Navigating the Estradiol Patch Shortage: What to Use Instead
There is currently a nationwide shortage of estradiol patches. If you use a patch for perimenopause or menopause symptoms, this is frustrating. Especially if you finally found something that works. The patch is convenient, but it is not the only way to take estradiol. There are several solid alternatives, and most women can transition without major issues. Here is what to know.
The estradiol patch shortage is happening because of a mix of manufacturing and supply chain issues. There have been production slowdowns and interruptions at the factories that make certain brands, and because only a few companies produce transdermal estradiol patches, there is not enough supply to meet demand. When supply is limited and there are no easy substitutes in the supply chain, pharmacies run low quickly, which leads to widespread shortages.
Why Estradiol Matters
Estradiol is the form of estrogen most commonly used in hormone therapy. It helps with hot flashes, night sweats, sleep disruption, mood shifts, brain fog, and vaginal dryness. It also plays a role in bone health.
Patches became popular because they deliver estrogen through the skin and avoid first pass metabolism in the liver. But other options do the same thing.
Estradiol Gel
Estradiol gel is applied to the skin once daily, usually on the arms, shoulders, or thighs depending on the product.
What I like about it:
It is transdermal, like the patch
It bypasses the liver
Dosing is flexible
What patients need to remember:
It has to dry before getting dressed
It is used daily
Avoid skin to skin contact with others until it fully absorbs
If someone wants to stay with a skin based option, gel is often my first choice during a shortage.
Estradiol Spray
The spray is another transdermal option. It is applied to the forearm once a day.
Pros:
Simple and quick
Absorbs through the skin
Consistent dosing
Cons:
Needs time to dry
Daily application
Do not wash the area right away
Some women prefer it because it feels lighter than a patch and less messy than gel.
Oral Estradiol
Oral estradiol is taken as a daily pill. For healthy women without contraindications, oral estradiol is a reasonable option. It may not be my first choice for everyone, but it works well for many.
Pros:
Easy to access
Simple to take
Straightforward dose adjustments
Cons:
Processed through the liver
Slightly higher clot risk in certain patients
Not ideal for women with higher cardiovascular risk
Vaginal Estrogen Ring
The vaginal estrogen ring releases a low dose of estrogen over about three months. If genitourinary symptoms are the main issue, this can be a very effective option.
Best for:
Vaginal dryness
Pain with intercourse
Urinary symptoms
Important point:
Low dose rings treat local symptoms well but do not reliably control hot flashes
Once Weekly Estradiol Patches
Some estradiol patches are designed for once weekly use instead of twice weekly. If your usual brand is unavailable, switching to a different patch formulation may solve the problem. Availability depends on what pharmacies can get, so it requires a little flexibility.
A Few Practical Reminders
The right alternative depends on:
Your symptoms
Your medical history
Your risk factors
What is actually in stock
If you have a uterus and are using systemic estrogen, you still need progesterone to protect the uterine lining. Switching forms does not mean you are locked in forever. Many women move to gel or oral estradiol temporarily and switch back to patches once supply stabilizes.
The patch shortage is inconvenient. But you have options. Estradiol can be delivered safely and effectively in several different ways. If your pharmacy cannot fill your patch, do not panic. There is almost always a workable alternative.