By Emmanuel Bobby
A dramatic rise in the popularity of hormone replacement therapy is placing growing pressure on the U.S. supply of estrogen patches, with doctors, pharmacists, and patients across the country increasingly reporting difficulties obtaining certain brands and dosages.
The surge in demand accelerated after the Food and Drug Administration removed the black box warning from hormone replacement therapies late last year, a move many experts believe helped reshape public perception of menopause treatment and encouraged more women to seek care.
Although federal regulators say the situation has not officially reached the threshold of a national drug shortage, medical professionals say supply problems are becoming more common in pharmacies nationwide.
“There’s been a surge in demand for the last two or three years where the utilization of transdermal estrogen has gone up significantly,” said Dr. Robert Kauffman, a professor of obstetrics and gynecology at Texas Tech Physicians of Amarillo.
Hormone replacement therapies are commonly prescribed to relieve symptoms associated with menopause, including hot flashes, mood swings, vaginal dryness, insomnia, urinary tract infections, and bone loss that can increase fracture risk. Treatments may contain estrogen alone, progesterone alone, or a combination of both hormones.
Among the most widely used forms are estrogen patches, which deliver hormones through the skin and are generally considered convenient, effective, and relatively safe compared with some oral alternatives.
Despite mounting reports of shortages, the FDA has not yet placed estrogen patches on its official drug shortage list, a designation that can trigger emergency measures such as alternative sourcing, expanded imports, and extended drug expiration allowances.
FDA Commissioner Marty Makary acknowledged this week that demand for estrogen patches has risen sharply since the warning label was removed.
“The industry has been able to keep up but barely,” Makary said. “They are recalibrating their distribution and manufacturing to have more robust supply.”
He added that while current supply levels have not officially met the agency’s criteria for a shortage declaration, the FDA is monitoring the issue closely.
“In the interim, the estrogen patches have not risen to the criteria of being on the shortage list, but it is something to manage,” Makary said.
Doctors and Pharmacists Report Growing Access Problems
While federal regulators remain cautious about formally labeling the issue a shortage, many medical professionals say patients are already experiencing significant difficulty filling prescriptions.
The American Society of Health-System Pharmacists currently lists 14 estrogen patch brands or dosages on its drug shortage tracking database. The organization first began flagging estrogen patch shortages in January.
“Our list is 100% reported by either practitioners, pharmacists, physicians, nurses or patients and caregivers,” said Michael Ganio, senior director of pharmacy practice and quality at ASHP, which gathers data in partnership with the University of Utah Health.
Dr. Lauren Streicher, a professor of obstetrics and gynecology at the Northwestern University Feinberg School of Medicine, said concerns about patch shortages now regularly arise during menopause discussions with patients and women’s health groups.
Dr. Kathleen Jordan, chief medical officer of Midi Health, a telehealth company specializing in menopause care, said pharmacy shortages have become increasingly common this year.
“This was happening occasionally last year but has escalated this year,” Jordan said.
Kauffman noted that supply issues are particularly noticeable in West Texas but said colleagues around the country are reporting similar experiences.
However, not every company is seeing disruption. A spokesperson for Alloy Health said the menopause-focused telehealth provider has not observed widespread patch shortages affecting its patients.
Experts say one challenge is that the FDA’s shortage monitoring system relies heavily on historical demand data, which may lag behind real-time prescribing trends.
Ganio explained that because the demand spike happened so rapidly, manufacturers may still be adjusting production schedules and distribution systems.
“We are assuming based on everything we know this is caused by increased demand, but without a manufacturer saying ‘We are having a supply issue,’ we can’t say that for sure,” Ganio said.
Meanwhile, Swiss pharmaceutical company Sandoz said earlier this year that it had increased shipments to the United States to help pharmacies manage rising demand.
Several major estrogen patch manufacturers, including Viatris, Noven Pharmaceuticals, and Amneal Pharmaceuticals, have not publicly commented on the supply situation.
Why Hormone Therapy Demand Is Surging
The renewed interest in hormone therapy marks a major reversal from the dramatic decline that followed the publication of the landmark Women’s Health Initiative study in 2002.
That research linked hormone replacement therapy to elevated risks of breast cancer, strokes, and heart attacks among some postmenopausal women, triggering widespread concern and causing prescriptions to collapse across the United States.
Over the following decade, hormone therapy use among menopausal women reportedly fell from roughly 22% to just 5%.
Later research, however, found that many of the original risks were concentrated among older women who began hormone therapy later in life, rather than women who started treatment earlier during menopause. As newer studies emerged, medical attitudes toward hormone therapy gradually shifted.
From 2018 to 2026, prescriptions for estrogen-based therapies among women ages 45 to 54 increased by 184%, according to data from health analytics company Truveta.
Demand has accelerated even more recently, with prescriptions rising another 20% between July 2025 and February 2026 alone.
Experts say women are also remaining on hormone therapy longer than in previous decades.
Older guidelines often recommended stopping treatment by age 60 or limiting use to five to 10 years. But newer evidence suggests many women benefit from starting therapy earlier — sometimes in their 40s — and continuing treatment well into their 60s, 70s, or even 80s.
“This means more women going to the pharmacy for refills,” Jordan explained.
Why Estrogen Patches Are So Popular
Doctors say estrogen patches have become especially popular because they are generally affordable, widely covered by insurance, and backed by extensive safety research.
Patches also avoid some of the clotting risks associated with oral estrogen because they deliver hormones through the skin rather than through the digestive system.
Transdermal estrogen products include patches, gels, and creams.
“In terms of safety, they are all equal,” Streicher said. However, she noted that nonpatch options are often less likely to receive insurance coverage, making patches the preferred option for many patients.
Alternatives for Patients Facing Shortages
Medical experts stress that women unable to find their preferred patch may still have several treatment alternatives available.
Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health and medical director of The Menopause Society, said many women can temporarily switch to another brand, use a lower-dose patch combination, or try other hormone delivery methods.
“I have not had a patient yet that we haven’t found an alternative for,” Faubion said.
Alternative forms of estrogen therapy include oral tablets, topical creams, gels, vaginal rings, and different patch schedules.
Oral estrogen may help improve cholesterol levels by lowering harmful LDL cholesterol and increasing protective HDL cholesterol, which could benefit some women with high cholesterol. However, women with a history of blood clots are generally advised to avoid oral estrogen because it can slightly increase clotting risk.
Vaginal rings can deliver either localized estrogen for vaginal dryness and urinary issues or systemic estrogen throughout the body.
Some estrogen patches are designed to be changed once weekly, while others are replaced twice weekly, giving physicians additional flexibility when managing shortages.
Uncertainty Over When Supplies Will Normalize
Experts say it remains unclear exactly when estrogen patch availability will stabilize nationwide.
Because pharmaceutical manufacturing is typically planned months in advance and drugs are produced in large batches, companies may not be able to rapidly increase output despite rising demand.
Ganio said manufacturers are expected to continue ramping up production throughout the coming months.
Faubion expressed cautious optimism that conditions may improve later this year.
“No one knows exactly when the shortage will be over, but companies are increasing production, so things should be better by the end of the year,” she said.
Until then, patients and doctors are likely to continue navigating intermittent shortages while demand for menopause care and hormone therapy continues climbing across the United States.
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