Provider Briefing: The 2026 Estradiol Patch Shortage

If your patients have been reporting difficulty filling prescriptions for Dotti (estradiol transdermal system), you are not alone. The United States is experiencing a significant and ongoing shortage of estradiol transdermal patches, and Dotti — manufactured by Amneal Pharmaceuticals — is among the most affected products.

This briefing provides a concise overview of the shortage, its clinical implications, and practical strategies for managing your patients' hormone replacement therapy (HRT) during this period of constrained supply.

Shortage Timeline

The current estradiol patch shortage has its roots in trends that began around 2020, but the acute phase was triggered by a landmark regulatory change in late 2025:

• 2020–2024: Telehealth menopause platforms (Midi Health, Alloy, Evernow) expanded access to HRT, steadily increasing prescription volume for estradiol patches.
• November 2025: The FDA removed the black box warning from bioidentical transdermal estradiol products (patches, gels, creams). This decision — supported by updated risk-benefit analyses — removed a major barrier that had discouraged both clinicians and patients from initiating HRT for over two decades.
• Late 2025 – Early 2026: Prescription volume for estradiol patches surged. Manufacturers, operating near capacity, were unable to scale production quickly enough. Widespread shortages emerged by December 2025 and have persisted into February 2026.

The FDA has confirmed it is monitoring the supply situation but has not provided a projected resolution date.

Prescribing Implications

The shortage creates several challenges for prescribers:

Prescription Fulfillment Uncertainty

Patients may present with unfilled or partially filled prescriptions. Some are rationing patches — extending wear time beyond 3–4 days or cutting patches (which is not recommended for Dotti, as it can affect drug delivery). Counsel patients against modifying patch use without clinical guidance.

Therapeutic Continuity

Abrupt discontinuation of estradiol can cause rapid return of vasomotor symptoms, mood disturbance, and in some cases rebound hot flashes more severe than baseline. Maintaining therapeutic continuity should be a priority. When Dotti is unavailable, timely substitution with an equivalent product is recommended.

Progestogen Coordination

When switching estradiol formulations, ensure that progestogen therapy (for patients with an intact uterus) is adjusted appropriately. Dose equivalency for estradiol is generally straightforward across transdermal products, but verify when switching between transdermal and oral formulations, as bioavailability differs.

Current Availability Picture

As of February 2026, availability varies by product, strength, and region:

• Dotti (Amneal): Intermittent availability. Some strengths (0.05 mg/day, 0.075 mg/day) are particularly hard to find.
• Generic estradiol patches: Also affected by the shortage, though availability varies by manufacturer.
• Climara (Bayer): Once-weekly patch; somewhat better availability in some regions, though supply is also constrained.
• EstroGel, Divigel: Topical estradiol gels have generally been less affected by the shortage and may be the most reliably available transdermal option.
• Oral estradiol: Widely available and rarely in shortage. Cost: $4–$15/month for generics.

Providers can use Medfinder for Providers to check real-time pharmacy availability and help patients locate in-stock products.

Cost and Access Considerations

The shortage has not significantly altered pricing, but access barriers compound cost concerns:

• Dotti retail price: $105–$191 per month (8 patches) without insurance
• With coupon (GoodRx): As low as $25.83
• Generic estradiol patches: $25–$50 with coupon
• Insurance: Most commercial plans and Medicare Part D cover estradiol patches with $10–$30 copays
• Patient assistance: Amneal offers a Patient Assistance Program for uninsured/underinsured patients and a PATHways Co-Pay Savings Program for commercially insured patients

Patients who cannot find their usual product may end up paying more at a pharmacy that has stock. Consider discussing cost-saving strategies, including coupon cards and manufacturer programs. For a patient-facing resource, direct patients to How to Save Money on Dotti.

Tools and Resources for Your Practice

Several tools can help you and your patients navigate the shortage:

• Medfinder for Providers: Real-time pharmacy availability search. Helps you direct patients to pharmacies that have their medication in stock.
• FDA Drug Shortage Database: Official shortage listings at accessdata.fda.gov.
• ASHP Drug Shortage Resource Center: Updated shortage information from the American Society of Health-System Pharmacists.
• Amneal Pharmaceuticals: Contact for supply updates and patient assistance program applications.

For a step-by-step workflow on helping patients find Dotti, see our companion guide: How to Help Your Patients Find Dotti in Stock: A Provider's Guide.

Substitution Guidance

When Dotti is unavailable, consider these clinically equivalent alternatives:

1. Generic estradiol transdermal patches (twice-weekly): Bioequivalent to Dotti. Same dosing schedule and strengths.
2. Climara (once-weekly): Same active ingredient, longer wear time. Dose equivalency is straightforward.
3. EstroGel (0.06%, topical gel): Applied daily. One pump delivers approximately 0.75 mg estradiol, producing serum levels comparable to a 0.05 mg/day patch. Useful when no patches are available.
4. Divigel (topical gel): Available in 0.25, 0.5, and 1.0 mg single-dose packets. Applied daily to the thigh.
5. Oral estradiol: Reserve for patients without elevated thrombotic risk. 1 mg oral estradiol is roughly equivalent to a 0.05 mg/day transdermal patch, though individual response varies.

Looking Ahead

Manufacturers are reportedly working to increase production capacity, but scaling specialized transdermal manufacturing takes time. Most supply chain analysts do not expect full resolution before the second half of 2026.

In the meantime, proactive prescribing — including prescribing alternatives on the initial Rx, noting "or equivalent estradiol transdermal product" when appropriate — can reduce the number of callbacks and patient distress.

Final Thoughts

The 2026 estradiol patch shortage is a supply-side problem with demand-side origins. The removal of the black box warning was a clinically appropriate decision that has led to more women receiving beneficial HRT — but the manufacturing infrastructure was not prepared for the surge.

As providers, our role is to ensure therapeutic continuity, communicate transparently with patients, and leverage available tools to navigate the shortage. Medfinder for Providers is designed to help with exactly that.

For patient-facing resources you can share, consider: Dotti Shortage Update for Patients and How to Find Dotti in Stock.