What can you do about the estrogen patch shortage?

There is a Global Shortage of estrogen patches and this has been ongoing for several years now. Here in Aotearoa we are feeling this too – and many women have been struggling to get hold of their usual patches for their HRT.

The situation keeps changing all the time, so to get the most up-to-date information about the current supply status here in NZ, keep an eye on the Pharmac webpage.

1. Phone around different pharmacies

Whilst some pharmacies may have no patches in stock, others may have had a delivery; so it’s worth calling around different pharmacies to ask if they have any estrogen patches - including pharmacies that are outside your area. They may be able to courier the medication out to you. However, you might get given a different brand to your usual one though.

The main brands here in NZ are:

• Estradot
• Estraderm MX
• Estradiol Mylan
• Estradiol Sandoz
• Estradiol Viatris

All of these different brands contain body-identical estradiol.

Whilst for most women the precise brand of patch makes no difference, some women seem to get on better with certain brands. If you think your symptoms have returned or worsened or you have felt any unpleasant effects since you switched to using a different brand of patch, you should see your doctor to discuss this.

2. Cut lower dose patches up to achieve your dose

You can cut a lower dose patch into smaller pieces to achieve your specific dose (eg, if your usual dose is a 25mcg patch, the pharmacist can give you a 50mcg patch to cut in half, or a 100mcg patch to cut into quarters).

Although it can be fiddly, this is ok to do. All of the patches used in NZ are matrix type patches, which means the drug is evenly distributed throughout the patch so it is ok to cut them to achieve a smaller dose.

It's best to store the remaining portion of the patch in a small zip-lock bag to make sure it doesn't lose its effects, before you are ready to apply it.

One study* showed that cut estradiol patches remain stable for up to 1 month if they are stored in an airtight plastic bag at room temperature.

*REF: Ankarberg-Lindgren C, et al. 2019;8(4):360

3. Use several patches at the same time

You can combine several lower dose patches at the same time to get your usual dose. So if you are usually on 100mcg, you can use x1 25mcg alongside x1 75mcg simultaneously.

However – since Pharmac only fund two patches per week of the same strength at present, then the pharmacy will likely charge you for the extra patches if you receive duplicate patches of the same strength (eg. x2 50mcg patches to make a dose of 100mcg).

If you receive two different strength patches (eg. x1 25mcg patch and x1 50mcg patch) then you should not have any extra charges

4. See your doctor about switching to an estrogen tablet

If you are really struggling to obtain any patches, you may be able to switch to taking estrogen tablets temporarily.

However, these are not suitable if you have certain medical issues, which include any of the following:

• You have a history of blood clots
• You are at high risk of having a blood clot
• You suffer from migraines with aura

You will need to see your doctor to figure out if estrogen tablets are a safe option for you and to obtain a new prescription.

See your doctor about switching to an estrogen gel

If you can't or don't want to take estrogen tablets, there are estrogen gels available which have all the same safety profile and benefits of estrogen patches.

This means any woman that uses an estrogen patch could safely use a gel instead.

They are not funded yet here in New Zealand but are available on prescription for a cost at your pharmacy.

About Menodoctor

Founded by Dr. Linda Dear, Menodoctor is a leading specialist menopause clinic in New Zealand. They educate and empower women with evidence-based information on perimenopause, menopause, and treatments, advocating for informed choices and support, especially in the workplace.