The Brief

With the removal of the black-box warning on hormone therapy for menopause, some providers and patients report shortages or delays, waiting for a pharmacy to restock transdermal estrogen patches.

When Jennifer Skoog Mondesir headed to the pharmacy to pick up her estrogen patch, she never knew what she'd find.

Mondesir, who is in her late 40s and in perimenopause, relies on the patch to help improve symptoms, including low energy. She lives in Jersey City, N.J. But last summer, she started running into a frustrating wall.

"I went to CVS. I can't tell you the amount of times I've been there and they're like, 'We're out of patches,'" she says. Or they'd tell her to check back tomorrow. "So it was like a monthly mad scramble," Mondesir says.

Mondesir is not alone. Doctors who prescribe hormone therapy to manage menopausal symptoms report rolling shortages and delays, which are in part due to rising demand. It's a reversal from the early 2000s, when the treatment fell sharply out of favor.

Dr. Nora Lansen, chief medical officer of Elektra Health, says use of hormone therapy has grown steadily over the past several years as both clinicians and patients have taken a fresh look at the evidence.

"Over the past four to five years, demand has picked up as clinicians have familiarized themselves with current research and patients have become more interested," Lansen said.

The shift is a turnaround from the early 2000s, when hormone therapy use plummeted. Back then, the Food and Drug Administration placed a black box warning — the strongest safety label — on estrogen products, following results from the large Women's Health Initiative study. It found women on hormone therapy faced increased risks of heart attacks, strokes and pulmonary embolism, "which of course incited grave concern among users and prescribers," Lansen says.

Last year, the FDA removed that black box warning, pointing to evolving evidence of safety, newer methods of delivering hormone therapy and alternative combinations of products.

One key change is how estrogen is delivered. As an alternative to oral estrogen pills, which is what the women in the Women's Health Initiative study took, many women now use estrogen patches or gels, which deliver the hormone through the skin, bypassing a first pass through the liver. Lansen says that distinction matters.

"The transdermal version of estradiol has a lower risk of blood clots, and a blood clot can cause a heart attack [or] a stroke. So without passing through the liver and its metabolism, this transdermal version of estradiol is really a much safer option. And that's why there's been such demand," she says.

CVS, in a statement to NPR, confirmed that manufacturers have been unable to provide sufficient supplies of several estrogen products. The American Society of Health-System Pharmacists lists multiple estrogen products with current or recent shortages, but the manufacturers do not give a reason for the shortages.

A spokesperson for Amneal Pharmaceuticals, one of the companies that makes estradiol patches, wrote in a statement to NPR that "following the FDA's removal of boxed warnings on hormone replacement therapy, we have seen a significant increase in demand." The company is meeting its current contracts and is working to increase production to help meet growing demand, the statement said.

For Mondesir, a personal trainer, the stakes felt high. Before starting hormone therapy, fatigue was a daily battle.

"I have to show up to my clients with energy. And I found that I would have to have a second, third cup of coffee, which is not like me," she says.

After switching to an online pharmacy, she has been able to fill her prescription without disruptions or delays.

"My energy level is much better," she says. And she hopes as supply and demand even out, the shortages and delays will cease.

Copyright 2026 NPR

“Unprecedented.”

That’s the word that the National Weather Service is using to describe the upcoming heat wave, which could bring near-triple-digit temperatures to the coastal areas of Southern California over the next week.

Temperatures could be high enough to make this the hottest March on record, even though we’re only 10 days into the month.

This week’s heat

As high pressure builds over the area, the first peak of the heat wave is expected to arrive on Thursday and Friday, with temperatures 30 degrees above normal in some spots. The coastal valleys (San Gabriel and San Fernando) could see temperatures in the upper 90s to 100s, while those along the coast will have to sweat through temperatures in the low to mid-90s. Desert areas will be slightly cooler, with temperatures in the upper 80s. Santa Ana winds are also likely, boosting temperatures and drying things out to a more severe degree.

Next week's heat

While we’ll get a slight reprieve over the weekend, the heat is expected to ramp back up to similarly extreme levels next week, though the exact days are unclear as it’s still a bit far out. There are some signs that the heat could break by the end of the next week, but that’s not certain.

“It’s hard to place into words how rare this will be,” said Robbie Munroe, meteorologist for the National Weather Service in Oxnard. The NWS will likely issue some sort of heat advisory due to the health risk the weather poses. “Normally we don’t have to communicate this type of messaging in March."

How does this effect the water supply?

Snowpack in the Northern Sierra — where California gets a substantial amount of water — is at just 34% of normal for early March. The Colorado River Basin is at 67% of normal. While California’s reservoirs are in good standing, it could be a rough year ahead for water. Much of the West is currently experiencing drought conditions.

What kind of fire risk is there?

There should be enough soil moisture left from earlier rains to prevent any fast moving fires from breaking out during this wave, though quick-drying grasses could be a risk.

It's the deadliest year for those in immigration detention in more than two decades.

More people have died in Immigration and Customs Enforcement custody since October — 23 — than died in the whole prior fiscal year.

The most recent death was of a 56-year-old Haitian man held at an immigration detention center in Arizona. He died in a hospital after going into septic shock.

The increase in deaths comes as nearly 70,000 people are in ICE detention, the highest number in several years.

Former agency officials and immigration advocates have warned that detaining more people — coupled with reduced oversight — will increase the likelihood of more fatalities.

"The abhorrent and worsening conditions in detention centers, gross negligence, and a complete lack of oversight have contributed to yet another grim record for deaths in ICE custody," said Jennifer Ibañez Whitlock, senior policy counsel at the National Immigration Law Center, an immigrant rights defense organization.

"As a country, we cannot accept that death in federal custody is an acceptable or inevitable outcome of American immigration policy."

The Department of Homeland Security (DHS) did not respond to a request for comment on the death count.

Democratic lawmakers have also raised questions about the increasing numbers of deaths in detention and detainees' access to health care, as well as the lag in reporting deaths to the public.

"At no time during detention is a detained alien denied emergency care," ICE stated in a press release announcing the death of the man in Arizona.

Last summer, Congress gave DHS about $70 billion to hire more staff, including deportation and detention officers, and increase its detention space, as part of Republicans' One Big Beautiful Bill Act spending and tax package.

But rapidly scaling up immigration arrests has contributed to overcrowding, unsanitary conditions and issues with food and health care access in detention centers, according to media reports and immigration advocates.

In January, detainees had confirmed cases of measles at the Florence Detention Center in Arizona and at the Dilley Immigration Processing Center in Texas, which houses families. Another outbreak was reported this month at Camp East Montana, a facility in Texas that has also separately had three deaths.

The department at the time defended the steps it took after the outbreak in Florence and Dilley, including quarantining people and controlling the spread of infection.

Steps to keep detainees healthy

Homeland Security Secretary Kristi Noem, whom President Trump is replacing, detailed the steps the agency takes to prevent fatalities.

"Medical treatment is provided to individuals in our processing and detention centers," she told senators. "Within 12 hours, they have a medical examination, we get them the prescriptions and medication that they need. They also have a full evaluation."

In general, the agency says detainees receive a full health assessment within 14 days of entering ICE custody or arriving at a facility, as well as getting access to medical appointments and 24-hour emergency care.

"ICE is actively recruiting healthcare professionals, including doctors, nurses, psychiatrists, pharmacists, and health administrators, to support the expanded detention capacity enabled by the historic funding provided under President Trump's One Big Beautiful Bill," a DHS spokesperson said in a statement, but declined to provide an update on the recruitment efforts.

Still, medical professionals who were assigned to work in immigration detention centers told NPR they witnessed chaotic screenings – and life-threatening delays in getting medicine and care to detainees. Overcrowded and understaffed conditions have pushed some to quit.

Austin Kocher, an assistant research professor at Syracuse University studying the immigration enforcement system, said the skyrocketing detention population alone may not explain the increase in deaths.

"This is a captive population with documented concerns about care, and it's a system that's grown incredibly quickly," Kocher said. "My concern is that these deaths are preventable, not just a function of simple demographics."

He pointed to a 2024 study from the American Civil Liberties Union and other advocacy groups that found the vast majority of the 52 deaths in immigration detention from 2017-2021 would have been prevented if people had received "clinically appropriate" medical care, such as providing access to needed medications or timely treatment.

Investigating deaths in custody

The Civil Rights and Civil Liberties office at DHS, the ICE Health Services Corps and the Immigration Office of Detention Oversight typically investigate any death in ICE custody.

But the civil rights office was among the oversight offices that experienced hundreds of staff cuts over the past year. Other employees have told NPR that the gutting of their office could result in more deaths in custody.

DHS oversight has also been affected by recent government shutdowns. During the 43-day full government shutdown last fall, DHS said its Office of Detention Oversight was shut. Five people died in custody during this time.

DHS did not respond to questions from NPR about whether the office is working during the current shutdown of the agency, which is now in its fourth week. It instead referred questions on shutdown impacts to the Office of Management and Budget. OMB did not respond.

Recent incidents include "medical distress," struggles with officers

Medical conditions surrounding deaths over the last few months have included heart-related issues and drug withdrawals, while others had unknown causes.

Each preliminary death report from DHS includes a synopsis of the detainees' immigration and criminal histories, as well as the events leading up to the time of death.

One man, Fouad Saeed Abdulkadir, had been in immigration custody for 215 days and was awaiting an immigration court hearing when he suffered "medical distress." Another, 25-year-old Jose Castro-Rivera, was killed by a truck during an arrest.

Another man, Geraldo Lunas Campos, died after a "struggle" with security staff at a detention center in Texas, according to DHS. Lunas Campos' death was classified as a homicide.

"ICE takes seriously the health and safety of all those detained in our custody. This is still an active investigation, and more details are forthcoming," the agency said in a January post on social media about Lunas Campos' case.

Democrats criticize the death count and reporting lag 

Democratic senators wrote to Noem in February, asking for more information on detainee healthcare, oversight, and standards.

"It is unacceptable that record numbers of people are dying in ICE custody," Judiciary Committee members wrote in February. "Each death in ICE custody is a tragedy and, based on the evidence available from agency records, 911 calls, and medical experts, many could have been prevented if not for this Administration's decisions."

Democrats have also raised concerns about reporting delays.

ICE promises to post a news release with initial relevant details on the public website within two business days. At times, there are delays while the agency notifies the next of kin. Congress requires that ICE publicize all reports regarding in-custody deaths within 90 days.

An NPR review of webpages and announcements shows that ICE's detainee death reporting site had a lag in updating fiscal year 2026 numbers. Some deaths, such as Lunas Campos', were notified after the two-day period. The page is currently updated through early January.

Georgia senators previously wrote to DHS requesting more information on the increase in deaths last year, including the death of one man while was being transferred from a county jail to the Stewart Detention Center, and another of an apparent suicide. In a response from ICE in February, the agency declined to answer several questions about the specific incidents, citing pending investigations.

In response to the death during a transfer, the agency did say that transportation contractors are not medical providers and that CoreCivic, a private prison company, is actively recruiting to fill mental health staff vacancies.

DHS also said it seeks to make sure staff are trained properly in identifying mental health concerns and preventing suicides.

It said the DHS division responsible for the bulk of detentions and deportations, known as Enforcement and Removal Operations, or ERO, "holds regular town hall and recall meetings where ERO discusses the importance of mental health awareness and equips the team with the tools to recognize and respond appropriately," according to the response sent to Georgia's Democratic Sens. Jon Ossoff and Raphael Warnock.

NPR's Martin Kaste contributed to this report.
Copyright 2026 NPR

At Las Siete Regiones de Oaxaca in Pico Union, owner Lidia Young hears from customers that gas prices are playing a major factor in whether they can eat at her restaurant.

“It’s becoming very difficult because I have customers who come from far away, and with the increase in gas prices, they’re telling me they won’t be coming here anymore,” Young said, who has operated the business for about 30 years.

“Yesterday, some customers told us it would cost them more to drive here than to pay for the food,” she said Monday. 

It’s a reality that many small business owners are grappling with, as gas prices react to the war in Iran.

Gas prices surged across the country over the last week, with the average price spiking 51 cents, according to data compiled by GasBuddy. In L.A. County, the average price stood at $5.25 per gallon as of Monday, a dollar more than a month ago, AAA reported, and experts said to expect more volatility as the United State’s and Israel’s deadly war with Iran continues.

Between attacks on oil facilities, slowing of traffic in a key Middle East shipping route and general uncertainty, the price of oil jumped to over $100 per barrel this weekend for the first time since the pandemic

Some states could see prices go up another 20 to 50 cents this week, Patrick De Haan, head of petroleum analysis at GasBuddy, said in a statement on Monday.

“While the situation remains highly fluid, consumers are already beginning to feel the impact as energy markets adjust to this sudden escalation,” he said.

By late Monday, the price of oil dropped back down to under $90 after President Donald Trump told CBS News the war is “very complete, pretty much.”

Trump later added he might remove sanctions on oil-producing countries — potentially Russia, though he did not specify — to keep oil prices from rising again. He also claimed the war in Iran was having a limited effect on gas in the U.S., in spite of prices jumping at pumps across the country.

“We have so much oil,” he said at a press conference Monday night. “We have Venezuela now as our new partner.”

At Un Solo Sol Kitchen, owner Carlos Ortez drives from Boyle Heights to about seven different suppliers every week for produce and ingredients for his vegan dishes. 

On Tuesday, he plans to drive to Glendale to purchase Armenian flatbread, known as lavash, as well as vegetables at Canto Food Company in downtown L.A. and grains at Whole Foods.

At Las Siete Regiones de Oaxaca in Pico Union, owner Lidia Young hears from customers that gas prices are playing a major factor in whether they can eat at her restaurant.

“Last week it wasn’t as bad as I expect it to be this time,” Ortez said on Monday. Even though Ortez drives an electric vehicle, he worries about the hit to his electric bill.

In Pico Union, Isabel Treminio has been selling cleaning supplies, snacks and toys at her small market Variedades Todito for about 25 years. She’s also worried about what the increase in gas prices means for her business.

“Yes, it affects us when gas prices go up because when gas goes up, everything else goes up too,” she said.

“Since we’re a small business, we can’t afford to keep our prices lower. Customers come in and tell us that everything is more expensive, and they’re not buying as much. Right now, it’s getting worse than in other times.”

At Las Siete Regiones de Oaxaca in Pico Union, owner Lidia Young hears from customers that gas prices are playing a major factor in whether they can eat at her restaurant.

Mariachis are also feeling the pinch at the pump as they travel for their gigs.

“We continue to charge the same while the costs for everything else rises,” said Joel Soto, a musician at Mariachi Plaza in Boyle Heights. 

For Teodoro Cuevas, another mariachi, the increase in gas prices impacts him because he’s retired and on a fixed income. The spike in gas prices coincides with a lack of work, Cuevas said. 

“You feel everything much more when you’re on [fixed] income,” he said. 

The bigger hit to small businesses may come when higher fuel prices affect imported ingredients, like at Las Siete Regiones de Oaxaca in Pico Union. Young, the restaurant owner, relies on many ingredients outside of a simple car ride.

“I also bring certain ingredients from Oaxaca, like quesillo, tlayudas, mole and chapulines,” Young said. “A plane flies them from Oaxaca to Tijuana, and then someone brings them to me by truck. With the higher gas prices, it will definitely cost me more.”

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