The hurdles in women’s health.  The gift that keeps on giving!

There has finally been progress catching up on the research that has been coming out since the infamous WHI results in 2002.  On October 30, the FDA approved labeling changes for three additional estradiol patches, removing statements about cardiovascular disease, breast cancer, and probable dementia from their boxed warnings. This continues a process announced in November 2025, with the first product-label approvals in February 2026. These updates simply address what is known now vs what we thought we knew in 2002.  It impacts access to hormone therapies.  It does not reflect an individual assessment of the appropriateness of blanket therapies.

I welcome the move toward a more thoughtful discussion. It has been a long time coming. Hormone therapy deserves the same consideration we give other treatments: the formulation, dose, route, timing, and the individual woman all matter.

But there is a frustrating disconnect. Women are reconsidering treatment, making decisions with their physicians, and sometimes finally feeling better—only to discover that their next box of patches is unavailable.

We have spent years trying to improve the conversation about menopause. Access to the actual treatment needs to catch up.

How did we get here? 

Some historical perspective helps. A 2024 study in JAMA Health Forum found that menopausal hormone therapy use among U.S. postmenopausal women fell from approximately 27% in 1999 to under 5% in 2020. That is a substantial retreat over two decades. It also helps explain why the recent increase in demand is landing on a market accustomed to much lower use.

The FDA identifies increased demand, including demand following its labeling initiative, as a contributor to patch access problems. Manufacturers are expanding production, but a transdermal patch requires specialized equipment and processes. Additional capacity takes time. Apparently this takes years, not months to ramp up.

A patch has to adhere to the skin and deliver medication predictably over several days. Its adhesive, medication-containing layer, backing, and other components all contribute to that performance. The manufacturers’ trade association acknowledges both the complexity of production and the difficulty keeping pace with demand. All pharmacies all are trying to get product, but availability is quite variable. Some pharmacies have a dose or two, or the weekly patch only or none at all.  The brands are variable as well.  The costs are all over the place.

I know many of you have experienced this! I receive multiple emails daily regarding these challenges.

The pharmacy counter is only one part of the problem 

There are several steps between manufacturing a patch and getting it into your hands. Wholesalers supply pharmacies. Insurers and pharmacy benefit managers administer coverage and payment arrangements. Those arrangements influence which products and pharmacies are practical options for you.

Independent pharmacists may have access to multiple wholesalers which sometimes allows those pharmacies to obtain patches that other pharmacies could not. But purchasing prices can increase without a corresponding increase in insurance reimbursement.

The financial incentives throughout this system are worrisome.  Still, it does not establish that middlemen deliberately created the patch shortage. There are documented manufacturing constraints, and there are purchasing, pricing, and coverage barriers that can make the consequences harder to manage.

As a physician, what concerns me is how much of that work ends up being handed to the patient.  Calling a million pharmacies to see what is on their shelves and worrying if cutting the high dose patches are safe are common concerns.

Is there a shortage or not? 

In its October 30 announcement, the FDA said it was not aware of an imminent nationwide shortage, while acknowledging localized access difficulties. It also reported that patch output had doubled over the preceding year. ASHP’s November 4 bulletin nevertheless lists back orders, allocation limits, and intermittent supply for multiple products.

National production figures and the ability to fill a particular prescription are different measures. More patches can be manufactured overall while your dose remains difficult to obtain.

When you are counting your remaining patches, that distinction offers very little reassurance.

What about cutting a patch? 

This deserves a careful explanation because the advice circulating online is often too broad.

With a reservoir patch, medication is contained behind a membrane that controls release. Cutting it can disrupt that system and allow leakage or rapid drug release. These patches should not be cut.

With a matrix patch, medication is distributed within an adhesive or another matrix layer. Reducing the surface area can sometimes be used to provide a smaller dose, but cutting is an off-label modification and needs assessment of the exact product.  Talk to your physician about this.

I’m not a fan of cutting once-weekly estrogen patches. In my clinical experience, estrogen levels can decline over the course of the week, and cutting the patch may add further variability. I tend to see more consistent levels with twice-weekly matrix patches.

How do I know? I regularly check hormone levels in the women for whom I prescribe menopause hormone therapy. I find that combining symptom monitoring with blood level monitoring gives us a more complete picture of how treatment is working, whether or not a patch is cut.

That information helps us have a more informed discussion about the options and their pros and cons. Depending on the individual, those might include changing patch brands, gels, sprays, systemic estrogen rings, oral estrogen, or compounded options. My goal is to find an approach that works well for the woman in front of me.

What you can do before your next refill 

• Plan ahead. Contact your pharmacy while you still have time to arrange an alternative. Ask when your next refill can be processed and whether your usual product can be ordered.
• Have the details in front of you. Take a photograph of the box showing the strength, manufacturer, and replacement schedule. Ask whether another equivalent manufacturer is available.
• Ask what is actually blocking the prescription. Is the product unavailable from the supplier? Is the available alternative excluded by your insurance? Is the refill too early? These require different solutions.
• Try a pharmacy with different suppliers. Another chain, an independent pharmacy, or a legitimate mail-order pharmacy may have different stock. Confirm availability and delivery timing before transferring the prescription.
• Compare prices. Ask for your insurance price and the cash or discount price, and compare them with mail-order options such as Cost Plus. Include shipping. Cost Plus is worth checking, but it is not always the least expensive or consistently stocked option.
• Discuss a backup prescription. Depending on your circumstances, that might mean another patch, a prescribed combination of lower-strength patches, or an estradiol gel or spray. Oral estradiol is another option for some women, but the reason you were prescribed transdermal treatment should remain part of that decision. Doses across formulations are not interchangeable milligram for milligram.
• Confirm the whole regimen. If you use progesterone or another progestogen, ask how it should continue during any change. Do not improvise by stretching the patch schedule or changing several parts of your treatment at once.

I am glad more women are asking about menopause care. My hope is that this renewed attention produces lasting improvements in treatment, education, and access. 

For now, the most useful step is to make a backup plan with your physician before the pharmacy tells you there is nothing to pick up.

Wellness always,

Dr. Lynd