There are multiple approaches to HRT (Hormone Replacement Therapy), the medicine-based process for relieving symptoms of menopause. In this short guide, we look at the effectiveness, benefits, and risks of transdermal oestrogens.

What are transdermal oestrogens?

Transdermal oestrogens are applied directly to your skin as using either patches, gels, or sprays. Replacing oestrogen helps in manage the majority of menopausal symptoms. Oestrogen has also been shown to be effective in maintaining or increasing bone mineral density. When HRT is taken within 10 years of menopause or below the age of 60 it can reduce the risk of cardiovascular disease. The advantage of transdermal delivery is that it allows oestrogen to enter your bloodstream directly, avoiding your liver, which reduces the risk of blood clots (VTE) or stroke seen with oral forms.

Who is the transdermal method best suited to?

Transdermal HRT is particularly suited for women who want to take HRT for their menopausal symptoms but have a history of, or risk of blood clots, liver disease, migraines or are deemed higher risk for cardiovascular disease or stroke. It’s also a good option for those who would benefit from a non-oral method of medication due to gastrointestinal disease or a history of gastric bypass surgery. Additionally, it can benefit women who seek a steady release of hormones without the peaks and troughs that sometimes occur with oral HRT.

What is venous thromboembolism (VTE)?

Venous thromboembolism (VTE) is a serious condition where blood clots form in the deep veins, primarily in the legs (known as deep vein thrombosis, or DVT). These clots can dislodge and travel through the bloodstream to the lungs, causing a potentially life-threatening blockage called a pulmonary embolism (PE). VTE can result from various factors, including prolonged immobility such as long-haul flights, certain medical conditions, surgery, or a genetic predisposition to clotting.

Is transdermal HRT more suitable for people at risk of VTE?

Yes, transdermal HRT is generally considered more suitable for individuals at risk of VTE. Unlike oral HRT, transdermal HRT delivers hormones directly into the bloodstream through the skin, bypassing the liver. This method reduces the impact on clotting factors and liver metabolism, leading to a lower risk of developing blood clots compared to oral oestrogen. Therefore, for those with a history or heightened risk of VTE, transdermal HRT is the preferred choice.

Which type of transdermal HRT is most effective?

The effectiveness of transdermal HRT – whether in the form of patches, gels, or sprays – is generally considered similar across the different delivery methods. The choice between them depends on personal preference, lifestyle, skin sensitivity, and ease of use.

  • Patches – Provide a steady release of hormones and are changed once or twice a week. They are convenient but can cause skin irritation for some users.
  • Gels – Applied daily, allowing for more flexibility in dosing. They’re less likely to cause skin irritation but require careful application and takes time to absorb before you can get dressed.
  • Sprays – Also applied daily, they are a newer option and can be an alternative for those who have skin reactions to patches or issues with gels.

Ultimately, the “most effective” type is the one that best aligns with your personal preference and in consultation with a healthcare professional.

Are there any risks in using transdermal oestrogens?

Yes, like all forms of HRT, transdermal oestrogens do carry some risks, although they might be lower in certain aspects compared to oral oestrogens. The key risks include:

  • Hormone-sensitive cancers – Use of oestrogens has been linked to an increased risk of certain hormone-sensitive cancers, notably breast cancer. Be sure to discuss personal and family cancer histories with a hormone specialist before starting treatment.
  • Skin reactions – Some individuals may experience skin irritation or allergic reactions at the site of application, particularly with patches.
  • Endometrial hyperplasia and cancer – In women with an intact uterus, oestrogen therapy can increase the risk of endometrial hyperplasia and cancer so progesterone must also be added to protect the lining of the uterus.
  • Other side effects – These can include breast tenderness, nausea, headaches, and mood changes, although they may be less severe than with oral oestrogens.

Regular monitoring and appropriate screenings are important during the course of your treatment, to minimise the risk of any serious complications. It is important to keep up to date with routine health screenings such as mammograms and cervical smears and to perform regular breast self-examination.

Need help regaining your hormone balance?

Hormone imbalance can occur at any time during a woman’s life. We understand the impact these symptoms can have on you, your family, your work, and your relationships. We offer advice, support, and treatment to get you back to feeling you again. Book a video consultation with us today or speak to our practice manager for further details.