot flashes and other systemic symptoms.

– Vaginal estrogen creams, rings, or inserts: For women whose main symptoms are vaginal dryness, itching, or burning, a localized vaginal estrogen product may actually be a better fit. These products treat symptoms directly and carry an even lower risk of serious side effects.

Doctors say the right choice depends on a person’s specific symptoms, health history, and what is available right now.

More women are pursuing HRT now than in previous decades, and the industry is shifting to meet that demand.

“50 million women have been denied hormone therapy or never offered it, or talked out of it over the previous 22 years because of the fear machine scaring women away from it,” Makary said in his presentation. “And the FDA is guilty.”

In the meantime, experts recommend refilling prescriptions early and staying in close contact with a provider who is knowledgeable about menopause care.