One of the key hormones in HRT is oestradiol and this can be taken as a tablet, gel or patch. Which one is right for you?
The female sex hormones we aim to replace using HRT are oestrogen, progesterone and sometimes testosterone. These can be used in perimenopause and menopause – your stage, symptoms and health concerns will determine what is best for you personally.
The body makes different forms of oestrogen – oestradiol made by the ovaries; oestriol made by the placenta during pregnancy and oestrone, made in fat tissues. The adrenal gland also makes some of the oestrogen.
Progesterone in its body-identical form is not reliably absorbed through the skin. It can be taken as a capsule.
There is a patch called Estalis that has combined oestradiol and norethisterone acetate, a progesterone-like hormone.
These days, women are mostly recommended to take their oestrogen replacement through the skin – a “transdermal” route. This is the safest way as it avoids passing through the liver and is not associated with a risk of blood clotting like oral or tablet forms of HRT (and also the pill). Both gels and patches are available. We will stick to regulated pharmaceutical treatment in this discussion.
Oestradiol gel
There is only one gel option in Australia – Estrogel.
This comes as a pump pack and is applied to the same area of skin each day, usually one or both of your upper arms depending on your dose (the hormone builds up under the skin in the subcutaneous fat tissue).
Your dose can easily be adjusted by using more or less pumps.
Pros
- no visible sign of using HRT
- simple daily route
- easily adjustable dose.
Cons
- have to wait for the gel to dry (bit cold in winter!)
- if you are not more than the standard dose of 2 pumps, the cost creeps up.
Oestradiol patch
There are several brands of patches in Australia. They are applied to you upper thigh, upper outer buttock or lower tummy. They vary in size but are small enough to stick well onto areas of skin and adhere well enough for showering, swimming or sweat-inducing exercise. The adhesive may cause some irritation so it is a good idea to vary the location of your patch.
Climara is a weekly patch; Estradot and Estraderm are patches you apply twice a week.
Pros
- some are on the PBS so may be a bit more affordable
- no need to think about dosage
- multiple dose options are available
- no waiting for the gel to dry.
Cons
- some women find it hard to remember to switch the patch, and may even leave the old one on
- people may see the patch
- usually combined with progesterone capsules so cost may be higher than the basic gel / capsule combo.
Combined oestradiol and progestogen patch
There is only one available in Australia – Estalis.
Pros
- you only have to think about one thing!
- does all the planning for you if you are in perimenopause and use cyclic HRT.
Cons
- uses a non-body-identical ‘progestogen’ which doesn’t have the sleep and mood benefits of the progesterone capsules.
It is easy to trial one and switch to the other to see what works best for you. Just talk to your doctor about it.
