What is the difference between oestrogen pills, patches and gel?
Oestrogen is the main hormone in hormone replacement therapy (HRT). Lack of oestrogen is the cause of most perimenopausal and menopausal symptoms. The oestrogen in HRT can be given as tablets, patches or gels. I usually recommend that my patients have transdermal oestrogen which means that they have either the skin patches or gel. In addition, I usually prescribe the oestrogen separately to any other hormones you may need so the dose can easily be adjusted.
How are the patches used?
The patches are usually changed twice a week. So, for example, if you put one on a Monday then you change it on a Thursday.
They should be stuck onto the skin below your waist. Most women stick them on the skin on their bottom or upper thigh.
The patches usually stick on really well and stay in place in the shower, bath or when exercising. A plaster mark sometimes occurs when they are removed. Using baby oil or eye make-up remover and a dry flannel is usually the most effective way of removing these marks.
How is the gel used?
The oestrogen gel usually comes in a pump pack. The gel should be rubbed onto your arms or legs but it can be rubbed anywhere on your body. It is not advisable to rub it onto your breasts however.
Your doctor will advise you how many pumps of the gel you need to use. Some women use the gel in the morning, others in the evening and some women use it in the morning and in the evening.
Most women use between two and four pumps of gel but the actual amount really varies between women. Generally younger women need more oestrogen than older women.
The oestrogen gel is also available in small sachets and this comes as two different doses.
The gel usually gets absorbed into your body very easily. You should avoid using other products on your skin after you have rubbed in the gel on for around an hour and you should ensure you wash your hands well after applying it.
What are the advantages of oestrogen as a patch or gel?
I usually recommend that women have the oestrogen as a patch or a gel (transdermal oestrogen). There are numerous reasons for this which include:
- As the oestrogen is absorbed straight into the body then the oestrogen does not have to be digested.
- There is no increased risk of clot or stroke using oestrogen as a patch or gel at standard doses. Taking oestrogen as a tablet leads to the liver clotting factors being activated so there is a small increased risk of clot and stroke in women who take oral oestrogen.
- Transdermal oestrogen can be used by women with migraines. Migraines can often become more severe and more frequent in the perimenopause and menopause and these can really improve with taking HRT. As there is a small increased risk of stroke in some women who have migraine, it is safer and advisable to use oestrogen as a patch or gel.
- Transdermal oestrogen does not worsen libido. Taking oestrogen as a tablet can increase levels of Sex Hormone Binding Globulin (SHBG) which binds to testosterone. This effect can result in a lower libido. Taking oestrogen as a patch or gel does not have this effect.
- The dose of transdermal oestrogen can be easily changed. It is very common that younger women need to have higher doses of oestrogen than older women. In addition, many women find that their oestrogen requirements change with time. It is very easy to either adjust the strength of the patch or alter the amount of gel used.
If you still have your uterus (womb) then you also need to take progesterone to protect the lining of your womb. This is because taking oestrogen by itself can increase the thickness of the lining of your womb. Taking progesterone reduces this effect. The progesterone is usually given as a tablet but it can also be given in the Mirena® IUS which can be beneficial to those women who also need contraception. Increasing the dose of your oestrogen does not mean that you need to change the dose of your progesterone.
Note: There are many different preparations of HRT and if one type does not suit you then it is very likely that another type will suit you.
Last updated: January 2018