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Patients are having trouble accessing a common estrogen therapy for managing menopause symptoms. But there are other options. (Credit: Wikimedia Commons) This story was originally reported by Jennifer Gerson of The 19th. Meet Jennifer and read more of their reporting on gender, politics and policy. One of the most commonly used forms of menopause hormone therapy is hard to find right now. This applies to estradiol patches, as two of the major manufacturers report being in shortage. Estradiol is a form of estrogen, and these patches are one way to deliver the hormone transdermally, or through the skin. Transdermal estrogen is often prescribed by menopause care specialists because the delivery keeps the estrogen from being processed by the liver, and thus does not increase the risk of blood clots or cardiac events. The reasons for the shortage aren’t entirely clear, though it is likely a combination of preexisting supply chain issues, the impacts of tariffs on overseas drug manufacturers, and an increased demand for the patches after a regulatory shift. In November, the Food and Drug Administration lifted the 20-year old black box warning on estrogen products used in menopausal hormone therapy warning of serious adverse effects, which likely has made these drugs feel more accessible. Systemic estrogen — the form of hormone therapy utilized via patch — treats some of the best-known, and most disruptive, symptoms of menopause: hot flashes, night sweats, heart palpitations and mood changes. But experts say that if you can’t find the patch you’ve been prescribed to address these symptoms, there are other options. Dr. Lauren Streicher, professor of obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University and author of a forthcoming AARP book on menopause, said there’s no need to panic. “It doesn’t matter how it gets in there, it’s going to help your hot flashes, it’s going to help your symptoms,” Streicher said. Patches are not the only form of transdermal estrogen available — and in fact, all transdermal estrogens use the same drug, often manufactured by the same company and then distributed to pharmaceutical companies. So, some end up in transdermal patches, but there are also gels, creams and sprays that go on your skin and have the same active ingredient. Transdermal estrogen isn’t the only form of estrogen available for hormone therapy either, Streicher explained. Oral estrogen — taken via pill — is also a safe form of estrogen for many people, depending on their medical history. For someone who does not have a history of blood clots, it can be a great option. It also has been shown to lower cholesterol levels and reduce lipids, both great for heart health. Some patients may turn to oral estrogen because the non-patch transdermal options are often not covered by insurance. Streicher advises against going to compounding pharmacies to help bridge the gap, as it is impossible to know the exact dosing you are actually receiving in the products dispensed there. As the systemic dose of estrogen leaves your body, any symptoms you are experiencing will return — how long this takes will vary from person to person — but Streicher assured that the impacts of going off the patch won’t be more severe than that. “Your brain isn’t going to start eating itself,” she noted. But other than discomfort, there is no inherent danger in going off hormone therapy for a time. Likewise, there is no danger in resuming again once you have access to hormone therapy of choice — and yes, your symptoms will once again abate once you resume taking your estrogen. In the face of a shortage, Streicher advised that those wishing to continue on hormone therapy seek out the care of a gynecologist who is well-versed in menopause care and is very familiar with the various forms of estrogen used in menopausal hormone therapy and its dosing. Seeing someone who specializes in menopause care can help ensure you have options if you want to continue on hormone therapy, even if you can’t find patches. (Can’t find a menopause specialist by you? There are also many telehealth services that focus on hormone therapy specifically and connect patients with menopause specialists who can prescribe it.) “This is nuanced stuff,” Streicher said. “It takes an expert to be able to help somebody with that. and most people out there, especially if you have someone who only prescribes patches, is going to be scratching their head and saying, ‘I don’t know how to help you.’ So keep looking. Keep looking until you find a doctor who has expertise in hormone therapy.” Because whether it means finding a brand name versus a generic, another form of transdermal application, seeing if you’re a candidate for oral estrogen, or just waiting things out — options, and care, do exist.

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