Your pharmacy is out of your patch

1. Ask which other makers they can order

Every common strength is made by several companies. In the US a 0.05 mg patch comes from 13 products across six makers, and some are listed as available while others are short (see the 0.05 mg page). Ask the pharmacist which ones their wholesaler can supply this week, not only whether they have your usual box.

The FDA's own advice is the same: your pharmacist "may be able to help locate another available FDA-approved estradiol transdermal patch that can be substituted for your current product, when appropriate" (FDA).

2. Ask whether your prescription allows a swap

In the US the FDA rates each generic against a reference brand: the weekly generics against Climara, and the twice-weekly ones against Vivelle-Dot or Minivelle (Orange Book). Whether a pharmacist can hand you a different rated product without calling your prescriber depends on your state's rules and on how the prescription was written. In Canada it depends on the province: the Toronto Star reported that Ontario pharmacists must go back to the prescriber, while a pharmacist in Newfoundland and Labrador could hand over an equivalent (Toronto Star).

3. Check the change days before you leave

Climara and its generics are changed once a week. Vivelle-Dot, Minivelle, Dotti, Lyllana, Estradot and their generics are changed twice a week, every 3 to 4 days. If the pharmacy offers a patch of the other type, the strength can be the same and your routine still changes. Switching between brands goes through the differences.

4. Ring other pharmacies

Stock differs from one pharmacy to the next. CVS has said makers were unable to supply enough for weeks at a time (NPR), and Medfinder's checks found brand patches in stock in only 1 to 3% of its checks over the last 30 days (Medfinder). Ringing a few, including independent and mail-order pharmacies, before you run out gives you time to sort the prescription.

5. Talk to your prescriber about a plan B

If no patch in your strength can be found, prescribers have other options: a different strength, a gel, a spray or tablets. Menopause societies publish tables of roughly similar doses, collected on the alternatives page. Each is a prescribing decision, and tablets are a different route with different risks for some people.

"Do not stop or change your medication without talking with your healthcare provider," the FDA says.

6. Watch out for these

• Cutting patches to make them last. None of the US patch labels mentions cutting. ASHP's bulletin warns that cutting a patch "may result in uneven dose release", and an Australian endocrinologist advises against it (University of Melbourne).
• Wearing two patches without being told to. Climara's label says to wear only one at a time (Climara label). Some prescribers do combine lower strengths during the shortage; that is their call.
• Patches sold online without a prescription. In the US and Canada estradiol patches are prescription-only.

7. Tell other readers what you found

Official lists trail the pharmacy counter by weeks. A four-tap reader report helps the next person know where things stand in your state or province.