Provider Briefing: The Estradiol/Norethindrone Supply Landscape in 2026

As a prescriber, you've likely fielded calls from patients who can't fill their Estradiol/Norethindrone prescriptions. The supply disruption that began affecting combination hormone replacement therapy (HRT) products in 2024 has continued into 2026, with particular impact on the transdermal formulation (CombiPatch) and intermittent availability issues for generic oral tablets.

This briefing covers the current state of the shortage, prescribing implications, alternative therapies, cost considerations, and tools to help you and your patients navigate the situation.

Timeline: How We Got Here

The Estradiol/Norethindrone supply challenges are part of a broader trend affecting hormone therapy products:

• 2023–2024: Updated FDA guidance on HRT safety contributed to a significant uptick in prescribing. Demand for estrogen-containing products — both oral and transdermal — began outpacing supply capacity.
• 2024: The CombiPatch (Estradiol/Norethindrone Acetate transdermal system) was added to the ASHP drug shortage list. Manufacturing constraints at the limited number of transdermal patch producers drove the initial shortage.
• 2024–2025: Estrogen patch shortages broadened, with Estradot and other estradiol-only patches also experiencing supply disruptions in both the US and UK. The FDA's removal of certain boxed warning language further increased demand.
• 2026: Generic oral tablets (Activella equivalents from Amneal, Teva, and others) remain more available than the patch but experience intermittent stock-outs at the pharmacy level, particularly for the lower-dose 0.5 mg/0.1 mg formulation.

Prescribing Implications

The shortage creates several clinical considerations:

Formulation Flexibility

If your patient is on the CombiPatch and it's unavailable, consider transitioning to generic oral Estradiol/Norethindrone tablets. The oral formulation has different pharmacokinetics — first-pass hepatic metabolism results in higher hepatic estrogen exposure — but for most patients, it's a clinically appropriate substitution.

Dose Availability

The 1 mg/0.5 mg oral tablet has been more consistently available than the 0.5 mg/0.1 mg tablet. If a patient requires the lower dose, consider whether separate low-dose estradiol plus a progestin component could be a viable workaround.

Generic Substitution

Multiple generic equivalents exist for the oral formulation (AB-rated generics of Activella). If you're prescribing by brand name, ensure the prescription allows for generic substitution. Brand names include Activella, Amabelz, Lopreeza, and Mimvey — all are therapeutically equivalent.

Current Availability Picture

As of February 2026:

• CombiPatch (transdermal): Remains on the ASHP shortage list. Availability is severely limited. No generic transdermal equivalent exists.
• Generic oral tablets (1 mg/0.5 mg): Generally available at most pharmacies, though spot shortages occur.
• Generic oral tablets (0.5 mg/0.1 mg): More limited availability. Some pharmacies report difficulty sourcing this strength.
• Brand Activella: Available in some markets but at significantly higher cost ($150–$200+/month vs. $15–$50/month for generic with discount cards).

Cost and Access Considerations

Cost is a meaningful barrier for many patients, particularly those without insurance or with high-deductible plans:

• Generic oral with discount card: $15–$50/month (GoodRx, SingleCare)
• Generic oral retail cash price: $50–$100/month
• Brand Activella: $150–$200+/month
• CombiPatch: $150–$250+/month when available

For patients who qualify, Novo Nordisk's Hormone Therapy Patient Assistance Program (PAP) provides brand-name Activella at no cost. Eligibility typically requires the patient to be uninsured or underinsured. Contact: 1-866-668-6336.

Additional resources: NeedyMeds and RxAssist databases list patient assistance programs for HRT products.

Tools and Resources for Your Practice

Real-Time Availability Search

Medfinder for Providers allows your team to check real-time pharmacy availability for Estradiol/Norethindrone by location. This can be integrated into your prescribing workflow to help patients find the medication before they leave the office.

ASHP Drug Shortage Database

The ASHP maintains the most up-to-date shortage tracking for CombiPatch and other affected products. Check ashp.org/drug-shortages for status updates.

Compounding as a Bridge

For patients who cannot find any manufactured Estradiol/Norethindrone product, compounding pharmacies may prepare a custom formulation. This requires a specific prescription. Note that compounded products are not FDA-approved and may not be covered by insurance.

Alternative Therapies

When Estradiol/Norethindrone is unavailable, the following alternatives offer similar clinical profiles:

• Prempro (Conjugated Estrogens 0.625 mg/Medroxyprogesterone Acetate 2.5 mg or 5 mg): Widely available as generic. Most clinical trial data of any combination HRT (WHI). Consider for patients who tolerate conjugated estrogens.
• Climara Pro (Estradiol 0.045 mg/Levonorgestrel 0.015 mg/day patch): Once-weekly transdermal option. May have better availability than CombiPatch. Preferred for patients who want to avoid first-pass hepatic metabolism or who are at higher VTE risk.
• Bijuva (Estradiol 1 mg/Progesterone 100 mg capsules): Uses bioidentical progesterone rather than a synthetic progestin. Brand-only, higher cost. May appeal to patients requesting bioidentical hormones.
• Separate prescriptions: Prescribing estradiol and a progestin (oral norethindrone acetate or micronized progesterone) as individual medications may improve availability, as each component is produced by more manufacturers.

Looking Ahead

The HRT supply situation is unlikely to resolve quickly. Demand continues to grow as menopause awareness increases and prescribing guidelines evolve. Manufacturing scale-up takes time, and the limited number of transdermal patch producers remains a structural bottleneck.

Proactive strategies — including real-time availability tools, formulation flexibility, and maintaining familiarity with alternative agents — will remain important clinical skills for managing menopausal patients in 2026 and beyond.

Final Thoughts

The Estradiol/Norethindrone shortage is a supply-side problem, not a clinical one. The medication remains safe and effective when available. Your role as a prescriber is to help patients maintain continuity of care — whether that means helping them find the medication, switching formulations, or transitioning to an alternative.

Bookmark Medfinder for Providers for real-time pharmacy availability data, and stay current with our patient-facing resource: Estradiol/Norethindrone shortage update for patients.