Estrogen patch backordered? Don’t panic

Picture it: You’ve just started sleeping through the night again after using hormone replacement therapy to relieve your hot flashes, and then you go to the pharmacy for a refill and find out your estrogen patches are…out of stock?? That’s the reality for many women across the country right now, as the demand for estrogen patches (which deliver synthetic forms of the hormone estradiol) has become greater than the supply. As of this writing, at least two of the major patch manufacturers are currently reporting shortages of some of their most popular brands and dosages. 

While it can be scary to think that you can’t get a needed prescription medication, know that you have options (and no, one of them is not to recharge your portable fan and resign yourself to dealing with night sweats). Here’s what you can do.

Don’t fall into the trap of thinking you need to ration your remaining Rx because of this shortage. “It might be tempting to wear your patch longer than prescribed or cut it in half to make your supply last, but please don't try to MacGyver your hormone therapy,” says Dr. Nisha Patel, M.D., medical director of clinical operations at Weight Watchers. These kinds of adjustments to your patch can lower your dose of estrogen by an unknown amount, so you run the risk of your menopause symptoms returning.

Instead, call your healthcare provider, who would understand your needs and discuss alternatives to your current dose. “The right solution for you will require a conversation with your clinician, who can take the time to understand your needs and preferences and your medical history,” says Patel.

If you discover that your current patch is backordered, here is a game plan for getting your prescription filled.

Try other pharmacies

Your doctor may be able to send your regular patch prescription to a different pharmacy, since what’s on backorder at one place may still be on the shelves at another. 

Join Weight Watchers

The estrogen patch shortage is not currently impacting Weight Watchers Med+ Menopause members, making the Weight Watchers Menopause Kits a good solution for many. And if a future shortage occurs that does impact WW members, there’s a plan for that. “If you get your medication through Weight Watchers Med+ Menopause program, your Care Team would reach out to other pharmacies on your behalf to help find it,” says Patel. 

Try another brand

Not every brand of estrogen patch is in short supply. Right now, the hardest to come by are Sandoz estradiol transdermal patches and several dosages of Dotti and Lyllana transdermal patches made by Amneal. If you use one of those patches, ask your doctor if a similar patch from another manufacturer could work for you. 

Try another dose

More popular dosages might be sold out, but your doctor may be able to switch you to an in-stock patch with a slightly different dosing schedule if it’s clinically suitable (for example, a larger once-a-week dose instead of your usual patch that you change twice a week).

Estrogen patches have been a godsend to many women — but they’re far from the only game in town. “There's not something so special about the patch that if one isn’t readily available, people need to suffer,” says Dr. Monica Christmas, M.D., associate professor of obstetrics and gynecology at UChicago Medicine and associate medical director of the Menopause Society. “In fact, some people don’t tolerate a patch well; either it falls off too easily or it adheres so well that they get skin irritation underneath it. Or their skin just doesn’t absorb the medication well and they still have terrible hot flashes.” For these women, switching to a different form of estrogen can be miraculous, she says. 

Try another application method

Besides the patch, estrogen also comes in the form of a spray, pump, or gel packet that you apply to your arm or thigh once a day, or in a flexible ring inserted into the vagina for up to three months. Vaginal estrogen cream is another option if your main menopause symptoms are genitourinary ones like vaginal dryness and urinary urgency.  

Try another delivery method

Estrogen can also be taken in a daily pill. While oral estrogen may, in theory, come with an increased risk of blood clots when compared to the patch or other transdermal applications, actual risk is personalized. “The pill is safe for the vast majority of people,” says Christmas. “When you ingest a pill, it’s metabolized by the liver, and that can bump up liver enzymes and clotting factors. But in most healthy individuals, that’s really not a concern nor a reason not to prescribe the pill.” If you have a family history of blood clots, or a personal history of high blood pressure, migraines, smoking, or liver dysfunction, make sure to share that with your provider as they may not prescribe the estrogen pill to you. 

Try a different type of medication

There are non-hormonal alternatives to the patch for treating menopause symptoms as well. “A class of medications called NK3 receptor antagonists are a highly effective option for managing vasomotor symptoms, and they may help with sleep and somewhat with mood as well,” says Christmas. Your healthcare provider will be able to tell you the best way to make the change from one prescription to another to minimize any disruption to your symptom relief.

Switching to a different prescription estrogen product could cause different side effects than what you’re used to. Common side effects of estrogen therapy in general include breakthrough bleeding, breast tenderness, nausea, headache, bloating, fluid retention, and leg cramps. “If you experience any new or worsening symptoms after changing estrogen therapy formulation, brand, or dosage, please call your doctor,” says Patel. That’s to rule out any concerns, but also to help you find a treatment that’s a better fit for you. That’s especially true if you have any unusual vaginal bleeding: While not uncommon, it always merits a quick trip to get checked out by your OB-GYN, since in rare cases it can be a sign of a more serious problem. 

Some other symptoms require immediate medical attention, including: 

• Severe headache or sudden vision changes

• Chest pain or shortness of breath

• Leg swelling, pain, or warmth (signs of a blood clot)

• Sudden weakness, numbness, or difficulty speaking (signs of stroke)

• Severe abdominal pain

That said, if you find yourself caught between prescriptions and wind up not taking any form of estrogen therapy for a couple days or weeks, don’t panic. “Stopping the estrogen patch without switching to a different dosage or form could result in symptoms of menopause returning, typically within a few days,” says Patel, but there aren’t any additional health risks to quitting abruptly.

If your estrogen patches are suddenly unavailable, it doesn’t mean you’re back to square one with your menopause symptoms. With your doctor’s guidance, switching to another brand, dose, or form of estrogen — or even a non-hormonal option — can help you stay comfortable until your usual prescription is back in stock. A temporary shortage doesn’t have to derail your relief.