A surge in demand for menopause hormone therapy — fueled in part by updated federal safety guidance and growing awareness around menopause care — is contributing to nationwide shortages of estrogen patches.
For women like Emily Padgett, the supply strain has been stressful and disruptive.
Padgett, 49, spent months bouncing between pharmacies, transferring prescriptions and switching brands three times before finally securing her estradiol patches. For two anxious weeks in January, she went without them entirely.
“There’s definitely some symptoms that I noticed popping back after I went off of the patch for a while,” said Padgett, who is in perimenopause. “They still haven’t completely gone away.”
Estradiol patches — small squares worn on the skin that deliver estrogen steadily into the bloodstream — are widely prescribed to treat hot flashes, night sweats, insomnia and brain fog. As estrogen levels decline during perimenopause and menopause, symptoms can intensify. For many women, the patches provide consistent relief.
Doctors say demand for hormone therapy has been rising for months as menopause becomes a more open topic of conversation and newer research reshapes understanding of risks and benefits.
Earlier this year, the U.S. Food and Drug Administration formally approved updated labeling for menopausal hormone therapy products, removing the long-standing boxed warning that highlighted risks such as cardiovascular disease, breast cancer and dementia. The change reflects more recent research showing that for many women — particularly those who begin therapy near the onset of menopause — benefits can outweigh risks.
Even before the label change, Dr. Timberly Butler, a board-certified OB/GYN in Georgia, said she was seeing at least a 50% increase in patients seeking hormone therapy.
“For years, many women were told to just suffer through menopause because the risks outweighed the benefits,” Butler said. “We now know that for many women, hormone therapy can be used safely and can support heart and bone health.”
Dr. Kathleen Jordan, chief medical officer at telehealth company Midi Health, said prescribing delays have occurred intermittently since 2022 but worsened significantly in January.
“We have increased awareness of menopause and its broad impact to women,” Jordan said. “If we continue to do our job well, demand is only going to increase.”
Supply Strains
Estradiol patches are available by prescription only, and lately some prescriptions are taking longer to fill.
“Manufacturers have been unable to provide sufficient supply of hormone replacement therapies (HRT) over the last several weeks,” CVS spokesperson Amy Thibault said in an email, adding that pharmacy teams work with patients and prescribers to identify alternatives when possible.
Major manufacturers of estradiol patches in the U.S. include Amneal, Sandoz, Noven, Viatris and Zydus. Products from Amneal and Sandoz are currently listed in shortage by the American Society of Health-System Pharmacists.
Manufacturers cite limited production capacity for the complex transdermal systems and a recent surge in utilization. Some companies say they are increasing shipments and expanding production to meet demand.
Because multiple brands exist, doctors can sometimes switch patients to alternative products. But that solution isn’t always simple.
“There are different brands of patches, so we can sometimes switch products,” Butler said. “But depending on insurance formularies, the alternative may not be covered, and that can mean a huge cost difference.”
Switching brands can also change dosing schedules. A once-weekly patch may become twice-weekly, requiring new instructions.
The Cost Question
Shortages can also raise concerns about affordability.
Without insurance, generic estradiol patches typically cost between $30 and $100 per month, depending on dosage and pharmacy. Brand-name versions can range from $150 to $300 or more monthly.
Most private insurance plans cover generic estradiol patches, often with copays between $10 and $40 per month. However, coverage depends on a plan’s formulary. If a shortage forces a switch to a non-preferred brand, out-of-pocket costs can rise unless a doctor files a coverage exception.
For women on Medicare, estradiol patches are generally covered under Medicare Part D prescription drug plans. Generic versions are usually included, with copays often ranging from about $5 to $20 per month during standard coverage phases. Brand-name products may carry higher costs depending on plan tiers.
Alternatives and Risks
If patches are unavailable, other transdermal options — including estrogen gels or sprays — may be appropriate. Oral estradiol tablets are another alternative, though they may carry a slightly higher risk of blood clots, stroke and high blood pressure because they are metabolized through the liver.
Still, doctors emphasize that for many women, the benefits of hormone therapy outweigh the risks.
Padgett is back on a twice-weekly patch — though a different brand than before — and hopes supply stabilizes.
Each refill, she said, still brings uncertainty.
“You just don’t want to hear those words,” she said. “‘Out of stock.’”