Why is there a shortage of oestrogen patches in Australia… again?

Updated article

Since 2020 or so, there have been recurring national shortages of oestrogen transdermal patches in Australia. Six years on, we’re still talking about them.

These easy-to-use skin patches are applied to the skin like a sticker and deliver oestrogen directly into the bloodstream. They contain the hormone oestradiol, an oestrogen that is naturally produced in the human body and has a major role in maturing and maintaining the female reproductive system.

Oestradiol is also important for bone health, heart health and maintaining mental health and wellbeing.

The patches are used by some perimenopausal, menopausal and post-menopausal women as menopausal hormone therapy (MHT) to help manage some of the more intrusive symptoms of hormonal fluctuations (hot flushes and night sweats, for example).

In Australia, not all menopausal women can or want to take MHT, but around 13 per cent (or 260,000) currently do.

And bear in mind that around two million women in Australia have recently undergone menopause, and another 80,000 women join this group each year.

And it’s not just older women who need these patches.

Younger women experiencing early menopause resulting from chemotherapy or diseases affecting the ovaries or pituitary gland require oestrogen.

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Transgender women and non-binary people also use oestrogen patches as feminising hormone therapy for gender affirmation.

Australia isn’t the only country to run out.

Global shortages are also affecting countries like the UK and the US, with reports of people travelling overseas to get hold of the patches or turning to the internet to order dubious replacements online.

Here in Australia, the Therapeutic Goods Administration (TGA) has approved several alternative transdermal patches as a short-term fix, but are the supply issues likely to continue?

What's causing these patch shortages?

There are fewer than a handful of oestrogen patches on the Australian market.

One of those, Climara, ceased production in mid-to-late 2023, putting extra demand on the remaining oestrogen-only brands, Estradot and Estraderm, as well as the combination oestrogen and progesterone patch, Estalis.

Currently, both Estradot and Estraderm are in short supply – so the loss of just one brand has had massive implications for other stocks.

Then there are ‘manufacturing issues’ – although we don’t know a whole lot about the reasons behind these. But reports suggest that supply chain problems are affecting production.

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Additionally, the ingredients – derived from soya beans or sweet potatoes – required to manufacture oestradiol patches are in short supply and high demand.

According to the TGA, shortages of several brands and doses are confirmed to last until at least the end of 2026 or even early 2027, although this estimated deadline has already been extended many times (ten to be exact).

Has demand outpaced supply?

If we look at oestrogen patches as a treatment for menopause, demand has risen. A UK study found that prescriptions for MHT in England had doubled over five years to more than 500,000 a month.

At the beginning of this century, there were concerns about the safety of menopausal hormone therapy after the large Women’s Health Initiative study was stopped early in 2002.

But over the last five years, many of these concerns have been debunked and there is greater awareness about the safety of MHT among doctors and patients. This has also contributed to an increase in demand.

These factors, along with increasing awareness of the options available to women, more accurate information about the safety of MHT and more education within health care about their potential benefits, has also driven interest.

Trans women and some non-binary people also use oestrogen patches as part of gender-affirming hormone therapy.

The medication is identical to that used for menopause, and the shortages affect both.

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Trans Australians are a small minority of the population, well under one per cent, and account for only a small fraction of patch prescriptions.

The shortage is not being driven by gender-affirming care. For trans people who do use patches, oestradiol supports physical changes that better reflect who they are, alongside improvements in mood, sleep and overall wellbeing.

Whether someone is going through menopause or affirming their gender, these patches are rarely optional.

For many people, steady oestrogen levels are what make daily life functional at home and at work.

Suddenly stopping oestrogen can cause bone loss, hot flushes, insomnia, headaches, mood swings, fatigue, and ongoing aches and pains.

The increasing demand for menopausal hormone therapy, set against ongoing manufacturing problems, is what’s driving the shortage.

Are there any alternatives to the patches?

Since March 2025, some alternatives are now subsidised on the Pharmaceutical Benefits Scheme (PBS).

Estrogel (an oestradiol gel absorbed through the skin) along with progesterone capsule Prometrium and the combination pack Estrogel Pro, are all now PBS-listed for menopausal hormone therapy. These were the first new additions of this kind in more than 20 years.

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In theory, this should help ease pressure on patch supply, as women who previously couldn't afford the gel alternative now have an accessible option.

Pharmacists can also now swap one brand of patch for another brand or strength without a new prescription, under the Serious Scarcity Substitution Instrument, rules designed to address medicine shortages.

The TGA has also approved an overseas patch called Estramon, which is now available in Australian pharmacies.

If you’re looking at the oestrogen gel, the Australasian Menopause Society has a dose conversion guide that doctors can use to match a usual patch dose to other forms of MHT.

Oral tablets are another option often used alongside progesterone tablets, although they’re not suitable for everyone as the hormone passes through the liver first and can come with some associated health risks.

There are reports of people resorting to cutting their patches in half to avoid running out, but this is not recommended.

The TGA warns that this can affect how the patch adheres to the skin and how oestrogen is absorbed, making the delivered dose unreliable.

There’s also now a lack of oestradiol implants.

About ten years ago, these implants (a little pellet inserted under the skin like the Implanon contraceptive), which are a fabulous option, were available. But the implant manufacturer stopped making them altogether and they have never been replaced.

Once inserted, the implants lasted six to nine months, negating the need to use patches regularly or take tablets.

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Globally, there is now only one manufacturer making a similar product called Estra-50.

It’s not routinely available in Australia, although a handful of doctors here bypass the standard route and import it themselves with some special paperwork.

All of this tells us that Australia desperately needs a more stable supply of oestradiol options, but it looks uncertain whether those people who rely on these medications will get that stability any time soon.

While these ongoing shortages are frustrating for patients, pharmacists and doctors alike, there seems to be no guarantee that they will be resolved any time soon.

But alternatives do exist. A conversation with your GP or pharmacist is the best place to start.