What estradiol patches are on shortage?

ASHP has listed estradiol transdermal system as a current shortage since January 30, 2026, naming twice-weekly patches from Amneal (Dotti, Lyllana), Mylan/Viatris, Noven, Sandoz and Zydus across the 0.025 to 0.1 mg/day strengths. As of September 2026 the FDA has not designated an official shortage; it reports manufacturers producing at capacity against rising demand.

Can a compounding pharmacy replace estradiol patches?

While compounding pharmacies cannot make transdermal patches, they can prepare topical estradiol creams, sublingual troches, and oral capsules. Topical cream is the closest alternative — it delivers estradiol transdermally like a patch, though the applied dose is higher than the patch's labeled delivery rate because only a fraction absorbs through the skin.

How do I convert my estradiol patch dose to a compounded cream?

Patch doses do not convert 1:1 to cream — the patch's labeled dose is the amount delivered systemically, while cream absorption varies by patient. A 0.05 mg/day patch typically transitions to 1–2 mg estradiol cream applied daily as a starting point. Your prescriber should confirm with follow-up serum estradiol levels at 4–6 weeks and adjust accordingly.

Drug Shortage Alert

Estradiol patches on backorder. We compound estradiol.

Multiple estradiol transdermal patches are on backorder. Your prescriber can order a compounded alternative — cream, gel, or troche — compounded in 1–2 days and shipped to your door.

Call 424-228-1049 For Providers

Current Status

What's on shortage

ASHP has listed estradiol transdermal system as a current shortage since January 30, 2026. The FDA has not designated an official shortage as of September 2026, which limits pharmacies' ability to substitute freely even while shelves are empty.

Twice-weekly estradiol patches from Amneal (Dotti, Lyllana), Mylan/Viatris, Noven, Sandoz and Zydus

Strengths affected: 0.025, 0.0375, 0.05, 0.075 and 0.1 mg/day

Cause reported: demand rising faster than capacity after the FDA removed the boxed warning on hormone therapy in late 2025

No resupply date published; the ASHP bulletin below is updated as manufacturers report

Don't stop estradiol abruptly

Sudden discontinuation of estradiol can cause rebound vasomotor symptoms — hot flashes, night sweats, sleep disruption — and may affect bone density in long-term HRT patients. Your prescriber can transition you to a compounded alternative while maintaining therapeutic hormone levels.

What to do right now:

1. Contact your prescribing provider
2. Ask about switching to a compounded estradiol cream, troche, or capsule
3. Your prescriber can send the prescription to Generation Pharmacy — we compound in 1–2 days

Clinical Reference

Patch → Compounded estradiol cream: typical starting doses

Patch doses do not convert 1:1 to cream. The patch's labeled dose is the amount delivered systemically per day; compounded cream needs a higher applied dose because only a fraction absorbs through the skin. Route equivalence for approved products (a 0.05 mg/day patch is roughly 1 mg of oral estradiol) follows the Canadian Menopause Society equivalency table and the Menopause Society's 2022 position statement, cited below. No guideline publishes a compounded-cream equivalence. The ranges here are this pharmacy's starting points, confirmed with serum estradiol at 4 to 6 weeks.

For prescriber reference only

Patch Dose (systemic delivery)	Estradiol Cream (applied dose, daily)
0.025 mg/day	0.5–1 mg
0.0375 mg/day	0.75–1.5 mg
0.05 mg/day	1–2 mg
0.075 mg/day	1.5–3 mg
0.1 mg/day	2–4 mg

Patch

0.025 mg/day

Cream

0.5–1 mg

Patch

0.0375 mg/day

Cream

0.75–1.5 mg

Patch

0.05 mg/day

Cream

1–2 mg

Patch

0.075 mg/day

Cream

1.5–3 mg

Patch

0.1 mg/day

Cream

2–4 mg

Why the cream dose is higher than the patch dose: A patch's labeled dose (e.g., 0.05 mg/day) is the amount delivered systemically. Cream absorption through the skin is partial and varies by patient, application site, and formulation — so the applied dose must be higher to achieve comparable serum levels. Serum estradiol should be checked at 4–6 weeks post-conversion and dose adjusted accordingly.

Other dosage forms: We also compound estradiol as sublingual troches and oral capsules. These routes have different bioavailability profiles than topical cream and require individualized dosing — they are not interchangeable at the same mg. Ask our pharmacist for guidance on troche or capsule dosing.

Considering Bi-Est? Some providers use the shortage as an opportunity to discuss Bi-Est (80/20 estriol/estradiol) formulations — but that is a different clinical decision, not a 1:1 patch conversion. Bi-Est adds estriol, which the patch does not contain. If switching to Bi-Est, the estradiol component should match the target dose while the estriol is an addition. Discuss with the patient before changing therapy.

Prescribing Reference

Topi-CLICK dosing & days supply

We dispense estradiol cream in Topi-CLICK metered-dose applicators. The cream concentration is compounded to your patient's prescribed dose — 2 clicks delivers the full daily dose regardless of strength, keeping it simple for patients.

30-Day Supply

Topi-CLICK 35

2 clicks (0.5 mL) daily

15 mL fill · 0.25 mL per click

Standard monthly fill. Concentration = prescribed dose ÷ 0.5 mL.

60-Day Supply

Topi-CLICK 35

2 clicks (0.5 mL) daily

30 mL fill · 0.25 mL per click

Same device and concentration as the 30-day, larger fill volume.

90-Day Supply

Topi-CLICK 140

2 clicks (1 mL) daily

90 mL fill · 0.5 mL per click

Larger dispenser, half the cream concentration — same daily dose in 1 mL.

Prescribed Dose	Cream Concentration	Clicks / Day (TC35)	30-Day Qty	60-Day Qty	90-Day Qty
0.5 mg/day	1 mg/mL	2 clicks (0.5 mL)	15 mL TC35	30 mL TC35	90 mL TC140
1 mg/day	2 mg/mL	2 clicks (0.5 mL)	15 mL TC35	30 mL TC35	90 mL TC140
1.5 mg/day	3 mg/mL	2 clicks (0.5 mL)	15 mL TC35	30 mL TC35	90 mL TC140
2 mg/day	4 mg/mL	2 clicks (0.5 mL)	15 mL TC35	30 mL TC35	90 mL TC140
3 mg/day	6 mg/mL	2 clicks (0.5 mL)	15 mL TC35	30 mL TC35	90 mL TC140

0.5 mg/day

Cream concentration1 mg/mL