Estrogen patches are in short supply as women seek menopausal support

Woman applies an estrogen patch during hormone therapy.

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Estrogen patches are in short supply as demand for menopause drugs skyrockets, and it could take at least a year for manufacturers to catch up.

Estrogen patch prescriptions have increased 162% in the last two years, according to data from HealthVerity. Already rising demand was boosted last fall when the Food and Drug Administration removed a more than 20-year-old black box warning that discouraged women from taking hormone replacement therapy.

Manufacturers are finding it difficult to keep up. According to the American Society of Health-System Pharmacists, which relies on reports from health care providers, three types of patches are in short supply. The FDA has not detected a deficiency in estradiol using another method.

“You can get them, but it takes a lot of time and effort when we are all so busy at this time in our lives,” Dr. Susan Loeb-Zeitlin, director of the Women’s Midlife Center at Weill Cornell Medicine.

Doctors across the country describe their patients’ difficulties finding hormone replacement therapies, particularly estrogen patches. When asked how much time she spends helping people find medications, Dr. laughs. Francesca Turner, a doctor in Iowa, just.

“My nurse, the patient pharmacists and I do this almost every day and try to figure out how to manage this for our patients,” Turner said.

Doctors prescribe estrogen to treat symptoms of menopause, including hot flashes and brain fog, which occur when a woman’s body produces less of the hormone. Estradiol is the most effective type and is usually administered via a patch that gradually releases the hormone onto the skin to relieve the physical and mental symptoms of menopause. Doctors prefer topical administration of estrogen because it is considered a safer option than oral administration, Loeb-Zeitlin said.

For more than two decades, the FDA discouraged women from treating menopause with estrogen because a 2002 study called the Women’s Health Initiative suggested it could put women at higher risk of breast cancer and other diseases such as dementia. Later analysis found that the study’s participants were older than most women starting hormone replacement therapy and that the risks of taking it were overstated. Last fall, the FDA changed course and said it would work with the companies to remove references to the risks from the drugs’ labels.

At this point interest had already increased again. Doctors are praising prominent voices like Oprah Winfrey and social media users for shedding light on menopause, the life-changing symptoms some women experience and how hormone replacement therapies can help.

“The demand is actually coming from more and more women who say in their groups or communities that they are still suffering,” said Dr. Jessica Shepherd, Chief Medical Officer of Hers. “This has been driven much more by social media, where people can really express their voices, and you also see a lot of celebrities talking about their journey.”

Given the momentum, Hers, part of telemedicine provider Hims & Hers, best known for offering erectile dysfunction medications and GLP-1, decided to enter the perimenopause and menopause business about a year and a half ago, Shepherd said. Interest in the program has tripled since its launch in October, the company said.

According to data from HealthVerity, prescriptions for all types of estrogen have increased by 78% in the last two years. The patches proved particularly popular: prescriptions more than doubled from 594,000 in June 2024 to 1.6 million in May, according to HealthVerity. They now make up 44% of all estrogen prescriptions.

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This popularity has put a strain on supply.

According to the ASHP database, three types of estradiol patches are currently in shortage. Two of the affected manufacturers – Zydus and Noven – did not respond to CNBC’s request for comment.

The third drugmaker, Amneal, said it was working to increase production to meet growing demand. The company said it did not provide specific production details or timelines but remains focused on continuity of patient care.

Other manufacturers of estrogen products said they are seeing similar trends. Sandoz said in a statement that recent changes in prescribing patterns have “created unprecedented demand that cannot currently be fully met.” The company said it is working to increase production of estradiol patches, but this is difficult because manufacturing the patches is “very complex.”

Pharmaceutical industry experts say increased demand may explain why the FDA hasn’t reported a shortage. The agency evaluates whether the supply of all manufacturers of a drug corresponds to the historical demand for a drug.

And while the ASHP’s shortage database is based entirely on public reports, the FDA’s data comes from manufacturers, said Michael Ganio, senior director of pharmacy practice and quality at the ASHP. This leaves the FDA trying to quantify new demand for a drug without being able to easily track unfilled prescriptions.

“It’s really, really hard to understand how much demand there is out there because you don’t know how many doctors, nurses and prescribers in general are switching their patients to alternative products. So it’s always difficult for the FDA to put a label on, ‘Yes, there’s a shortage,’ without really being able to quantify the actual market demand,” Ganio said.

An FDA spokesperson said there is currently no shortage of estradiol patches and all six manufacturers report production is at full capacity while working to keep up with increased demand. The agency said it continues to monitor supply and is offering manufacturers support to increase supply.

It may take some time to see the results of these efforts. Making transdermal patches requires more complex manufacturing than treatments like pills.

Generic drug makers typically rotate their production lines throughout the year, Ganio said, meaning they might use one line to make an estradiol product for the first three months and then use it for the entire year. And to increase production, they would either have to wait until the next day year or run another batch. For manufacturers of generic drugs, the calculation is more difficult because the profit margins on the products are lower than on brand-name drugs, he said.

The strain already appears to be spreading to other hormone replacement therapies, with ASHP recently listing several estradiol creams and progesterone pills, which are given along with estrogen, as in short supply.

Now some people are looking for alternatives. Loeb-Zeitlin suggests her patients try estrogen gels if they can’t find patches. Some doctors use creams from pharmacies.

Jenn Burch, a pharmacist in Durham, North Carolina, began marketing the creams to doctors in her area earlier this year when she had trouble keeping the patches in stock. She notes that some patients prefer them because she can adjust them to combine estrogen with other hormones such as progesterone or testosterone.

Insurers rarely cover compounded drugs, meaning patients must pay the cost out of pocket. Burch says she charges about $50 for a month’s supply of cream, a price she says helps cover the investment she made to comply with a current regulation on the composition of hazardous substances. The special handling requirements could be another factor limiting manufacturers’ ability to quickly ramp up production, Ganio said.

He predicts it will take a year or two for manufacturers to find the optimal compromise between supply and demand. This means that women might be busy struggling for some time.

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