Estradiol Patch Hard to Find? Why Compounded Hormones (BHRT) Belong in the Conversation

It has been reported that many patients are having difficulty accessing their usual estradiol transdermal patches because of low supply at pharmacies, due to increased demand. That demand surge follows the FDA’s November 2025 action requesting that manufacturers remove boxed warnings about breast cancer, cardiovascular, and dementia risk from menopausal hormone therapy labeling. With that language gone, more patients and providers are having open conversations about hormone replacement therapy (HRT), and more patients are pursuing it. That’s a genuinely good development for women’s health. It also means prescribers are fielding more questions about HRT and receiving more requests for estrogen patches than the current commercial supply chain can always keep up with..

Where Compounding Fits

When a specific strength, combination, or delivery method isn’t available commercially, a compounding pharmacist can prepare a patient-specific compound for a patient. That means prescribers aren’t limited to whatever patch happens to be on the shelf that week, and patients don’t have to worry about therapy disruption before starting or continuing hormone therapy.

Compounded bioidentical hormone therapy (BHRT) also gives prescribers room to individualize dose, ratio, and delivery route in ways a single commercial patch strength can’t. For patients who’ve never started hormone therapy, that flexibility can make the first prescription a better fit from the outset.

Bi-Est and Tri-Est: Formulation Options Commercial Patches Don’t Offer

Combination estrogen options that prescribers can only get through compounding pharmacies are Bi-Est and Tri-Est. Bi-Est combines estradiol and estriol, typically in a ratio weighted toward estriol with estradiol making up the smaller share, though the exact ratio is written by the prescriber and prepared to that specification. Tri-Est adds a third estrogen, estrone, to the mix, again in a prescriber-specified ratio.

Some prescribers choose one of these combinations because it allows multiple estrogens to be dosed together in a customized proportion rather than relying on estradiol alone, and because the ratio and total dose can be adjusted over time as a patient’s symptoms and response change. Commercial patches don’t offer this kind of formulation flexibility. Every patch on the market delivers estradiol only, at a fixed strength, so a prescriber who wants to explore a Bi-Est or Tri-Est approach has no commercial equivalent to reach for.

Dose Customization Beyond What a Patch Allows

Commercial patches come in a limited number of fixed strengths, which means a patient’s dose is often rounded up or down to whatever the manufacturer produces. Compounding removes that constraint. A prescriber can order a specific milligram strength, adjust it at a follow-up visit based on symptom response or lab work, and have it prepared exactly to that specification, whether the patient needs a lower starting dose, a dose between two commercial strengths, or a change in estrogen ratio.

Patch-Related Issues Some Patients Run Into

Beyond the current backorder, patches come with a set of practical complaints that lead some patients to ask about alternatives:

• Skin irritation at the application site, including redness, itching, or contact dermatitis from the adhesive
• Adhesion problems, especially in humid weather, during exercise, or after swimming or showering, leading to patches that lift or fall off before the next change
• Visibility, since patches are worn externally and some patients would rather avoid a visible reminder on the skin
• Rotation site limitations, as patients are instructed to rotate application sites to reduce irritation, which can become difficult to manage over time
• Absorption variability tied to skin type, body location, or activity level, which can affect how consistently the dose is delivered

For patients running into any of these issues, a compounded cream, gel, troche, or capsule offers a different delivery route without asking the patient to give up on hormone therapy altogether.

Common Dosage Forms We Compound 

Town & Country Compounding offers hormones and combination of BHRT, in several delivery methods so prescribers can match the dosage form to the patient rather than the other way around:

• Topical creams and gels – gentle,non-irritating topical dosage form developed especially for hormones,  applied to the skin at a prescriber-specified dose.
• Lozenges/troches – dissolved under the tongue or in the cheek, bypassing first-pass liver metabolism, often used when patients want an oral-adjacent option without swallowing a capsule.
• Oral capsules – most commonly used with progesterone.
• Vaginal inserts and suppositories – for patients whose primary concern is genitourinary symptoms, delivering estrogen or other hormones locally.