California woman shares struggle finding estrogen patch for menopause amid shortage, supply chain issues

A nationwide surge in demand for hormone replacement therapy is fueling shortages of estrogen patches, leaving some women scrambling to manage symptoms of perimenopause and menopause.

Since 2021, there has been a 72% increase in women using hormone replacement therapy, according to a study by Epic Research. Manufacturers of estradiol patches have struggled to keep pace, creating supply disruptions at pharmacies across the country.

Martie Jo Pennisi, a professional organizer from Glendale, said she began experiencing severe menopause symptoms in October 2020.

"I was kind of crawling out of my skin and really the symptoms came on like gangbusters," Pennisi said. "I had everything in the book. I had depression, anxiety, sleeplessness, joint pain, dry itchy skin, hot flashes like crazy."

She said she felt "so disconnected" and feared for her health before a friend suggested hormone replacement therapy, often referred to as HRT. Last spring, she began using an estradiol patch along with a progesterone pill.

"Almost exactly a year ago, it was spring of last year, and I went on the patch, estradiol patch, with the progesterone pill," she said.

Pennisi said her symptoms improved almost immediately. But when she went to refill her prescription last month, her pharmacy told her the medication was unavailable.

"So, I decided to call and they said, 'We don't have the medication,'" she said. "I said, 'What do you mean you don't have it? You're going to get it soon, like when should I come in?' 'No, we don't have it, it's not available.'"

Pennisi said she contacted multiple pharmacies across the county, but none had the estradiol patch in stock.

Dr. Jessica Shepherd, a menopause expert, said the shortage reflects both progress and ongoing supply chain challenges.

"There is good news and bad news to it," Shepherd said. "The good news is that means that more women are asking for estradiol in the form of a patch. So that's great news. The bad news is that we see a supply chain issue, and this is not just one particular pharmacy; this really is across the board."

Four months ago, the U.S. Food and Drug Administration removed the boxed warning from certain hormone therapies, a move that physicians say helped drive increased prescriptions. Awareness around perimenopause and menopause has also grown in recent years as more women seek treatment for symptoms that were once rarely discussed openly.

Pennisi said women in her family endured menopause quietly.

"Nobody in my family, not my mother, my grandmother, my sisters, nobody," she said. "I had to really go to them each and inquire."

During the shortage, Shepherd advises patients to speak with their doctors about alternative forms of estradiol, including creams, gels, pills or pellets.

"There's no difference in how it works," Shepherd said. "Now, there are some people who notice differences in how their body responds to a different type, but the thing is, you'll never know until you try it."

Pennisi ultimately found a weekly estradiol patch instead of her usual twice-weekly version. While grateful to continue treatment, she said the situation has been frustrating.

"I think if the world experienced men losing all their testosterone at once, there would be a whole different story," she said. "I think that things are catching up, though, because there are so many wonderful female cutting-edge doctors out there that are really fighting for this."

Some women have switched from generic to brand-name hormone treatments during the shortage. However, brand-name options are often not covered by insurance and can cost hundreds of dollars per month, adding another layer of difficulty for patients seeking relief.