Estrogen patch demand surges after warning rollback, supply tightens

The federal government says estrogen patches are not officially in shortage. Patients and doctors are telling a different story: pharmacies are running out of certain doses and brands just as demand for menopausal hormone therapy has surged after regulators rolled back long-standing warning labels.

In November 2025, the U.S. Department of Health and Human Services said it was beginning to remove broad black box warnings from menopausal HRT products. By February 2026, the Food and Drug Administration had approved labeling changes for six menopausal hormone therapy products and said 29 drug companies had submitted proposed changes. FDA Commissioner Marty Makary said the November action triggered a “tremendous increase” in demand for estrogen patches, adding that manufacturers had so far been able to keep up “but barely” as the agency worked with companies to boost supply.

That strain is showing up in the drug-shortage system even if the FDA has not formally listed estrogen patches as shortage items. ASHP’s shortage database identifies multiple estradiol transdermal products as affected, including Amneal’s Dotti and Lyllana patches, Noven’s estradiol patches and products from Zydus. ASHP lists increased demand as the reason for Noven’s shortage, while Amneal and Zydus did not provide a reason. Other estradiol patch options remain available from Bayer, Viatris, Sandoz and other manufacturers, but availability has become uneven enough that patients and clinicians are chasing prescriptions from one pharmacy to another.

The access problem matters because estrogen therapy is not a cosmetic add-on to menopause care. Hot flashes, vaginal dryness and related symptoms can disrupt sleep, work and daily functioning, and for some women the treatment is a key part of maintaining quality of life and long-term health. The current squeeze comes against a longer history of caution: after the 2002 Women’s Health Initiative findings, hormone replacement therapy use fell sharply as fears about breast cancer and cardiovascular risk spread through medicine and the public.

That pattern has reversed. Epic Research data show HRT prescriptions among women ages 50 to 65 rose 72% from the second quarter of 2021 to the third quarter of 2025, then climbed 86% by the fourth quarter of 2025. Truveta found estrogen-based HRT prescribing more than doubled from 2018 to 2026, while patch use more than tripled. In February 2026, one in 20 women ages 45 to 54 in Truveta’s dataset had evidence of an estrogen-based HRT prescription.

The result is a familiar policy gap: official data lag behind what patients feel at the counter. The FDA’s warning rollback opened the door to wider use, but the manufacturing system has not yet fully caught up, leaving some women to switch doses, switch brands or search from pharmacy to pharmacy just to stay on therapy.