Bridging the Gap: What You Can Do While Estrogen Patches Are Hard to Get
Last week, we covered why you’re not imagining the estrogen patch shortage and how to search smarter when you’re calling pharmacies.
This week: what to do once you’ve confirmed there’s nothing on the shelf, in your dose, in any brand, anywhere.
Here are the options, in order of how closely they might keep you to your current routine.
Start With the Closest Match
Weekly instead of twice weekly, same dose.
We touched on this last week: a 0.05 mg twice-weekly patch and a 0.05 mg weekly patch are designed to release the same amount of medication per day, just on a different schedule.
Some women do fine on it. Others, myself included, and several of my patients notice symptoms creeping back in the days before the change.
If you try it because you have to, know that going back to twice weekly the moment it’s available is fine.
And if you’re tempted to solve this by getting a higher-strength patch and cutting it in half, check with your provider first.
If a Patch Isn’t an Option
Topical options
I prescribe a low-dose compounded cream that patients can apply as needed when symptoms creep back, especially when going from twice-weekly to weekly patches. That might include brain fog, irritability, disrupted sleep, hot flashes, or night sweats.
Be careful about where it’s applied. If you live with other people, I prefer labial or vaginal tissue over the inner arm, elbow, or wrist so there’s no risk of accidentally transferring hormone to someone else through skin contact.
Some providers offer a pharmaceutical topical gel instead, with brands like EstroGel or Divigel. Both are legitimate options and are applied once daily to the arm or thigh.
I don’t love them personally. They’re applied to exposed skin and need time to dry before you can safely touch anyone. The manufacturer’s labeling for Divigel specifically warns about the risk of estrogen transfer to others through skin contact.
Having worked at Doctor’s Data for so long, reviewing thousands of hormone results and seeing how these products can transfer throughout the household, I don’t take these chances with my patients or myself.
But for someone living alone or without pets, a gel may be a reasonable choice.
(Olive has a warning about this below!)
Other Routes to Consider
Oral estrogen
Oral estrogen is easier to get ahold of right now than patches, but it’s not something I offer in my practice.
The dosing doesn’t translate cleanly from patch to pill, and oral estrogen passes through the liver before reaching circulation, which has been shown to increase clotting risk in a way transdermal estrogen does not.
Other compounded options
Other compounded options exist, too: oral troches that dissolve under the tongue, sublingual sprays, and gels.
I have less personal experience prescribing these and tend to reach for the cream first. But I know women who like them, and if your provider is comfortable with one of these routes, it’s worth asking about.
Membership Options
You may hear about telehealth memberships like HRT Club claiming reliable patch supply. They buy large quantities in advance, so they’re not waiting in the same line as your local pharmacy.
When wholesalers have to ration limited supply to pharmacies, the club has already secured its stock. It’s not that more product exists. They’ve secured their market share before it gets rationed downstream.
Membership runs around $12/month or $99/year, and their member price for a box of patches runs roughly $40–$48 depending on dose, compared with a typical retail price of anywhere from $45–$109.
Since the shortage, I’ve been paying upwards of $70 a month for a twice-weekly patch!
At that gap, a membership fee can pay for itself in a few months.
You can also request the transfer from your local pharmacy to the club pharmacy yourself using an online tool.
Your Move
If your patch isn’t available, talk to your provider about which of the above options is the best fit for you.
Click here to report a drug shortage to the FDA.
You can also email to report a shortage at drugshortages@fda.hhs.gov.
Next week
Just in case the mention of a compounding pharmacy gives you pause, next week I’ll explain why compounding doesn’t deserve the bad rap it gets.
Warmly,
Dr. Krista
Olive Says
When Mom couldn’t get her patches on time and was using hormone cream to tide the gap, some must have gotten on Birdy (Mom’s granddog) while she was visiting, which impacted her own little doggie menstrual cycle.
This isn’t unheard of. In fact, Birdy’s vet suggested that she may have been exposed to topical estrogen, and she was right.
So remember: animals can be impacted by topical hormones, too.
Be careful how you use it!