Hayley Harris, 42, is a bit younger than most menopausal women. Last December, doctors removed her second ovary to relieve chronic pain from endometriosis, throwing her into surgical menopause.
It took Harris a while to find a form of estrogen that helped quell her menopausal symptoms, like hot flashes and migraines. After trying estrogen creams and gels, she eventually landed on patches.
But amid a nationwide shortage, estrogen patches have been harder to come by. Women have to get creative, using other brands or types of estrogen that don’t work as well for them or cause uncomfortable side effects.
Harris splits her time between Glenwood Springs and San Diego — where she just got a patch that’s bigger and stronger than she’s accustomed to.
“Now I'm kind of stuck with, for an entire month, this one patch that gives me these rashes and isn't sticking very well,” Harris said. “But at least I have a patch, because some people don't have any patches at all.”
Estrogen patches have long been a popular form of hormone replacement therapy for menopausal women, according to Mary Glode, a gynecologist at Grand River Health in Rifle. She said her patients tend to prefer patches because they’re cheaper and more convenient than other forms of estrogen, like gels or sprays. They’re typically small, ranging from the size of a quarter to the size of a palm, and stick to the skin near the patient’s underwear line.
“It's the most common, and it's the one that we've used for years,” Glode said.
Changing medical guidance
Medical research on the treatment’s safety has flip-flopped over the decades. In the past few years, recent studies have reaffirmed the benefits of hormone replacement therapy, countering old research that said it was too risky.
“Hormones went from being good, good, good, good to bad, bad, bad, bad, bad,” Glode said. “A whole generation of women did not use hormone replacement therapy.”
Carbondale resident Nicole Rom saw the effects of that generational gap firsthand. As a teenager, she watched her mom struggle through hot flashes.
“She'd be visibly sweating, and her philosophy was like, ‘Well, women just endured it,’” Rom said. “There wasn't the sense of ‘my life could be better,’ or ‘this could be managed.’”
Now, women like Rom, who started perimenopause last year, are returning to treatment.
“More and more women, I think, are getting more education and awareness of these tools and medicines that help us manage these symptoms in a way that allows us to live normal, full lives,” she said.
But recently, manufacturers haven’t been able to keep up with the increased interest in hormone replacement therapy, particularly when it comes to estrogen patches.
This past February, the FDA lifted a black-box warning it had previously placed on the patches, causing demand to skyrocket and leaving pharmacies scrambling to fill prescriptions.
An independent pharmacy’s solution
In a beige, stone building off of Grand Avenue, Downtown Drug in Glenwood Springs has been a community staple for over 30 years.
Each day, pharmacist and owner Jason Gotzinger starts at his computer, clicking through inventory from seven different estrogen patch distributors.
On a Saturday morning in September, some distributors didn’t have any patches available for purchase, but the pharmacy already had enough backup supply.
“It looks like we're kind of stocked up across the board, which is good,” he said. “We'll just continue to try to hold these amounts.”
As an independent pharmacy, Gotzinger isn’t locked into buying from one drug wholesaler. He can shop around to see where products are available all over the country.
Gotzinger said he’s fared better than corporate pharmacies. From his past experience, many of them have contracts that restrict them to purchasing some products from one wholesaler.
“When I was a corporate pharmacist, I [would] push a button and hope for the best,” he said.
Local women adapt
But not all women have access to these independent pharmacies, so they’re getting resourceful. Some local patients are switching to other estrogen products, like gels, that don’t work as well for them. Others are paying out of pocket for patches from mail-order pharmacies in Canada.
And menopausal women aren’t the only ones who benefit from estrogen patches — some transgender women also use them for gender-affirming care. Without supplemental estrogen, they too face menopausal-like symptoms.
For Elara Jefferson, a transgender woman who lives near Glenwood Springs, patches have helped her feel more like herself. She’s been able to access the patches regularly, aside from a blip earlier in the year.
When she showed up to Target and the pharmacists said they couldn’t fill her prescription, Jefferson had a panic attack in her car.
“That's when I knew, ‘Oh, this is working,’” Jefferson said. “Because I'm panicking if I can't get it.”
She was able to transfer her prescription to City Market and hasn’t had any issues since. But she still worries about what could happen if the shortage continues and she loses supply.
“I want to keep a consistent dose and stay on it,” she said. “So to combat that, I try to get my full prescription amount all at once.”
Some women, like Harris, are cutting up patches to get the right dose when their preferred alternatives are unavailable. Harris also has a backup of old prescriptions, just in case.
“We're going to do our best, but we all need to show up and be creative,” she said. “You as the patient, the doctor, the pharmacist, like we all have to do this.”
For Harris, working closely with pharmacists like Gotzinger has made them a crucial part of her care team. At Downtown Drug, Gotzinger said that’s intentional.
“We at the pharmacy see patients 12 times or more a year, where your doctor may see you once or twice,” he said. “It's a huge access point for patients.”
Even with the support of independent pharmacists, Harris can’t always get her preferred medication. In San Diego, she’s currently riding out the side effects of a stronger estrogen patch.
These backup solutions aren’t ideal, and they’re unavoidable for many women nationwide, but Harris has found some ways to cope during the shortage.
She’s staying active and getting outside, taking walks on the beach and hanging out with her dog.
“That natural seawater, air, and the breeze and more sun… it makes a big difference,” she said.
