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Despite the government’s pre-election commitment to women’s health and making HRT more accessible, ongoing shortages are sparking questions about equity in healthcare. By Hannah Bambra.

No end in sight to HRT shortages

The TGA says overall supply of HRT patches will remain “very limited” this year.

Credit: Kemal Yildirim / iStock

At least three years into Australia’s nationwide supply shortage of hormone replacement therapy (HRT) patches, the Therapeutic Goods Administration still cannot say with certainty when or whether they will become reliably available.

Government officials and peak bodies say this is simply a global supply issue. For those affected, however, the ongoing shortage highlights the system’s fragility and nation’s inability to ensure continuous access to essential medicines for vulnerable groups.

The transdermal patches, which contain a form of oestrogen, are most commonly used for menopausal and gender-affirming hormone therapy.

Two million women have recently gone through menopause in Australia, with another 80,000 reaching that stage each year. About 50,000 trans people are also estimated to need hormone therapy to support their gender-affirming care. Doctors are being actively discouraged from making new prescriptions for patches while supplies remain unpredictable.

The extended shortfall and persistent uncertainties around supply are at odds with the Australian government’s pre-election focus on women’s health. In February, Minister for Women Katy Gallagher announced a package of more than $570 million to deliver “lower costs and better healthcare”, including more Medicare support for those experiencing menopause, and Pharmaceutical Benefits Scheme (PBS) listings to lower the price for hormone therapies Prometrium, Estrogel and Estrogel Pro.

Only a handful of pharmaceutical companies hold the patents or exclusive manufacturing rights for oestrogen patches, giving them tight control over global supply. This lack of competition means that any production issue at a single company can trigger widespread shortages.

Climara, a popular brand of HRT patches, was discontinued in 2023 due to a “strategic decision” by the company. Estradot (in all strengths) and Estalis (which are combined hormone patches) have been particularly affected by what their producers refer to as “manufacturing issues”.

“Clinics have women calling – nearly every GP has experienced this – asking where they can find patches,” says the chief executive of Jean Hailes for Women’s Health, Dr Sarah White.

Late last year there were reports of people stockpiling patches when they could find them. Many users are still needing to cut down and patch together different forms of medication to get their prescribed dosage.

White says a sudden loss of access can cause the resumption of unpleasant menopausal symptoms. “Not receiving it can be really disruptive with knock-on effects for work and quality of life,” she says.

Some people have reported debilitating migraines, sudden bursts of rage, hot flushes, heart palpitations, relentless insomnia and night sweats. There are community concerns for the long-term consequences on bone density, heart health and mental wellbeing without consistent treatment.

Annie, who is 37, lives with premature ovarian insufficiency, a chronic and incurable condition that pushed her into menopause at the age of 15. She had to go off the pill when it started causing aura migraines, which put her at a higher risk of stroke. HRT was prescribed as the safest option.

As the patches are often out of stock, Annie now uses a gel on her skin and takes a quarter of a progesterone pill every day. She has to chop each pill into quarters to try to get the correct dosage. Moreover, shifting between different brands and dosages makes it hard for her to plan her treatment financially, as not all of these drugs are permanently listed on the PBS.

Annie says she’s had dismissive responses from doctors to her increased pain and discomfort. “They were basically telling me, this is normal – women are meant to accept and live in pain, and that’s that.” Of the shortages, she says, “it sends a message to infertile women that we are of less priority in the health system because we are of less importance”.

“Considering we have an ageing population and more younger women are being diagnosed with conditions that require HRT … it would seem that this might be deemed a priority, but then, women’s health rarely is.”

Katy Gallagher’s office directed questions to the Department of Health, Disability and Ageing, where a spokesperson told The Saturday Paper that pharmaceutical companies “are private businesses and the government does not have the power to compel a sponsor to register, manufacture, market or continue supply of a medicine in Australia”.

Over several years of shortages, the TGA has issued emergency import approvals, and the PBS expansions do show some political will to mitigate the crisis. While adding alternatives to the PBS helps with affordability, it can put even further pressure on supply.

The ongoing message from the TGA is that people need to speak to their healthcare provider if they are having issues accessing their regular hormone therapy. For many, that advice leads to a frustrating cycle of appointments and phone calls, without any real progress towards consistent care.

Hormone patches deliver a steady dose of medication through the skin and directly into the bloodstream, bypassing the liver. This transdermal method more closely mimics the natural release of hormones from the ovaries than oral options.

Switching between doses or forms of HRT can lead to side effects as the body adjusts to changes in hormone levels.

Many consumers say they only discover their medication is unavailable between seeing their doctor and arriving at the pharmacy.

Nikki, a 55-year-old healthcare worker, takes HRT for osteopenia and has been on variations for half a decade.

“Five years ago I was able to confidently take my prescription to the chemist,” she says. “Now I can rarely get the prescription filled at my pharmacy. One month they do have it, the next month they don’t. It’s so irregular.”

While gel has been suggested as an alternative to patches for Nikki, it can be harder to manage, travel with and apply.

The pharmacist often tells Nikki she has to change brands and strengths of patches, which means going back to her GP for a new prescription. “It’s another cost and another appointment,” she says. “There’s lots of problems if that means I have a few days where I can’t get anything at all.”

Nikki has high health literacy due to her work in the industry, and she worries about how people navigate this system without a sophisticated understanding of their rights or strong relationships with their GPs, specialists and local pharmacists.

“This has been ongoing for a long time. I feel like there would be more noise if it was a men’s health issue,” she says.

Asked whether gender is a factor in health inequity in Australia, the Department of Health spokesperson told The Saturday Paper “the Australian government is committed to addressing existing sex and gender biases in the health system through its strong agenda and investment in women’s health”.

The trans and gender diverse community also has much at stake, however.

“For many trans and gender diverse people, medical affirmation is an incredibly important part of their gender transition, and starting hormone therapy marks a big moment in their lives – a moment in which they are taking a significant and positive step towards self-actualisation,” says Dr Portia Predny, the vice-president of the Australian Professional Association for Trans Health (AusPATH) and a GP specialising in gender-affirming care in Sydney.

“For someone who has been waiting eagerly to start the medical part of their journey of affirmation, not being able to fill the prescription your doctor has provided you with would be particularly devastating.”

Predny says that for the people she works with, sudden interruption to their hormone therapies can be additionally complicated by worsening of their gender dysphoria, as well as levels of physical, emotional and cognitive distress and disruption.

The TGA’s last update in mid July suggests previous expectations for a restock of two brands have again come to nothing and that overall supply will remain “very limited” in 2025.

There are hopes that generic brands of estradiol will become available in Australia as patents expire and large companies fail to meet demand.

However, the ingredients used to make estradiol patches, derived from soybeans or sweet potatoes, have also been in short supply. Some say the scarcity of raw materials has been exacerbated by climate change – further weakening an already fragile, globalised pharmaceutical supply chain.

This article was first published in the print edition of The Saturday Paper on August 9, 2025 as "HRT failure".

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