The Estrogen Patch Shortage Has Spread to Creams and Injections

Since the FDA removed its strongest warning from menopause hormone therapy, demand has outrun supply. Patches were first. Now some estradiol injections and vaginal creams are on backorder too. What happened, who disagrees, and what to do if your pharmacy says no.

By Teona Abuladze · 6 min read

The pharmacist says the patch is out. Try again Thursday. On Thursday it is still out, and the other pharmacy has the brand but not the dose.

Women on hormone therapy for menopause have been having this conversation since the start of the year. On 28 October Reuters reported that it has widened. Some estradiol injections are now in short supply, as are vaginal estradiol creams, partly because women who couldn’t find patches switched to something else.

How it started

For more than twenty years, menopause hormone therapy in the US carried a black-box warning, the FDA’s most serious label. It went on after the 2002 results of the Women’s Health Initiative linked hormone therapy to breast cancer, heart attacks and strokes. Later analysis found that much of that risk was in women who started hormones years after menopause, but the box stayed, and a generation of women and doctors stayed away.

In July 2025 FDA Commissioner Marty Makary convened an expert panel that recommended taking the warnings off. On 10 November 2025 the agency announced it would. On 12 February 2026 it approved the first new labels, for six products. The boxed warnings about cardiovascular disease, breast cancer and probable dementia were removed. Warnings about blood clots, stroke and gallbladder disease remain on the label, and so does the boxed warning about endometrial cancer for estrogen taken alone by women who still have a uterus.

Demand rose fast. Health data company Truveta found estrogen patch use rose 26 percent between the November announcement and February, and 184 percent since 2023.

Estradiol patch prescriptions went from about 594,000 in June 2024 to 1.6 million in May 2026, according to HealthVerity.

Why the factories can’t keep up

Estrogen patches are old, generic and cheap. Profit margins are thin, so manufacturers have had little reason to build new production lines, which need specialised equipment and can take years. In April, Sandoz described the demand that followed the FDA’s decision as one “that cannot fully be met at present.” Industry sources told Reuters the shortage could last up to three years.

Some companies are moving. Viatris added a shift at its plant in St. Albans, Vermont, which now runs around the clock. Amneal says it is increasing output. Cost Plus Drugs, Mark Cuban’s pharmacy, told Reuters demand had risen five- to tenfold, “for almost every product.”

According to Reuters, the American Society of Health-System Pharmacists now lists estradiol injections from Hikma, American Regent and Par Sterile Products as in shortage, and vaginal creams from Viatris’s Mylan unit, Padagis and Teva as on backorder or allocation. CVS says supply of some injection strengths has got worse in recent weeks.

“Not a shortage,” officially

The FDA’s position is that there is no shortage of patches. In a September update it said patches “remain available,” that it was working with all six manufacturers, and that supply had nearly doubled in a year. In May, Makary told NBC that patches had not met the criteria for the federal shortage list. HHS has said there is no nationwide shortage because at least one version is available from at least one maker at any given time.

That definition is cold comfort if your version, at your dose, isn’t on the shelf. The pharmacists’ list, which counts products that are hard to get, is far longer. The FDA did not respond to Reuters’s request for comment on the new shortages.

The argument behind the shortage

Not everyone thinks the FDA should have moved the way it did.

Public Citizen, the consumer group, argued in March that “the FDA’s decision was based on opinion, not additional safety data.” Diana Zuckerman of the National Center for Health Research criticised the agency for skipping a public scientific meeting. The Women’s Health Initiative itself takes no position on the label but says hormone therapy should not be used to prevent chronic disease.

On the other side, ACOG’s president, Steven Fleischman, said the old warning simply frightened patients away from treatment that helps. Harvard’s JoAnn Manson, one of the best-known WHI researchers, agreed that the box scared women off, while saying the evidence for wider health benefits was less conclusive than Makary suggested.

Whatever one thinks of the FDA’s process, the women now calling around for patches already have prescriptions, for hot flashes, broken sleep and the other symptoms the medicine treats.

The debate is about how the FDA got there. The shortage is about women who are already on treatment.

If you can’t fill your prescription

Don’t stop on your own. The FDA’s advice is plain: “Do not stop or change your medication without talking with your healthcare provider.” Stopping suddenly can bring symptoms back, and switching products can cause new side effects.

Ask the pharmacist whether a different approved estradiol patch, another brand or a combination of strengths that adds up to your dose, can be substituted. Order refills as early as your plan allows. Try mail order or an independent pharmacy, and ask your doctor’s office to call around.

If you switch forms, know the trade-offs. Gels and sprays go through the skin like patches, but they cost more and insurers cover them less often. The Menopause Society says estrogen through the skin may carry a lower risk of blood clots than pills. A Penn endocrinologist, Anna Groysman, told WHYY that finding the right dose on a new product can take six to eight weeks or longer. A new form may need a new prescription or prior authorisation, so call your insurer first.

Be cautious with compounded “bioidentical” hormones offered as a stopgap. The Menopause Society says they raise safety concerns: they are not FDA-approved, doses can vary, and they come without the standard risk information.

Teona Abuladze is the founder and editor of Shansi Magazine.

Sources: Reuters, 28 October 2026, via Investing.com — https://www.investing.com/news/stock-market-news/us-estrogen-supply-crunch-widens-as-women-seek-alternatives-to-scarce-patches-4978221 ; Reuters via SRN News — https://srnnews.com/us-estrogen-supply-crunch-widens-as-women-seek-alternatives-to-scarce-patches/ ; Newser — https://www.newser.com/story/398965/estrogen-shortages-are-spreading-beyond-patches.html ; FDA update on estradiol patch availability — https://fda.gov/drugs/drug-alerts-and-statements/fda-update-estradiol-transdermal-patch-availability ; Becker’s Hospital Review — https://www.beckershospitalreview.com/supply-chain/fda-disputes-estrogen-patch-shortage-concerns/ ; Reuters, April 2026, via MarketScreener — https://in.marketscreener.com/news/patients-scramble-to-find-estrogen-patches-as-shortage-worsens-after-us-fda-champions-use-ce7e50dbde8cf42c ; HealthDay — https://powershealth.org/about-us/newsroom/health-library/2026/04/10/demand-surge-leads-to-shortages-of-estrogen-patches ; Moneytalksnews (HealthVerity data) — https://www.moneytalksnews.com/women-cant-find-this-medication-the-shortage-could-last-years/ ; RAPS on the July 2025 panel — https://www.raps.org/resource/fda-to-remove-boxed-warnings-from-hormone-therapie.html ; OPB/NPR, 10 November 2025 — https://www.opb.org/article/2025/11/10/the-fda-removes-a-long-standing-warning-from-hormone-based-menopause-drugs ; FDA release on label changes, February 2026 — https://www.biospace.com/press-releases/fda-approves-labeling-changes-to-menopausal-hormone-therapy-products ; Drug Topics — https://www.drugtopics.com/view/fda-removes-black-box-warning-on-6-menopausal-hormone-therapy-products ; Public Citizen, March 2026 — https://www.citizen.org/?p=119575 ; Women’s Health Initiative statement — https://www.whi.org/md/news/whi-fda-hrt-warning ; The Menopause Society, 2022 position statement release — https://menopause.org/wp-content/uploads/press-release/ht-position-statement-release.pdf ; WHYY — https://whyy.org/articles/pennsylvania-women-estrogen-patches-shortage-menopause