Your experience matters. Please complete this brief survey to help us better understand how the estrogen shortage is affecting you.

What state do you live in?

How often do you wear your patch?

Once-weekly

Twice-weekly

Did the shortage cause a return or worsening of symptoms?

Yes

No

Unsure

What would you like people to know about your experience?

Are you a:

Patient

Healthcare professional

Pharmacist

Other

May we anonymously quote your comments in advocacy or media materials?

Yes

No

Please share your email address if you’d like to receive updates on the Patch Problem. Your email will remain private and will not be published or shared.