Since 2020 or so, there have been recurring national shortages of oestrogen transdermal patches in Australia.
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). 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.
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.
While there are legitimate alternatives to the patches – like tablets and gels – they are more expensive.
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 really only four 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 Estalis are in short supply – so the loss of just one brand has had massive implications for other stock.
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.
Additionally, the ingredients – derived from soya beans or sweet potatoes – required to manufacture oestradiol patches are in short supply and high demand.
Neither the TGA nor the distributors seem able to provide a clear explanation for the shortages, but according to the TGA website, some products aren’t expected to be back in stock until May 2024.
Has demand outpaced supply?
If we look at oestrogen patches as a treatment of 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 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.