Since 2020, Australia has had an ongoing shortage of oestrogen patches, which are usually prescribed to help ease menopause symptoms.

In March, the Therapeutic Goods Administration (TGA) confirmed shortages of several brands and doses of patches will last until at least the end of this year. But this estimate has already been pushed back many times.

So, what can you do when the pharmacy has run out of the hormone replacement therapy (HRT) patches you rely on?

You don’t need to ration your supply (and this doesn’t work anyway). Here are your other options.

What are HRT patches for?

HRT patches are small sticky squares worn on the skin, usually on the lower belly, back or buttock. This is sometimes also called menopausal hormone therapy (MHT).

HRT patches slowly release oestrogen (and sometimes a second hormone called progestogen) through the skin and into the bloodstream. Most brands need to be replaced every 3–4 days (twice a week).

Patches are prescribed to two groups of people. The vast majority are women going through perimenopause and menopause, when the ovaries make less oestrogen. Menopause typically happens around 50 years of age, but low oestrogen can occur earlier due to certain conditions, as well as surgery or cancer treatments.

The drop in oestrogen is what causes hot flushes, night sweats, broken sleep, brain fog, mood changes, joint aches and vaginal dryness. Symptoms vary from person to person, but about one in ten women in Australia are prescribed HRT for menopause.

Read more: What are the most common symptoms of menopause? And which can hormone therapy treat?

A much smaller group using HRT patches is transgender women and some non-binary people. They make up less than one per cent of Australia’s overall population.

As part of gender-affirming hormone therapy, HRT patches raise oestrogen levels in the body to bring about physical changes that align with the person’s gender, and to support their mental health and wellbeing.

The medication is identical. The shortages hit both groups.

Patches are a popular first choice for hormone therapy for a good reason. They deliver the hormones via the skin and not the gut, meaning unlike tablets the liver doesn’t have to process them. This carries a lower risk of blood clots, which matters for people with migraine, high blood pressure or a higher clot risk.

Patches also release a steadier level of hormone in the blood than a once-a-day pill.

Hormone patches are not just “good to have”. For many people they are the difference between functioning at work and home, and not.

What happens when you stop using them

If you stop using your HRT patches, your oestrogen levels will drop. This can mean hot flushes, night sweats and disrupted sleep return – usually within days.

Symptoms can really impact mood and mental health. This is not “withdrawal” in the way people withdraw from alcohol or opioids, as oestrogen patches are not addictive. But as the oestrogen that was easing symptoms is no longer there, the symptoms come back.

Many people may choose to stop HRT after a period of time. Research has shown that around half of people report a return of symptoms after stopping, which can sometimes lead them to restart treatment.

Some longer-term benefits of HRT, such as stronger bones, take months to fade. A short gap of a week or two while finding an alternative will not make a big difference.

If you have limited patches and can’t find more, you may consider tapering off. This means gradually using less over time (for example, by using fewer patches a week). But this doesn’t prevent symptoms returning – it only delays them. So if supply has run out, the priority is switching to another formulation, rather than rationing what remains.

One thing to avoid: cutting patches in half to make them last longer. The TGA specifically warns against this. It can affect how the patch sticks to the skin and how the oestrogen is absorbed, making the delivered dose unreliable.

What are the other options?

The first is a different patch. Pharmacists can now swap one brand for another brand or strength without a new prescription, under rules that specifically address medicine shortages. The TGA has also approved an overseas patch called Estramon, which is available in Australian pharmacies now.

A pharmacist may also provide multiple lower-dose patches, to use together.

The second option is an oestrogen gel, rubbed on the skin once a day. It works the same way as a patch and, as it’s delivered through the skin, has the same benefit of lower blood clot risk. But gels need to be applied daily. The Australasian Menopause Society has a dose conversion guide that doctors use to match a usual patch dose to other forms.

The third option is a tablet. Oral oestrogen works well for hot flushes and other body-wide symptoms, and may also be used alongside progesterone tablets. The trade-off is a slightly higher clot risk than skin-based options, because the hormone passes through the liver first. So tablets may not suit those with a history of clots or migraines.

For those whose main problem is vaginal dryness or discomfort during sex, a vaginal oestrogen cream or pessary works right where it is needed. Very little hormone reaches the bloodstream, so it is generally safe and can often be used with, or replace, other forms of HRT.

The shortage is frustrating for patients, pharmacists and doctors alike, and won’t be fixed any time soon. There are many alternative options. A chat with a GP or pharmacist is the place to start.

Ada Cheung is an Endocrinologist and Professor at The University of Melbourne. She has received travel support as an invited speaker from the Australasian Menopause Society and International Menopause Society. Ada Cheung has received research funding from National Health and Medical Research Council, Medical Research Future Fund, Heart Foundation, Suicide Prevention Australia, The Paul G. Allen Frontiers Group, University of Melbourne, Endocrine Society of Australia, Royal Australasian College of Physicians Foundation, Austin Medical Research Foundation, Sir Edward Dunlop Medical Research Foundation and Viertel Charitable Foundation. She is currently a member of the Endocrine Society (US), Endocrine Society of Australia, Australian Medical Association, World Professional Association for Transgender Health and Australian Professional Association for Trans Health.