The Food and Drug Administration (FDA) removed the black box warning for hormone replacement therapies late last year, and recently the most widely used type, estrogen, has been in short supply as the therapy’s popularity has boomed.
“There has been an increase in demand over the last two to three years, where the use of transdermal estrogen has increased significantly,” said Dr. Robert Kauffman, professor of obstetrics and gynecology at Texas Tech Physicians in Amarillo.
Although doctors and patients report difficulty obtaining certain doses of estrogen patches, the FDA has not yet included any on its list of drugs in short supply.
FDA Director Dr. Marty Makary said Tuesday that the agency’s decision to remove the black box warning label for hormone therapy in November caused a huge increase in demand for estrogen patches, but not enough to cause a shortage.
“The industry has been able to keep up, but just barely,” Makary added in an interview. “They are realigning their distribution and manufacturing to have a more robust supply. Meanwhile, estrogen patches have not met the criteria to be on the shortage list, but it is something that needs to be managed.”
Being placed on the FDA’s shortage list is important because it can help trigger actions such as identifying alternative suppliers and extending expiration dates on medications.
Hormone replacement medications are prescribed to treat hot flashes, mood swings, urinary tract infections, vaginal dryness, and sleeping problems, as well as to prevent bone fractures. They may contain only estrogen, only progesterone, or a combination of both, which are the main female sex hormones.
Is there a shortage of estrogen patches?
There is no single answer.
The American Society of Health-System Pharmacists (ASHP), a professional organization of pharmacists, includes 14 brands or doses of estrogen patches on its most recent list of drugs in shortage. The group began listing estrogen patches in January.
“Our list is based 100% on reports from health care professionals, pharmacists, doctors, nurses or patients and caregivers,” explained Michael Ganio, senior director of pharmacy practice and quality at ASHP, which collects data in collaboration with the University of Utah Health.
Dr. Lauren Streicher, a professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine in Chicago, said the shortage of estrogen patches always comes up when she talks to women’s groups about menopause.
Dr. Kathleen Jordan, medical director of Midi Health, a telehealth company specializing in menopause, added that patients are increasingly facing problems filling prescriptions for estrogen patches “due to shortages in pharmacies.”
“This happened occasionally last year, but it has gotten worse this year,” he said.
Kauffman, the Texas gynecologist, said there is a shortage in western Texas and that colleagues “from all over the country” are also reporting it.
Separately, a spokesperson for Alloy Health, a telehealth company specializing in menopause, said in an email that it has not seen a shortage of estrogen patches affecting its patients.
Meanwhile, the FDA relies on historical demand data to determine whether drug companies are meeting demand, so its information on current increases could be outdated, Ganio noted.
An FDA spokesperson said if the domestic supply becomes short, it will be posted on the agency’s dedicated website.
Swiss generic maker Sandoz told Reuters news agency in April that the company has sent additional supplies to the United States to help pharmacies meet demand. NBC News contacted four estrogen patch makers — Viatris, Sandoz, Noven Pharmaceuticals and Amneal Pharmaceuticals — in May to ask about the shortage, but did not receive a response.
“We assume, based on everything we know, that this is due to an increase in demand, but without a manufacturer saying ‘we have a supply problem,’ we can’t say that with certainty,” Ganio added.
What is driving demand?
After the highly publicized Women’s Health Initiative study, published in 2002, linked hormone therapy to an increased risk of breast cancer, heart attacks and strokes in postmenopausal women, prescriptions plummeted among menopausal women in the United States, dropping from 22% to 5% over the following decade. Even after new evidence revealed that the risk was primarily in women who were older when they started hormone therapy, the perception that it was dangerous persisted until recent years.
From 2018 to 2026, the number of women ages 45 to 54 prescribed estrogen-based therapies increased by 184%, according to a recent survey by Truveta, a health data analytics company. Prescriptions increased by 20% between July 2025 and February 2026 alone.
Not only has demand increased, but there has also been a change in the way women use medications.
Midi Health’s Jordan said women are using hormone therapy longer than in the past, adding to increased demand.
Guidelines used to recommend that women only receive menopausal hormone therapy for five to 10 years, and stop at age 60, but more recent studies suggest that women may benefit from starting hormone therapy earlier — often at age 40 — and continuing it into their 60s, 70s or 80s, Jordan added in an email.
“This means that more women go to the pharmacy to renew their prescriptions,” she said.
Refill prescriptions are typically for estrogen patches—compared to other types of hormone therapy, such as creams or vaginal rings—because they are typically cheaper than the alternatives, have the most safety data, and are most likely to be covered by insurance, Kauffman explained.
When will estrogen patch supplies recover?
It is not clear.
Although pharmaceutical companies appear to be ramping up production, some estrogen patches could remain in short supply for years.
Dr. Stephanie Faubion, director of the Mayo Clinic Women’s Health Center, was a little more optimistic.
“No one knows exactly when the shortage will end, but companies are increasing production, so the situation should improve by the end of the year,” Faubion said in an email.
Because pharmaceutical companies typically make drugs and therapies in batches and plan them months in advance, some companies may not be able to ramp up production of estrogen patches for a few months, Ganio said.
In the coming months, manufacturers “will certainly try to increase production,” Ganio said.
What are the alternatives?
Some women may switch to a different brand or use two lower-dose patches if their usual prescription is not available, said Faubion, who is also medical director of The Menopause Society.
There are also other forms of estrogen: topical creams and gels, vaginal and oral rings. The patches come in two types: one that is changed twice a week and one that is changed only once, so alternating between both options can also help women continue using estrogen patches even if their usual brand and dosage are low, Faubion said.
“I haven’t had a patient yet for whom we haven’t found an alternative,” Faubion said.
Alternatives include:
oral estrogen
Oral estrogen has been shown to lower harmful LDL cholesterol and increase protective HDL cholesterol, which could make it the best choice for women with high cholesterol, Northwestern’s Streicher said. Women with a history of blood clots should avoid taking oral estrogen as it may slightly increase the risk of clotting.
vaginal ring
Localized estrogen delivered through a vaginal ring can help women who suffer from vaginal dryness or recurrent urinary tract infections, but a vaginal ring can also deliver systemic estrogen, Streicher said.
Transdermal estrogen
Gels, creams, and patches belong to a category called transdermal estrogen.
“In terms of security, everyone is equal,” Streicher said. However, “non-patch options are less likely to be covered by insurance.”
