Many Women Are Still Struggling to Fill Estrogen Patch Prescriptions. What to Do If You Can’t Get Yours

When 56-year-old Lila Davachi began the menopause transition several years ago, she was caught off guard by the severe brain fog.Davachi, a neuroscientist and professor, knows the brain well. But she struggled to manage her mental symptoms. “It was bad. I’m a scientist, I teach, I have to perform,” Davachi said on TODAY. For the working mom of two, every day felt grueling. “Your brain literally feels tired, like a muscle, and it makes it harder to be on point and feel good about what you’re saying and how you’re thinking,” says Davachi. It wasn’t until Davachi found herself napping between lectures that she went to her doctor for answers. After multiple appointments, an OB-GYN finally prescribed her menopause hormone therapy in the form of an estradiol (a type of estrogen) patch.The patch was a game changer. Her hot flashes and night sweats disappeared almost overnight, and within a few weeks, the brain fog was completely gone, too. “It really felt like I was myself again,” Davachi says. For the next four years, she was back to feeling 100%.That changed this past spring, when her pharmacy was unable to refill her prescription. “I was told it was not available, it was back ordered, (then) ... that there was a shortage,” Davachi says. After many unsuccessful attempts to refill her medication at different pharmacies, Davachi was forced to pause using the patch.“I was getting increasingly more desperate,” says Davachi. Eventually, she found a small pharmacy some 25 miles away that had the patch in stock. The pharmacist agreed to deliver her prescription, but she now pays hundreds of dollars out-of-pocket for a three-month supply, which her insurance didn’t cover.“The pharmacist came into the lobby of my building and handed me a bag, and I handed her an envelope with cash,” Davachi says.Now, getting her hands on a medication prescribed by her doctor feels more like a back-alley deal, she says. And she worries if she’ll be able to get a refill when she runs out in three months.She’s not alone — almost half of women with estrogen patch subscriptions have struggled fill them, according to a May survey by Midi Health, which provides virtual care for women midlife.Is There an Estrogen Patch Shortage?The U.S. Food and Drug Administration has acknowledged the reports of challenges obtaining estrogen patches, but has not officially declared a shortage. Estradiol patches are not listed on the FDA’s drug shortage database.In a Sep. 3 update, the FDA said it “is aware of reports of patients having difficulty readily accessing their usual estradiol transdermal patches due to increased demand and is working with all six manufacturers to increase supply.”“Although availability of certain products or brands may vary by pharmacy or location, estradiol transdermal patches remain available,” the agency added.However, according to the American Society of Health System Pharmacists, there has been a shortage of certain formulations and doses of estradiol transdermal patches since Jan. 30.In the meantime, the FDA faces mounting pressure to declare a shortage from patient advocacy groups.Why Are Estrogen Patches Hard to Access?While there are likely multiple factors at play, a major one, according to the FDA, is the recent removal of a warning label on these treatments.In November 2025, the FDA announced that hormone therapies for menopause would no longer carry a black box warning, the agency’s strictest safety alert to warn about a drug’s risks.These labels were added after a 2002 study from the Women’s Health Initiative linked hormone therapy to an increased risk of breast cancer, heart disease and stroke. This caused demand to plummet, and instilled widespread fear among women.However, a recent analysis of the study found that link to be much smaller than previously reported.Many experts have similarly argued that the black box warnings were unnecessary or based on outdated science, and that the potential benefits of hormone therapy outweigh the risks, NBC News previously reported.After the removal of these warnings, demand rose, according to the FDA.But even before the labeling change, estrogen patch prescriptions had been increasing thanks to a broader cultural shift around menopause, including more open discussions about symptoms and advocacy to expand access to treatments, says Dr. Candice Fraser, an OB-GYN at the Carolyn Rowan Center for Women’s Health and Wellness at Mount Sinai.Providers have been using hormone therapy to treat menopause for decades, Fraser tells TODAY. But today, more women are actively asking about it. “Patients are more aware and seeking out this care,” she adds.Tamsen Fadal, a journalist and menopause advocate, tells TODAY that the increased demand hasn’t been met with enough supply.Earlier this year, Fadal joined a group led by Midi Health to meet with FDA officials about the shortage. “They understood it, they were aware of it. I was pleasantly surprised by the response. ... Unfortunately, this is a manufacturing problem,” says Fadal, adding that it could take “years” to resolve. In the meantime, many of the women who finally found relief from these medications now struggle to fill their prescriptions.“At first, I thought it was just me,” says Davachi, adding that she’s since realized many of her friends share the same plight.Fadal has also had trouble getting her estrogen patches. “Then I had my sister-in-law call me and she couldn’t get a patch, then I had women emailing me asking where to get a patch,” Fadal says.As of now, it’s unclear when these patches may become more widely accessible.“When you’ve gone through the relief of feeling normal again ... you really want to feel that way again,” Davachi says.How Do Estrogen Patches Work?Hormone therapy is used to boost estrogen and progesterone, which decline during perimenopause and menopause. These medications include pills, gels sprays and patches. “The primary indication for the estrogen patch is for the treatment of vasomotor symptoms, so hot flashes and night sweats,” says Fraser. They may also help relieve other menopause symptoms, such as brain fog and mood swings, and they’re sometimes used to prevent osteoporosis, Fraser adds.Estradiol patches deliver a steady dose of estrogen directly into the bloodstream through the skin, bypassing the liver. “It’s not impacting some of the clotting factors that the liver will produce as a result,” says Fraser. Compared to the estrogen pill, patches and other topical forms of estrogen carry a lower risk of blood clots.The creams and gels are used to treat more localized vaginal menopause symptoms, including dryness and pain, says Fraser.Each type of hormonal therapy works slightly differently.“There are many different symptoms that occur during the menopause transition, so we do personalize treatment to the patient and do a risk assessment,” says Fraser.Although hormone therapy can have a significant impact for patients, it’s not the only treatment option.“Hormone therapy can be a bridge to get someone past the most debilitating symptoms. ... A lot of times you have to get them feeling better to incorporate the other changes,” says Fraser.Menopause symptoms may also be managed with non-hormonal medications, such as antidepressants or gabapentin. Lifestyle changes can help, too, Fraser notes. These include eating a healthy diet, exercising regularly or cognitive behavioral therapy.What to Do If You Can’t Get Estrogen PatchesIf you are struggling to fill your estrogen patch prescription, the experts recommend taking a few steps: Inform your healthcare provider.Call your pharmacy to ask what’s in stock.Try switching to a new pharmacy.Ask about alternatives to the patch. Report it to the FDA.Generally, patients are advised not to stop taking prescription medications without talking to their healthcare provider. So if you’re unable to access your estrogen patch, let your provider know, the experts note.There are many different formulations, dosages and brands of estrogen patches available.If your pharmacy doesn’t have your medication, ask when it will be restocked and whether there’s availability of an equivalent dosage from a different manufacturer, says Fraser.Next, consider changing your pharmacy. If you go to a national chain, check if other locations have your medication in stock. Some experts recommend calling smaller local pharmacies to see if they have supply, or switching to a mail-order service.“Depending on what’s available, you may have to change it from a twice weekly to once weekly or vice versa,” says Fraser.If you are unable to access any form of the estradiol patch, talk to your doctor about alternative hormone therapies.“Sometimes we have to change from the patch to a gel, which is also topical estradiol ... but it’s obviously not the most convenient,” says Fraser.Finally, experts encourage women to advocate for themselves and speak up. If there’s a shortage in your area, Fadal recommends reporting it to the FDA through their website. “It might take a little legwork, but that does not mean a patient should have to discontinue their prescription or estradiol,” says Fraser.