The stimulus for this article came from a cry for help from a person who had never before considered sourcing her medications from anything other than traditional “brick-and-mortar” local pharmacies, but was driven to desperation owing to her inability to obtain a product she had grown to depend on, due to persistent shortages of estrogen patches she relied on as part of her hormone replacement therapy (HRT). The customer had heard from a friend that in the past, she had been able to buy drugs that were in short supply in the US, even some that were officially listed by the FDA as out-of-stock nationwide, from IsraelPharm.
In a quick chat with our online help team, we were able to reassure that that we were well aware of the situation of estrogen patch shortages. Millions of women were having to contend with lack of ability, not just in the US, but as far afield as Australia, to get their hands on the estradiol patches that were such a boon for women struggling with the effects of their transition into menopause.
A brief history of the estrogen patch shortage.
Quite coincidentally, the roots of the sudden stop in supplies of what had been a freely-available product until very recently were laid out in an article we published just one month ago. As we explain more fully in our article Hormone Replacement Therapy and Safety published on 16th March this year, the story goes back many decades, to the period when hormone replacement therapy for menopausal women fell into disrepute, with many doctors refusing to endorse any use of medications that could fill the gap in the production of estrogen, a key female reproduction hormone, that comes about when women mature past their age of fertility and slip into menopause.
In brief, the snap change came about when the U.S Department of Health and Human Services removed the “black box warnings” that for two decades had been printed on the information leaflets of HRT products. This reversal was based on clear scientific studies that showed that the initial move to issue the warning had been based on narrow and unsustainable evidence. Once again, doctors could confidently prescribe HRT for their patients, and women could start to once again enjoy the benefits of this therapy without the fears that had been injected into the general knowledgebase that had led many women to refuse to take these treatments for (unwarranted) fear of health risk.
The surge in demand from the millions of women who were keen to get back on the HRT wagon caused supplies to run out almost overnight. Making things worse, in the form of a double-whammy, the major drug manufacturers had almost written-off HRT patches as a viable stream from which they could make money, so while they could, with some engineering, switch some of their manufacturing plants over to start making oral estrogen tablets (same process, different ingredients), there was simply no latent capacity in their factories enabling them to start the wheels turning in the short term for the more specialized estrogen patches that had become one of the “gold-star” first-choice solutions that women had gotten used to.
Why HRT patches may be preferred to traditional oral routes
The table below sets out the broad differences, advantages and disadvantages of HRT therapy via the two main routes. As in the case of all medical treatments, the ultimate decider is the prescribing doctor, who takes into account the specific requirements of an individual patient.
| Treatment | How it works | Pros | Cons | Typical use |
|---|---|---|---|---|
| Oral HRT (estradiol tablets, conjugated estrogens, combined oral preparations) | Estrogen, sometimes combined with a progestogen, is swallowed daily and absorbed through the gut. The hormone passes through the liver before reaching the general circulation, a step known as first-pass metabolism. |
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Postmenopausal women seeking symptom relief who have no elevated thrombotic or cardiovascular risk and who prefer an oral regimen. |
| Transdermal HRT patches (Estalis, Estraderm, Estradot) | Estradiol, alone or combined with norethisterone, is delivered through the skin into the bloodstream from an adhesive patch worn for several days at a time. The liver is bypassed on first circulation. |
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Postmenopausal women with thrombotic, cardiovascular, or metabolic risk factors, women with migraine with aura, and women who prefer a non-oral, less frequent dosing schedule. |
Many women looking to get back on hormone replacement therapy via patches were hunting month to month for their prescribed brand.
Product specifics – comparing the HRT patches
| Treatment | How it works | Pros | Cons | Typical use |
|---|---|---|---|---|
| Estalis (estradiol + norethisterone) | A combined matrix patch that releases both estradiol and the progestogen norethisterone through the skin into the bloodstream. The two hormones are delivered continuously from a single patch, providing continuous combined HRT without a separate progestogen tablet. |
|
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Postmenopausal women with an intact uterus who need combined HRT and prefer a single twice-weekly patch over separate estrogen and progestogen products. |
| Estraderm (estradiol) | A reservoir-style transdermal patch that releases estradiol from a liquid drug reservoir through a rate-controlling membrane into the skin. Estradiol alone is delivered; any required progestogen is prescribed separately. |
|
|
Postmenopausal women who need estrogen-only therapy, typically after hysterectomy, or women who need combined therapy with a separately prescribed progestogen tailored to their tolerance. |
| Estradot (estradiol) | A small matrix transdermal patch in which estradiol is dissolved directly in the adhesive layer and released through the skin into the bloodstream. Estradiol alone is delivered; any required progestogen is prescribed separately. |
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Postmenopausal women who want a low-profile estrogen-only patch with fine dose control, either after hysterectomy or combined with a separately prescribed progestogen. |
How to access estrogen patch supply through IsraelPharm
For women already established on Estalis, Estraderm, or Estradot, the sourcing question is simple: how do you keep the patches coming without gaps? IsraelPharm is a licensed international pharmacy that stocks these exact branded products and ships them directly to patients holding a valid prescription from their physician.
Four points matter for patients evaluating this option.
- Legitimacy: IsraelPharm operates under official Ministry of Health regulatory oversight, dispenses prescription medicines only against a valid physician prescription, and does not alter the clinical relationship between patient and prescriber.
- Access : We stock the named branded patches rather than swapping in generics or near-equivalents, which matters when a doctor has deliberately prescribed one formulation over another.
- Continuity: The need for HRT therapy usually lasts for many years, and could be life-long. A patient depends on a predictable monthly or weekly supply, and an international pharmacy like ours, with multiple supply lines, is less exposed to the specific US-market disruptions that have driven the current estrogen patch shortage.
- Affordability: Branded patches sourced through IsraelPharm are priced substantially below US retail rates, which adds up to great savings over a multi-year estrogen patch course of treatment.
Further reading
- Practical guidance on managing the estradiol patch shortage. World Wide Web.
- Tips for patients facing the estrogen patch shortage. AARP.
- Coverage of menopause experts on the estrogen patch shortage. Forbes Health.
- Background on the transdermal HRT patch shortage. TGA.
- HRT safety: the changing conversation for patients on estrogen patches. IsraelPharm blog.
- Menopause estrogen patches are in short supply. What are the alternatives? Healthline.
Frequently asked questions
Can I order Estalis, Estraderm, or Estradot from IsraelPharm with a US prescription?
Yes. IsraelPharm dispenses Estalis, Estraderm, and Estradot to US patients who upload a valid prescription from a licensed physician.
- The prescription must name the branded patch and the strength.
- Orders are placed through an account on the IsraelPharm website.
- The pharmacy contacts the patient if the prescription needs clarification.
- Shipment is to a US residential address.
- Physician oversight of the HRT plan remains with the prescriber.
How does IsraelPharm help during an estrogen patch shortage?
IsraelPharm draws on supply lines outside the US distribution channels most affected by the current estrogen patch shortage.
- The pharmacy stocks Estalis, Estraderm, and Estradot as branded products.
- Substitution to an unrequested brand is not made at the counter.
- Repeat orders are designed to preserve continuity of the twice-weekly schedule, with single orders covering up to three months of continuous application.
- Patients can receive reminders to arrange refills before running down the last box.
What does Estalis, Estraderm, or Estradot cost through IsraelPharm compared with US retail?
When sourcing from IsraelPharm, Estalis, Estraderm, and Estradot usually cost substantially less than standard US retail costs. Current pricing is shown on each product page. Right now, comparative pricing is pointless, since the patches are simply not available from many US pharmacies at any price!
- Savings accumulate over a multi-year HRT course.
- Pricing reflects the branded product, not a generic.
- Shipping costs are shown at checkout.
How long does delivery of an estrogen patch order from IsraelPharm take?
Delivery to US addresses typically takes a small number of business days once the prescription is verified.
- Prescription verification usually completes within one working day.
- Tracking is provided once the estrogen patch order ships.
- Customer service is available for delayed or missing shipments.
- First-time orders may take slightly longer than repeats.
Do I need a new prescription every time I reorder Estalis, Estraderm, or Estradot?
No. A valid prescription can cover the repeat quantity authorised by the prescribing physician.
- Repeat dispensing follows the quantity and duration written on the prescription.
- A new prescription is needed when refills are exhausted.
- A new prescription is also needed if the brand or strength changes.
- IsraelPharm records the prescription against the patient account.
Glossary
- Estradiol: The main form of estrogen produced by the ovaries and the active hormone delivered by the three patches discussed.
- First-pass metabolism: Processing of an oral drug by the liver before it reaches the general circulation, reduced or avoided by transdermal delivery.
- Hormone replacement therapy: Treatment that supplies estrogen, sometimes with a progestogen, to ease menopausal symptoms and reduce bone loss.
- Norethisterone: A synthetic progestogen combined with estradiol in Estalis to protect the uterine lining during continuous HRT.
- Transdermal: Delivery of a drug through intact skin into the bloodstream, the route used by Estalis, Estraderm, and Estradot.
- Venous thromboembolism: A blood clot forming in a deep vein or lung, a known risk factor weighed when choosing between oral and transdermal estrogen.
