I first realized there was a problem with the estrogen patch supply when my phone started lighting up — not with patient portal messages, but with texts from friends.
They all followed the same pattern. A warm opening, a quick catch-up, and then the real question, barely contained.
“Hey girl! How are you? I’ve missed talking to you 🤍 I wanted to pick your gynecology brain for a second… do you know why I cannot get my estrogen patch right now??? 😬😳”
Sometimes there were multiple question marks. Sometimes a panic-face emoji. Sometimes a half-joking tone that didn’t quite land. But underneath the friendly vernacular was the same thing every time: urgency and anxiety. The sense that something essential had suddenly become uncertain.
These weren’t women new to hormone therapy. These were women who had already done the hard part — found care, navigated stigma, started a treatment that worked. And now, month after month, they were calling pharmacies, switching brands, wondering if this refill would be the one that failed.
As an OB-GYN who cares for women through perimenopause and menopause, I’ve spent years talking with patients about the menopause transition. But these messages were different. They weren’t asking for education. They were asking for an explanation that would make the scramble feel less personal, less like they were doing something wrong.
Not long after, I realized that these texts mirrored what women across the country were experiencing. Every month, women are making the same phone call to their pharmacy, asking: “Do you have my estrogen patch?”
And every month, the answer feels like a gamble.
For many, this isn’t a minor inconvenience. It’s the difference between sleeping and lying awake drenched in sweat. Between steady moods and brittle ones. Between functioning at work, at home, in relationships, and barely holding it together.
At first glance, the estrogen patch shortage looks like yet another drug supply issue — one more consequence of manufacturing slowdowns, supply-chain disruptions, or corporate consolidation. Those factors are real, and they matter. But they don’t fully explain why a medication this established has become so fragile.
Estrogen patches are not new: They’ve been prescribed for decades and are among the most studied forms of hormone therapy. For many women, transdermal estrogen is a first-line option because it delivers estrogen steadily, avoids first-pass metabolism through the liver, and carries a lower risk of blood clots than oral formulations. For women with migraine, cardiovascular risk factors, or other medical considerations, patches are often the safest choice.
So how did something so common become so difficult to access?
Part of the answer lies in what changed recently — and what didn’t.
In late 2025, the FDA removed the black box warning from menopausal hormone therapy, a warning that for years overstated risk and discouraged both patients and clinicians from even discussing estrogen. The decision was evidence-based and long overdue. Professional medical organizations had been calling for this change for years, noting that hormone therapy was significantly underused because of outdated safety messaging.
It's reasonable to assume that this shift has begun to change prescribing behavior for doctors. Assumably, the removal of the warning has led to an increase in estrogen patch prescriptions — even in the relatively short window between the FDA announcement and now — as clinicians and patients revisit a therapy that many had previously avoided. But that assumption exposes a deeper problem: The supply chain wasn't built to absorb even a modest increase in demand.
That vulnerability comes down, in part, to how few companies manufacture estrogen patches.
Estradiol transdermal systems are produced by a limited number of manufacturers. Major producers include Noven Pharmaceuticals, Sandoz, and Mylan, and a small group of generic manufacturers such as Amneal and Zydus. When production slows, a product is discontinued, or demand rises faster than anticipated, there's very little redundancy to buffer the impact. A disruption at even one manufacturer can ripple nationally.
What’s striking is not just that a shortage exists, but how predictable it was.
This stands in sharp contrast to medications like sildenafil — commonly known by its brand name, Viagra — or metformin. Both are manufactured by a multitude of companies globally. Their widespread use and long-established markets have resulted in broad production networks. When one supplier falters, others often compensate. Shortages still occur, but they are typically shorter, more localized, and less destabilizing.
Estrogen patches do not have that safety net.
The result is that women are being pushed into a kind of pharmaceutical musical chairs: switching patch brands month to month, calling multiple pharmacies, driving long distances, or paying hundreds of dollars out of pocket for brand-name alternatives not covered by insurance. Even when FDA-approved generics are available, differences in delivery systems or inactive ingredients can affect how patients feel and how well symptoms are controlled.
Clinicians are clear that women should not ration estrogen or go without it. But reassurance doesn’t eliminate anxiety — especially when symptoms return quickly with missed doses or forced switches. For many patients, this is not about convenience. It’s about stability.
What’s striking isn't just that a shortage exists, but how predictable it was. Medical organizations openly acknowledged that removing the black box warning would increase interest in hormone therapy. That was the goal. Yet production capacity didn't expand in anticipation of that shift. No parallel investment was made to ensure supply would meet renewed demand.
So the question isn’t whether prescriptions increased dramatically. The question is why the system wasn’t prepared for the possibility that they would.
Menopause affects half the population, meaning estrogen therapy is not a niche treatment. It's essential healthcare for millions of women — women who are working, caregiving, leading organizations, and making decisions for families and communities. Yet access to that care remains surprisingly fragile.
This shortage isn't about women suddenly wanting something unreasonable or about hormone therapy being unsafe. It’s about a healthcare system that has long treated menopause as optional, inevitable, or invisible — and therefore not worth building resilience around.
When access to care is this precariouis, the burden shifts quietly to patients. Women become coordinators, advocates, and problem-solvers on top of everything else they carry. They make the calls. They do the driving. They absorb the stress. And they keep going — but they shouldn't have to.
The estrogen patch shortage is a reminder that progress in women’s health doesn’t end with better science or updated warnings. It requires infrastructure, redundancy, planning — and a willingness to believe women and clinicians when they say a therapy is essential, not just helpful.
Menopause care is essential healthcare. And access to it shouldn’t depend on luck, geography, or how many pharmacies someone has the time and energy to call.
Sarah Berg, MD, is a board-certified OB-GYN and certified menopause practitioner who spent over a decade in clinical practice caring for women across all stages of life. She now focuses on evidence-based education and storytelling that helps women understand their bodies, prioritize preventative care, and navigate midlife health with clarity and confidence. Learn more at Selfority.
