HRT prescriptions have more than doubled — and supply is the new bottleneck

New NHS data released this month shows something the U.S. has not measured as cleanly: an estimated 2.0 million women aged 40 and over received a hormone therapy prescription at least once in 2025/26, up from 0.8 million in 2020/21. That is a two-and-a-half-fold increase in five years. Within days of publication, pharmacy bodies warned that supply chains are not keeping pace and that shortages of specific formulations are likely to worsen.

Both facts are worth sitting with. Demand correcting after two decades of underprescribing is the story of the decade in women's health. Demand outrunning supply is the reason a woman who finally gets a prescription can still spend three weeks calling pharmacies.

How we got here

The 2002 Women's Health Initiative results were reported in a way that collapsed prescribing almost overnight — use fell by more than half in the following years, in the U.S. and the U.K. alike. Subsequent reanalysis established that the absolute risks had been widely misread, that risk differs sharply by age at initiation, and that women starting therapy under 60 or within 10 years of menopause have a favorable risk-benefit profile for moderate-to-severe symptoms.

It took roughly twenty years for prescribing to reflect that. The current surge is that correction arriving at once, accelerated by three things: a generation of women in perimenopause who will not accept "your labs are normal," specialist guidance that finally reads plainly, and telehealth removing the six-month wait for a specialist appointment.

Notably, recent analyses attribute much of the growth to perimenopausal women — women still having periods, who were historically told to wait until their symptoms qualified them. That group is the fastest-growing segment of hormone therapy users.

Why shortages happen even when a drug is not "in short supply"

Hormone therapy is not one product. It is estradiol patches at several strengths, estradiol gels and sprays, oral estradiol, micronized progesterone capsules, combination patches, and vaginal estrogen in cream, tablet, and ring form. Each has its own manufacturing line and its own inventory.

Two dynamics make this fragile:

• Demand shifts faster than production plans. When guidance and public conversation move women toward transdermal estradiol, patch demand can jump within a quarter. Patch manufacturing capacity does not.
• Substitution cascades. When one patch strength runs out, prescribers move patients to another strength or another route — which drains that product next. A single-product shortage becomes a category shortage.

Pharmacy organizations have flagged exactly this pattern, warning that prescription surges concentrated in particular formulations are the mechanism by which shortages spread.

What this means for you

You cannot fix a supply chain from your kitchen. You can make yourself much harder to strand.

Ask for the therapeutic goal in writing, not just a product name. A prescription that says "transdermal estradiol, 50 mcg/24 hr equivalent" with your clinician's note that equivalent strengths and alternate transdermal routes are acceptable lets a pharmacist substitute a gel or spray without a new prescription and another week of waiting.

Know your equivalents before you need them. Estradiol patches, gel, and spray are all transdermal routes to the same hormone. Dose equivalence is not exact and should be set by your clinician, but knowing that alternatives exist changes the conversation at the counter.

Do not let a patch shortage push you to oral estrogen by default if you have venous thromboembolism risk factors. Transdermal delivery avoids first-pass hepatic metabolism and carries a lower clotting risk. That distinction is clinically meaningful and worth protecting.

Protect your progesterone separately. If you have a uterus, endometrial protection is not optional. Never continue systemic estrogen alone because progesterone is unavailable — contact your prescriber the same week.

Refill at 10 days remaining, not 2. The single most effective personal defense against a shortage is buffer.

Call ahead and ask about stock before the prescription is sent. Pharmacy inventory is local and volatile. Five minutes on the phone routinely saves a week.

Vaginal estrogen is a separate supply chain. For genitourinary symptoms — dryness, pain with sex, recurrent UTIs — local estrogen works independently of systemic therapy and is often available when systemic products are not. It carries minimal systemic absorption and is appropriate for most women, including many who cannot take systemic estrogen.

The bigger read

A doubling of prescriptions is not overprescribing. Roughly 75% of women experience vasomotor symptoms and a substantial share have symptoms severe enough to warrant treatment; the historical prescribing rate was far below need, not above it. The correct response to this data is to build capacity — manufacturing, pharmacy stock planning, and clinicians trained in menopause medicine — not to slow the correction.

For women, the practical takeaway is narrower and more useful: the era of being told to wait it out is ending, and the new bottleneck is logistics. Plan around logistics.

Sources

• NHS Business Services Authority, hormone replacement therapy prescribing data, 2025/26. https://www.nhsbsa.nhs.uk/
• National Pharmacy Association statements on HRT supply. https://www.npa.co.uk/
• The Menopause Society (NAMS), 2022 Hormone Therapy Position Statement. https://www.menopause.org/
• ACOG, Management of Menopausal Symptoms. https://www.acog.org/
• NICE guideline NG23, Menopause: diagnosis and management. https://www.nice.org.uk/guidance/ng23
• Women's Health Initiative, NIH. https://www.nhlbi.nih.gov/science/womens-health-initiative-whi

This article is health education, not medical advice. Discuss formulation changes and substitutions with your prescribing clinician.

Medically reviewed by Kindr Health Clinical Team
Kindr Health Inc. — Editorial & Clinical Team (physician-supervised)
NPI 1609792902 · Last reviewed: July 3, 2026