Good News, Bad News, and No Estrogen Patches

Estrogen.

Let’s talk about the positive.

More people in perimenopause are finally having their symptoms taken seriously and addressed. And in 2025, the FDA removed the black box warning on estrogen products—a pretty big shift.

Back in 2002, the Women’s Health Initiative study linked hormone therapy to increased risks of heart attacks, strokes, and pulmonary embolism. That study changed practice overnight. But over the following decades, more nuanced research showed that those increased risks were primarily seen in women over age 65—and that hormone therapy can actually be beneficial for those who begin treatment during perimenopause.

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Now let’s talk about the bad news.

Companies that produce estrogen patches are currently experiencing a shortage. Part of this is due to increased demand over the past few years—YOU are advocating for your symptoms to be treated, and physicians are becoming more educated about menopause care.

Unfortunately, ramping up production isn’t simple. It’s not just the patch manufacturers—raw material suppliers also have to increase output. Add in supply chain challenges and the limited number of companies that make these patches, and here we are.

All of this leaves a lot of people who were finally being heard… back in a tough

spot.

Not ideal for anyone. Frustrating for patients. And honestly, not a great look for healthcare.

So, best to “be prepared” (yes—I was a Girl Scout).

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If you run into trouble getting your estrogen patch—which is the formulation most affected by the shortage—there are other options.

Estrogen pills

The good: they’re inexpensive (around $20 for a 90-day supply). If cost were the only factor, I’d probably use them all the time. But there are a few important considerations.

Oral estrogen is metabolized in the liver, which stimulates certain proteins. It can increase HDL (“good”) cholesterol and decrease LDL (“bad”) cholesterol—but it also raises triglycerides by about 25% on average, which can increase the risk of pancreatitis.

There’s no clear consensus on whether oral estrogen changes overall cardiac risk, but there is evidence that it may increase stroke risk, and that risk appears to be dose-dependent.

That said, it really depends on the individual. For someone with an elevated risk of blood clots, stroke, or heart disease, transdermal estrogen (like the patch) is generally safer than oral therapy.

However, in average-risk women under age 60, low-dose oral estrogen has not been shown to significantly increase the risk of blood clots, stroke, or heart disease. So pills are absolutely a reasonable option. I still prefer the patch, but if it’s not available, starting with the lowest effective dose of oral estrogen is a very reasonable plan.

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Estrogen gel, spray, and lotion

These options have a similar risk profile to the patch. Because they don’t go through the liver, they don’t raise triglycerides (although they also don’t boost HDL cholesterol).

The trade-off is consistency. The patch delivers a steady dose, while topical forms can vary a bit—did it fully absorb? Did any rub off? These products are used daily.

• The gel is applied to the skin and should dry for about 5 minutes.

• The spray dries in 60–120 seconds.

• The lotion (when available) is rubbed in and dries in about 2–5 minutes.

The medication is absorbed through the skin into the bloodstream. One important caution: skin-to-skin contact within two hours of application can transfer small amounts of the hormone to others, so be mindful—especially around children.

These are great options…but you knew there was going to be a “but.”

They are expensive. That’s the biggest barrier. The gel and spray can run around $200 per month, and the lotion isn’t widely available anymore.

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FemRing

This is a vaginal estrogen ring that is placed in the vagina and left in for 90 days. The estrogen is absorbed into the bloodstream and—like the patch and other topical options—it avoids first-pass metabolism in the liver.

The vaginal ring has a similar side effect profile to the patch and topical versions and is thought to carry a lower risk of blood clots. It’s also one of the few vaginal estrogen options that provides enough systemic absorption to treat whole-body symptoms.

Most other vaginal estrogen products (rings, creams, or gels) are absorbed locally and are primarily used for dryness, irritation, and other genitourinary symptoms—not hot flashes or systemic concerns.

On GoodRx, the FemRing is listed at about $900 for three months. Sigh.

Other options

I haven’t included birth control pills, combined estrogen-progesterone patches and pills, or low-dose vaginal estrogen products in this overview. These can all be appropriate depending on your symptoms, stage of menopause, and individual risk factors—but they really need to be discussed on a case-by-case basis with your doctor.

So what’s the takeaway?

This is one of those moments where medicine and real life collide. We finally have better data, more awareness, and more perimenopausal patients are getting the care they deserve—and now we’re dealing with access issues.

The good news is that you have options. The “best” choice isn’t one-size-fits-all—it depends on your personal risk factors, your symptoms, your preferences, and yes, sometimes what’s actually available at the pharmacy.

If your usual therapy isn’t accessible, don’t panic—but don’t go it alone either. Talk to your doctor, reassess your options, and adjust as needed. This is not about perfection; it’s about finding a safe, effective plan that works for you in the real world.

And if nothing else—consider this your reminder to stay flexible, stay informed… and maybe channel a little Girl Scout energy when you need it most.

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