For months now, menopausal women across the U.S. have been unable to fill prescriptions for the estradiol patch, a long-established and safe hormone treatment. The news media has whipped up a frenzy over this scarcity, warning of a long-lasting nationwide shortage. The problem is real — but the explanations in the media coverage miss the mark. Real solutions depend on an accurate understanding of the causes.

Reporters, pharmaceutical companies and even some doctors have blamed women for causing the shortage, saying they were inspired by a “menopause moment” that has driven unprecedented demand. Such framing does a dangerous disservice to essential health advocacy.

In this narrative, there has been unprecedented demand, and it is explained in part by the Food and Drug Administration’s recent removal of the “black-box warning” from estradiol patches’ packaging. That inaccurate (and, quite frankly, terrifying) label had been required since a 2002 announcement overstated the link between certain menopause hormone treatments and breast cancer. Right-sizing and rewording the warning was long overdue. But the trouble with this narrative is that even after the black-box warning was removed, there has not been unprecedented demand.

Around 40% of menopausal women were prescribed hormone treatments in some form before the 2002 announcement. Use plummeted in its aftermath, dipping to less than 5% in 2020 and just 1.8% in 2024. According to the most recent data, the number has now settled back at the 5% mark. Unprecedented? Hardly. Modest at best.

Nor is estradiol a new or complex drug; the patch formulation has existed for decades, and generic versions are widely manufactured. There is no exotic ingredient, no rare supply chain dependency, no fluke that explains why women are suddenly being told their pharmacy is out of stock month after month.

The story is far more an indictment of the broken insurance industry: market concentration, perverse incentives and the consequences of allowing insurance companies to own the pharmacy benefit managers that effectively control drug access for the majority of users. Three companies — CVS Caremark, Express Scripts and OptumRx — manage 79% of all prescription drug claims in the United States. Those companies are wholly owned subsidiaries of three insurance behemoths: CVS Health, Cigna and UnitedHealth Group, respectively. This means that the same corporation that sells you your insurance plan also decides which drugs get covered, at what price, and whether your pharmacy can stock them. This is called vertical integration. In another era, we might have called it a cartel. The resulting problems are not unique to hormone treatments; they have affected widely used medications including blood thinners, inhalers and antibiotics. When a low-cost generic such as estradiol — a medication with no blockbuster profit margins and no patent protection — runs into friction in this system, the friction is not random. It is structural. Every decision in that chain is filtered through the same corporate profit motive. And when the drug in question is an off-patent estradiol patch that has negligible profit margins because of generic competition but requires logistical investment to keep consistently in stock? The math on “how much does this company care about ensuring access” is not complicated.

Unfortunately, there is little financial incentive to ensure smooth, consistent access. There is, however, significant financial incentive to steer patients toward branded alternatives, or simply to let supply tighten — because the companies aren’t losing much profit if sales of that product dwindle. This is not a conspiracy theory: The Federal Trade Commission noted this dynamic in a report that documented how pharmacy benefit managers’ practices inflate costs, reduce competition and harm patient access, particularly for independent pharmacies and for generic drugs.

Any claim that the estradiol patch shortage is meaningfully caused by more women now demanding hormone treatments is a distraction. It is also misogyny, pure and simple, to imply that the solution to the shortage is for women’s health advocates to dial it down and for women to temper their expectations. The scarcity of estradiol patches is the outcome of a broken system refusing to provide adequate supply.

Meanwhile, there are a few strategies to cope.

• Ask your prescriber about alternatives. Estradiol is available in multiple formulations, including gel, spray, cream, oral tablet, vaginal ring and weekly transdermal patch, which is a different product from the twice-weekly patch and may be more consistently available depending on manufacturer and region.

• Consider an online pharmacy. Many are doing a good job locating and filling these prescriptions from outside the pharmacy benefit manager system.
• Call ahead. Patch shortages are inconsistent across regions and distributors. A call to pharmacies in your area, or a broader geographic radius if you’re able, can locate stock that your regular pharmacy doesn’t have.
• Consider a compounding pharmacy. These sources can sometimes meet needs when commercially manufactured products are inaccessible. The hormones used are the same FDA-regulated bulk ingredients.

Beyond those Band-Aid solutions, more Americans need to fight for systemic change. The FTC report exists because Congress asked for it and committed to legislation that will address at least some of the problems. The FDA took action to change the labeling on estrogen in the face of citizen and medical experts’ pressure; it should do more now to demand transparency from patch manufacturers.

Most importantly, it is on all of us to call out the cracks in the current system. Instead of repeating “there’s a patch shortage” or a “surge in demand,” say that a shockingly small minority of menopausal women still even get hormonal treatments prescribed at all, and three drug companies control the vast majority of claims in this country. Those are the real problems that need real solutions.

Jennifer Weiss-Wolf, the executive director of the Birnbaum Women’s Leadership Center at New York University School of Law, is the author of the forthcoming book “When in Menopause: A User’s Manual & Citizen’s Guide.” Suzanne Gilberg, an obstetrician and gynecologist in Los Angeles, is the author of “Menopause Bootcamp.”

WASHINGTON — NASA recaptured the world’s attention with Artemis II, which took astronauts to the moon and back for the first time in half a century. But the agency’s scientific projects could again be under threat as the Trump administration makes a renewed push to drastically cut their funding — including at the Jet Propulsion Laboratory.

The cuts, proposed in the Trump administration’s 2027 budget request to Congress, would pose further challenges to the already weakened Caltech-managed lab and could be broadly damaging to American efforts to bring back new discoveries from space. They echo last year’s attempt by the administration to slash NASA funding, which Congress rejected.

Though the Artemis project is billed as laying a foundation for a crewed NASA mission to Mars, exploration of the Red Planet is among the endeavors that could be slashed. The rover currently exploring Mars’ ancient river delta and a mission to orbit Venus are among projects with JPL involvement targeted for spending cuts, according to an analysis of the NASA budget proposal by the nonprofit Planetary Society.

“This isn’t [because] they’re not producing good science anymore. There’s no rhyme or reason to it,” said Casey Dreier, chief of space policy at the Planetary Society, which led opposition to the administration’s similar effort to cut NASA funding last year.

This time, the administration is asking Congress to cut NASA funding by 23% — including a 46% cut to its science programs, which are responsible for developing spacecraft, sending them into outer space to observe and analyzing the data they send back.

The proposal would cancel 53 science missions and reduce funding for others, according to the Planetary Society analysis. The effort to pare down NASA Science comes amid the Trump administration’s broader effort to cut scientific research across federal agencies.

The plan swiftly drew bipartisan criticism from members of Congress, who rejected the administration’s similar 2026 proposal in January. Republican Sen. Jerry Moran of Kansas, who chairs the Senate appropriations subcommittee that oversees NASA, indicated last week that he would work to fund NASA similarly for 2027, saying it would be “a mistake” not to fund science missions.

Moran plans to hold a hearing with NASA Administrator Jared Isaacman before the end of April to review the budget request, a spokesperson for his office said. The president’s budget request is an ask to Congress, which ultimately holds the power to allocate funding.

But until Congress creates its own budget, NASA will use the plan as its road map, which could slow grants and contracts. The proposal “still creates enormous chaos and uncertainty in the meantime for critical missions, the scientific workforce, and long-term research planning,” said Rep. Judy Chu (D-Monterey Park), whose district includes JPL.

A NASA spokesperson declined to comment Friday. In the budget request, Isaacman wrote that NASA was “pursuing a focused and right-sized portfolio” for its space science missions in order to align with Trump’s federal cost-cutting goals.

The budget “reinforces U.S. leadership in space science through groundbreaking missions, completed research, and next-generation observatories,” Isaacman wrote.

Jared Isaacman testifies during his confirmation hearing to be the NASA administrator in the Russell Senate Office Building on Capitol Hill on Dec. 3, 2025.

(Anna Moneymaker / Getty Images)

Advertisement

At JPL — which has for decades led innovation in space science and technology from its La Cañada Flintridge campus — questions had already swirled about the lab’s role in the future of NASA work.

Multiple rounds of layoffs over the last two years, the defunding of its embattled Mars Sample Return mission and a shift by the Trump administration toward lunar exploration and away from the type of scientific work that JPL executes had pushed the lab into a challenging stretch.

It has had a steady stream of employee departures in recent months, and those left have been scrambling to court outside funding from private investors, sell JPL technology to companies and increase productivity in hopes of keeping the lab afloat, according to two former staffers, who requested anonymity to describe the mood inside the lab.

“If we’re not doing science, then what are we doing?” asked one former employee, who recently left JPL after more than a decade there.

A spokesperson for the lab declined to comment, referring The Times to the budget proposal.

The NASA programs marked for cancellation or cutbacks support thousands of jobs at JPL and other centers, said Chu, who has led a push for increased funding for NASA Science. After last year’s layoffs, JPL “cannot afford to lose more of this expertise,” she said in a statement.

Among the JPL projects that appear to be slated for cancellation are two involving Venus, Dreier said. One, Veritas, is early in development and would give work to the lab for the next several years, he said.

The project would be the first U.S. mission to Venus in more than 30 years, Dreier said, and aims to make a high-resolution mapping of the planet’s surface and observe its atmosphere.

The Perseverance rover, which is on Mars collecting rock and soil samples, could face spending reductions. The budget request proposes pulling some funding from Perseverance to fund other planetary science missions and reducing “the pace of operations” for the rover.

Though how the Mars samples might get back to Earth is uncertain, the rover is still being used to explore the planet and search for evidence of whether it could have ever been habitable to life.

Researchers hope the tubes of Martian rock, soil and sediment can eventually be brought back to Earth for study. The team has about a half a dozen more sample tubes to fill and the rover is in good shape, said Jim Bell, a planetary scientist and Arizona State University professor who leads the camera team on Perseverance, which works daily with JPL.

He said NASA’s spending proposal put forth “no plan” for the future of the agency’s work.

“Are people just supposed to walk away from their consoles,” Bell asked, “and let these orbiters around other planets or rovers on other worlds — just let them die?”

The NASA document did not clearly show which programs were targeted for cuts and did not list which projects were targeted for cancellation. The Planetary Society and the American Astronomical Society each analyzed the proposal and found that dozens of projects appeared to be canceled without being named in the document.

Across NASA, other projects slated for cancellation according to the Planetary Society’s analysis include New Horizons, a spacecraft exploring the outer edge of the solar system; the Atmosphere Observing System, a planned project to collect weather, air quality and climate data; and Juno, a spacecraft studying Jupiter.

The administration’s plan also doesn’t prioritize new scientific projects, Bell said, which further jeopardizes long-term job stability and space discovery at centers like JPL.

“We’re going through this long stretch now with very few opportunities to build these spacecrafts,” Bell said. “All of the NASA centers are suffering from the lack of opportunities.”

Last year, the Trump administration proposed to slash NASA’s 2026 funding by nearly half. Instead, Congress approved funding in January that provided $24.4 billion for the agency — a cut of about 29% rather than the proposed 46%. The 2027 budget request asks for $18.8 billion.

Congress kept funding for science missions nearly steady, allocating $7.25 billion for science missions, about a 1% decrease from 2025. The administration had proposed cutting the science investment down to $3.91 billion. This time, the budget requests $3.89 billion.

Under the Trump administration, NASA has put an emphasis on moon exploration, including this month’s successful Artemis II mission. Isaacman, who defended the proposed cuts on CNN last week, touted the agency’s lunar plans, including a project to build a base on the moon.

The agency has indicated commitment to some existing science missions, including the James Webb Space Telescope, the to-be-launched Nancy Grace Roman Space Telescope, the Dragonfly spacecraft set to launch for Saturn’s moon in 2028, and other projects.

“NASA doesn’t have a topline problem, we just need to focus on executing and delivering world-changing outcomes,” Isaacman said on CNN.

Scientists have urged the government not to choose between funding science and exploration but to keep up investment in both.

“It’s ultimately kind of confusing, especially on the heels of the Artemis II mission,” said Roohi Dalal, deputy director for public policy at the American Astronomical Society. “The scientific community … is providing critical services to ensure that the astronauts are able to carry out their mission safely, and yet at the same time, they’re facing this significant cut.”