May 6, 2026 Updated May 7, 2026, 8:00 a.m. ET
Physicians have spent years working to improve the care for women in menopause and perimenopause − from training providers to setting standards for hormone replacement therapy.
Now they fear a lack of access to the most common medication prescribed for menopause could undo this work. And they are asking the Food and Drug Administration to do more.
A group of women, led by the founders of Midi Health, the largest provider of menopause care in the United States, is meeting with FDA officials on Wednesday, May 6, to talk about solutions for the estrogen patch shortage.
Estrogen patches have been in short supply since the start of the year.
The FDA told USA TODAY in April that the organization was talking with the five biggest patch manufacturers, ensuring all companies are running at capacity. Officials said they weren’t yet categorizing the difficulty in finding the patch as a shortage, but some providers and patients disagree.
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USA TODAY has reached out to the FDA for an update.
How did we get here?
Almost half of all women who are on hormone replacement therapy said they are having difficulty filling their estrogen patch prescriptions, according to a recent Midi survey. This survey included more than 8,000 women who responded from 49 states.
One in 10 women surveyed said the shortage caused them to stop treatment. And nine in 10 women said they weren’t confident they could fill their next prescription.
“Women are no longer confused about menopause. They are informed patients. They’ve found providers, they’ve had conversations and now they have a prescription,” says Tamsen Fadal, Midi's chief women's health ambassador who wrote “How to Menopause." “We got them to this place and now we’re saying, ‘Congratulations you’re here, but now we don’t have what you need.’ Women are rationing patches and stopping treatment.”
One third of the women surveyed said the estrogen patch shortage is affecting their health.
Hormone replacement therapy − estrogen often coupled with progestin − is the preferred treatment for menopause, according to The Menopause Society.
“The shortage is only going to get worse,” says Kathleen Jordan, the chief medical officer and cofounder of Midi. “We need the FDA to recognize this shortage and that manufacturing isn’t keeping up with demand.”
The patches do more than simply lessen symptoms such as night sweats and irritability. Estrogen helps protect against osteoporosis and can help with blood pressure, mood, memory and libido. A recent study also shows the patch is an effective part of treatment for some men with prostate cancer.
Some women have been forced to use a different brand of estrogen each month, leading to inconsistent care. Other transdermal methods which avoid the blood stream such as gels and creams often aren’t covered by insurance and cost three times as much as patches.
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Some drug manufacturers have blamed the shortage on the increased use of the patches since the FDA removed its black-box warning label last fall.
For more than 20 years, the warning has kept many women away from hormone replacement therapy after a 2002 Women’s Health Initiative study linked it to a higher risk of breast cancer, heart attacks and strokes in postmenopausal women. The risks, recognized later, were mostly found in women who were older when they started hormone therapy.
The study's ramifications affected millions of women, with the use of hormone replacement therapy dropping from 40% to 5% in the past 20 years as many doctors stopped prescribing it, and even if they did, women were reluctant to take it.
Estrogen patch shortage solutions
Still, Jordan says, the use of hormone replacement therapy has been steady for the past six years with around 5% of women in menopause or perimenopause using it. So while there has been an increase in use of the patch since November due to the change in labeling, it hasn’t been large enough to cause the shortage.
“The problem isn’t an increase in demand of the patch, the problem is the manufacturers” Jordan says. “The demand is only going up as access to care is improving.”
Some companies, such as Bayer, stopped producing the patch in 2023. Sandoz, one of the larger manufacturers of estrogen patches, is working to increase its global capacity.
A spokesperson for the company told USA TODAY the patches are more complex and time consuming to manufacture than other medicine. In the meantime, the company is allocating additional quantities to patients in the United States to meet demand.
While many women still struggle to find care in menopasue, it's improving. In the past few years, more providers have become certified in menopause care. Membership in the nonprofit Menopause Society has quadrupled to 4,000 in the last decade. And telehealth companies are growing, some taking insurance such as Midi and others offering their own medications and supplements.
Women also are now on hormone replacement therapy longer. Women are starting it during perimenopause, Jordan says, the years before a woman’s last menstrual period when she may experience estrogen fluctuations. And women now often stay on medication as long as they have symptoms, sometimes into their 80s.
Jennifer Weiss-Wolf, a lawyer who has advocated better healthcare for women, says insurance companies still control the market for drug access.
"The story is far more an indictment of the broken insurance industry: market concentration, perverse incentives and the consequences of allowing insurance companies to own the pharmacy benefit managers that effectively control drug access for the majority of users," she wrote in a recent editorial for The Los Angeles Times.
Weiss-Wolf is the executive director of the Birnbaum Women's Leadership Center at New York University's School of Law, and has a book coming out in October called "When in Menopause: A User's Manual & Citizen's Guide."
She sees hope in the increased advocacy for better menopause coverage, more than 60 bills were introduced in state legislatures in the past year for menopause education and workplace protections.
"The FDA is part of this wave of movement,” she tells USA TODAY. “They can make a real difference here in ensuring all women have access to the medication they need.”
Laura Trujillo is a national columnist focusing on health and wellness. She is the author of "Stepping Back from the Ledge: A Daughter's Search for Truth and Renewal" and can be reached at ltrujillo@usatoday.com.