Two gremlins, one house -- me holding a box of estrogen patches, and the furry one who could not care less. He has never run out of anything.
I talked to a friend last week. She had just quit her job.
Not because she hated her boss, or because she had a better offer, or because she had finally decided to pursue her dream of opening a bakery in the East Village. She quit because she ran out of estrogen patches and, in her words, she simply couldn't stand it anymore.
We laughed about it, eventually. But there was a solid 48 hours in there where nothing was funny.
If you are on HRT patches and you have tried to fill a prescription recently in the US, you already know what I am about to say. The shortage is real. Estrogen patches have been in short supply across the country, and for women who depend on them to function, this is not a minor inconvenience. This is a full system crash.
Here is the thing about estrogen. When your levels are stable, you feel like yourself. When they drop suddenly -- not gradually, not over months, but overnight because your pharmacy ran out -- your brain does not know what hit it. The technical term is estrogen withdrawal. The lived experience is what my friend and I have started calling the hormonal gremlin.
You know the rules. Feed it after midnight and things get dark. Get it wet and everything multiplies. The hormonal gremlin operates on similar logic. Forget the patch for a few days and you are not just irritable. You are a different person. Hot, furious, foggy, tearful, convinced that everyone around you is an idiot, and also somehow freezing cold at 3am.
I have my own gremlin at home, by the way. The grey, furry one currently sitting on my head in the photo above. He does not care about estrogen levels. He cares about breakfast and proximity to warm surfaces. We get along better on good hormone days.
The patch shortage is a supply chain issue that has been building for a while, and it is hitting at the worst possible time -- just as more women are finally getting diagnosed, finally accessing HRT, finally feeling like themselves again. Having that pulled away abruptly is cruel in a way that is hard to explain if you have not lived it.
Understanding what is actually happening to your body during perimenopause is the first step to advocating for yourself when the system fails you. The symptoms are real, they are documented, and they are not something you simply push through.
If you are dealing with this right now, a few things worth knowing:
Your pharmacist can check other locations or transfer the prescription. It is worth asking. Some women have switched temporarily to a gel or spray form of estrogen, which has been more consistently available. Talk to your doctor before switching, but know the option exists. Compounding pharmacies are another route, though they are not right for everyone. You can also explore what treatment options are available beyond patches -- the solutions page at peripal has a breakdown.
And if you are the partner, colleague, or friend of someone who is navigating this right now: please be patient. This is not drama. This is a woman whose medication supply has been cut off and whose body is responding accordingly. The gremlin is not who she is. It is what happens when the system fails her.
My friend, for what it is worth, took a week and got her prescription filled at a pharmacy two towns over. The hormonal gremlin has been fed. Things look different.
Estrogen should not be this hard to access. But until it gets easier, at least we can name what is happening. And sometimes naming it is enough to get through the day.