Women are rationing estrogen patches, including me. But the FDA says there's no shortage: Leila Atassi

CLEVELAND, Ohio -- Gloria Steinem died last week at 92 — the writer and activist whose name became shorthand for American feminism, who co-founded Ms. magazine and spent decades insisting that women deserved to be full citizens of their own lives. She's been on my mind, for the obvious reasons. But also because, as the country was remembering Steinem and the movement she helped build, I was driving across Cuyahoga County in search of an estrogen patch. Recently, my Cleveland Clinic pharmacy told me it was out of the estradiol patches I use. I eventually found some in Middleburg Heights, several suburbs away from my home. When I got there, the pharmacist would give me only a one-month supply. 'Because of the shortage,' she said, casually, as if talking about the weather. I knew about the shortage. What surprised me was how frightened I felt by it. This is the part that is harder for me to write. At 46, hormone therapy has changed my life, and not in subtle ways. It gave me back a steadiness, a sense of well-being and clarity that I hadn't felt in a long time. They were qualities I had slowly lost, and I had half-convinced myself that it was simply the price of getting older. It isn't. A small adhesive square restored them to me. And suddenly, standing at a pharmacy counter with one month's supply in my hand, I found myself wondering how long this version of me will get to last. Steinem spent much of her life teaching women to recognize moments like this for what they are. The personal is political. What happens to us in our bodies, our homes, our doctors' offices and, yes, at pharmacy counters is shaped by decisions made far beyond them. This particular decision — or the government's failure to make one — is affecting millions of women. The maddening thing is that the shortage grew out of something good. For two decades, American women were frightened away from hormone therapy. In the early 2000s, the Women's Health Initiative linked it to strokes, blood clots and breast cancer. The government slapped a 'black box' warning on estrogen, prescriptions plummeted and a generation of women learned to regard hormone therapy as dangerous. Later we learned that the study had largely tracked women who were older and well past menopause, using formulations that differ from many prescribed today. For women who begin hormone therapy in their late 40s and 50s, the risks had been terribly overstated. Last November, the FDA finally removed the decades-old boxed warning from menopausal hormone therapy. The correction was long overdue – and women noticed. Estrogen-patch prescriptions climbed from roughly 594,000 a month in the summer of 2024 to about 1.6 million a month by this spring, according to prescription data reported by CNBC — a 162% jump. By early this year, researchers at Truveta found, roughly one in 20 women ages 45 to 54 was using estrogen-based therapy, about twice the rate of a few years earlier. The patch had become the most common way American women take it. There is a reason for the sudden popularity. Hormone therapy is not the fountain of youth, but for women who are good candidates and begin it before 60 or within about 10 years of menopause, it is the most effective treatment we have for the hot flashes and night sweats that torment as many as four in five women. It is a first-line treatment for the vaginal dryness, painful intercourse and urinary issues no one warned us about or the shifting body composition we assumed would just be a fact of middle-aged life. And it protects against the bone loss that left generations of older women vulnerable to devastating fractures and frailty as they age. Mostly, for many women, including me, it makes life better. Gone is the insomnia, the debilitating brain fog and mood swings that had made my daily life a slog. Our mothers largely missed this correction in medical thinking. My generation arrived just in time for it. And now we can't find the patches. The American Society of Health-System Pharmacists, working with the University of Utah, has classified estradiol patches as being in national shortage since Jan. 30. Its latest bulletin lists 17 patch products that are backordered, under allocation or have no estimated release date. Nearly every manufacturer and nearly every dose is affected. Yet according to the FDA, there is no shortage at all. The patches do not appear in the agency's official drug-shortage database. An FDA spokesperson told CNBC in June that estradiol patches were not in short supply and that all six manufacturers were operating at full capacity. That may even be technically true. The FDA relies on manufacturers to determine whether there is enough national supply to meet demand. But those numbers don't necessarily reflect what is happening at pharmacy counters — where women are being told their prescriptions can't be filled, rationed to a single month's supply or forced to call pharmacy after pharmacy looking for a box. So, why can't manufacturers simply make more? Because patches are considerably harder to produce than pills. They require specialized coating and lamination equipment that cannot be added overnight. And because estradiol patches are generics, manufacturers make relatively little money selling them. A small number of companies supply most of the market, leaving little slack when demand suddenly surges. Industry insiders told Reuters the scramble could last as long as three years. So, to cope, women have become amateur supply chain analysts. Spend any time in peri-menopause forums and subreddits and you'll see it happening. Women trade intelligence about which pharmacy chain just got a shipment, which mail-order service still has stock, which generic brand remains available in which city. They swap strategies for stretching what they have. Some ask doctors to prescribe higher-dose patches so they can cut them in half — a workaround that comes with its own risks because not every patch is designed to be cut and doing so can affect how the medication is delivered. Others switch to estrogen gels or pills, even when the patch worked better for them or carried advantages that made it their doctor's first choice. It's depressing to watch women crowdsource access to basic medical care. And some women simply run out. Stopping estrogen is not generally medically dangerous in the way abruptly stopping some drugs can be. But symptoms return, sometimes hard and fast. Doctors often recommend tapering when women decide to discontinue hormone therapy because hot flashes, insomnia and other symptoms can come roaring back. Now indulge me in the obvious thought experiment. Imagine this were happening to men. Imagine a medication that restored middle-aged men's sleep, steadied their moods, relieved debilitating symptoms and protected their aging bodies suddenly became difficult to find across the country. Imagine men calling pharmacies all afternoon, driving from suburb to suburb and taking advice from strangers online about how to ration what they had left. Would the federal government be debating the definition of 'shortage'? I doubt it. No man has ever had to drive three counties over for the little blue pill. More important, the government has tools for situations like this. A formal FDA shortage designation can open additional options to stabilize supply, including regulatory flexibility around manufacturing and, in some circumstances, importing products from overseas to help fill the gap. The agency can expedite reviews of manufacturing changes and additional suppliers. Congress, meanwhile, has spent years debating proposals to strengthen the generic-drug supply chain through stockpiles, incentives and other requirements. We know how to treat a drug shortage like a national problem when we decide the drug matters enough. Gloria Steinem spent 60 years arguing that women's lives are not a peripheral concern to be managed somewhere outside the main currents of public life. She taught generations of women to look at something happening privately to them and ask whether it was really private at all. I understand that lesson differently this week. I have one patch left in my medicine cabinet. I don't yet know where the next one will come from. That is a small problem, until you multiply it by the many women calling pharmacy after pharmacy, changing medications or rationing patches. The shortage is real. So is the message it sends: women's health remains something we are expected to manage ourselves, preferably without making too much noise.