Relief Is on Backorder
From my desk above the pharmacy consultation area at C.O. Bigelow, I hear at least five women a day asking what they are supposed to do about the ongoing shortage of estrogen patches. The medication has helped them. They are desperate to stay on it. And far too often, we have no good answer.
It’s just another everyday situation in the pharmacy where I feel incredibly stupid being the face of American healthcare.
Sometimes we have an alternative strength in stock, or we can identify another way to keep treatment going, but first we need the prescribing doctor to approve the change. That can become a multiday cycle of messages and waiting, during which the patient runs out and goes without treatment. There is medication on our shelf, a pharmacist who knows how it could be used, and a woman in need going without.
I find that much harder to explain than an empty shelf.
Women in 2026 are finally being told they do not have to suffer through menopause. Apparently, they still have to suffer through getting the prescription filled.
The screenshots below show Amazon Pharmacy and one of my primary drug wholesalers, AmerisourceBergen, with every estrogen patch product (Vivelle Dot, Dotti, etc…) and strength shown out of stock, and no expected availability date. A major online pharmacy and a major wholesaler, both delivering the same unhelpful news.
Patients cannot build a treatment plan around a wild goose chase. It’s not fair. And it doesn’t have to be this way.
What makes this particularly maddening is that the demand reflects something we should celebrate: women finally getting help for a common problem.
For decades, menopause was something women were expected to manage quietly. Stigma was one thing, but the fear surrounding hormone therapy made it even harder. In the early 2000s, prominent black box warnings for cardiovascular disease, breast cancer, and probable dementia became a defining feature of menopause treatment. The risks deserved attention, but the message that reached patients often left little room for the differences between women, treatments, and stages of life.
More than two decades later, that conversation has finally begun to change. Women are speaking openly, clinicians are pushing for better care, and symptoms that were once dismissed as something to endure are getting serious attention. Last November, the FDA requested removal of those specific risk statements from the boxed warnings and approved the first revised labels this past February. (Other risk information remains, including the endometrial-cancer boxed warning for systemic estrogen-only products.)
In a Truveta analysis, estrogen-patch dispensing rates more than tripled between 2018 and February 2026, including a 26.1% increase from July 2025 through February 2026. Demand was already climbing prior to the November request, but the FDA’s announcement gave women another reason to seek treatment, and manufacturers are now struggling to keep up.
Patches deliver estradiol through the skin to treat symptoms such as hot flashes and night sweats. This route may also carry a lower blood-clot risk than oral estrogen. There are reasons a clinician chooses a patch, and reasons a patient wants to stay with something that works.
The FDA said in September that supply had nearly doubled over the preceding year, with manufacturers adding shifts and expanding production. But patches require specialized equipment and processes. Meeting that demand takes more than a few extra hands on deck.
That problem can’t be solved overnight. But there are ways to ease the pain. One is formally recognizing the shortage, which has turned out to be more complicated than you might think.
The American Society of Health-System Pharmacists lists estradiol patches in shortage. Its August update identifies specific products on backorder with no estimated release date. The FDA, meanwhile, has taken the opposite route, saying in September that patches “remain available,” while acknowledging difficulty obtaining them. Its assessment has stopped short of a national shortage designation.
There is a technical explanation. The FDA assesses national supply against demand, including projected demand. ASHP also captures verified disruptions that force changes in dispensing or patient care. Those standards can produce different answers.
At the counter, the question is considerably less complicated: Can this woman get her medication before she runs out? From where I’m sitting, the answer is clearly no.
Members of Congress raised a related concern in July, warning that historical demand data could lag the rapid increase in prescribing. A market changing this quickly needs an assessment that can keep up.
An official shortage designation has practical consequences. It creates a public record of affected products and expected duration. It can also relax certain federal restrictions on compounding copies of approved drugs.
That does not mean a compounding pharmacy can suddenly manufacture a reliable patch, or that a compounded cream is an equivalent substitute. The equipment, expertise, and drug delivery still matter. But it can create additional options, even if it cannot guarantee a workable replacement.
The FDA also has tools to support supply, including faster manufacturing reviews, carefully evaluated temporary imports, and expiration extensions when data support them. These tools are not all contingent on a formal listing, and the agency says it is already helping patch manufacturers expand production.
If national supply figures suggest adequate availability while women repeatedly go without, we need to ask what those figures are missing.
The measure of success has to be whether a woman can stay on treatment. All the evidence is showing that has been uncertain for months. I’m sure plenty of readers are nodding in agreement. Whatever the official designation, the interruption in her treatment is real.
So what do you do if you’re one of the women worried about your next refill?
Until supply improves, my advice is to speak to your pharmacist before you are down to your last patch. Give us time to work.
This is one of the reasons I care so much about the relationship between a patient and a pharmacist. When we know what you take and when your next refill is due, we can anticipate the problem. We can order ahead when supply allows, remember which products you tolerate, and think of you first when an appropriate product becomes available.
We cannot guarantee stock. But there is value in having someone who knows your situation already looking for a solution, instead of starting from scratch when you have nothing left.
Other patches, gels, sprays, or oral treatment may be options, depending on your medical history. They need a coordinated plan: low-dose vaginal estrogen does not replace systemic treatment for hot flashes, and women with a uterus generally still need appropriate protection of the uterine lining.
But even with that relationship, and even when an appropriate alternative is available, we can still get stuck.
At Bigelow, we manage this multiple times a day. Stock changes constantly. We find an option, contact the prescriber, and wait for approval. Meanwhile, the patient may lose the relief she worked so hard to get.
We are treating the interruption of therapy as an acceptable consequence of making everyone follow the process. I think that gets the priorities backward.
Pharmacists are drug experts. Evaluating doses, formulations, interactions, and appropriate alternatives is central to our training. We also happen to be the people who can see what is actually available to dispense.
The law already allows qualifying generic substitutions at the same strength and dosage form. What I want goes further: defined authority to make clinically appropriate adjustments during supply disruptions, so an established treatment can continue.
Set clear protocols for substitutions and dose conversions. Get the patient’s consent, document the change, provide counseling, and promptly notify the prescriber. Changes outside those protocols still require consultation. Insurers need to cover the authorized alternatives, too. Otherwise, we will have replaced one reason the patient cannot get her medication with another.
The UK has already used Serious Shortage Protocols for estradiol patches, allowing pharmacists to supply specified alternatives with patient consent, without first obtaining the prescriber’s authorization. These decisions are consistent with our clinical training. Our legal authority should reflect that.
For a woman whose hot flashes and night sweats return, a treatment gap can mean losing sleep and struggling through the next day, or several days. Calling that a temporary inconvenience does not make it one.
We have spent years telling women to speak up about menopause, advocate for themselves, and seek treatment. Now that more are doing exactly that, we owe them more than another phone number to call.
They have already done the work of recognizing their symptoms, asking for help, and finding something that works. They should not also have to become experts in pharmaceutical distribution.
Women already have a drug expert at the pharmacy. Let us do our job.
Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy
