If you're thinking about starting hormone therapy to help with menopausal symptoms, you may be wondering - should I take estrogen pills or use a patch? It's a common question. Both methods can help relieve symptoms like hot flashes, but there are some important differences to understand.
Pills are easy to take, but the estrogen goes through your whole body. Patches deliver estrogen through the skin and into the bloodstream, right where you need it most. There are pros and cons either way relating to risks like blood clots or stroke.
This article goes over the key points to help you make the best choice for your body and health situation. I'll explain how oral and patch estrogen work, look at the latest research on safety for both, and help you weigh up which might be better for your personal needs.
Understanding Menopausal Hormone Replacement Therapy
Estrogen, a group of hormones made naturally in the body, is an important part of hormone therapy for menopausal women. There are a few different estrogens - estrone, estradiol, and estriol. Of these, estradiol packs the biggest punch in the body. So, although I use the word estrogen throughout, remember the important natural form is estradiol.
Why Consider Menopausal Hormone Therapy?
As women transition through menopause, they often experience a range of symptoms that can significantly impact their quality of life. There are many reasons for these symptoms. DHEA, progesterone, testosterone and growth hormone decrease as women age. But the main culprit responsible for the symptoms of menopause remain the same, it's estrogen. Specifically, the drop in estrogen. The drop in estrogen is responsible for the following symptoms:
Hot flashes and night sweats
Vaginal dryness and discomfort
Mood swings and irritability
Sleep disturbances and insomnia
Bone density loss, increasing the risk of osteoporosis
Urinary tract issues
Skin changes and loss of elasticity
Reduced libido
Menopausal hormone therapy is a treatment used to alleviate symptoms of menopause by replacing hormones that the body no longer produces in sufficient quantities. Supplement the body with estrogen and these symptoms will dramatically improve and potentially go away. It can be administered in various forms, with oral and transdermal being the most common options. It can be bioidentical (estrone, estradiol, and estriol) or Conjugate Equine Estrogen (CEE) which comes from horses. The brand name for CEE is Premarin.
Now, if it was that simple, we would be done with this article. However, the route of administration of the estrogen replacement therapy is the most important decision once there is a plan to treat,
Oral vs Transdermal Estrogen Therapy
When it comes to estrogen treatment for menopause, there are two ways you can take it - as a pill or absorbed through your skin. Swallowing estrogen pills has been the standard approach, especially in the U.S. In the past, oral conjugated equine estrogen was among the most prescribed medications in the U.S. But rubbing creams, gels, or using patches that supply estrogen through your skin has become more common. This is the delivery method that is referred to as transdermal. Both methods deliver needed estrogen to relieve unpleasant menopause symptoms like hot flashes.
Benefits of Oral Estrogen:
Convenience: Easy to take - just swallow a pill as part of your daily routine
Effectiveness: Proven treatment for hot flashes and night sweats
Bone Health: Helps reduce the risk of osteoporosis in postmenopausal women
Lipid Profile: May improve HDL to LDL cholesterol ratios, potentially benefiting cardiovascular health
Well-studied: Extensive research has been conducted on oral estrogen in menopausal HRT
Hormone Levels: Oral estrogen results in higher peaks and lower troughs of estrogen levels in the blood
Risks of Oral Estrogen:
Liver Metabolism: Undergoes first-pass metabolism in the liver, which can affect other medications
Blood Clots: Slightly higher risk of venous thromboembolism (VTE), including deep vein thrombosis
Stroke Risk: Potential increased risk, especially in women over 60 or more than 10 years post-menopause
Gallbladder Disease: May increase the risk of gallstones
Triglycerides: Can increase triglyceride levels in some women
Potential Side Effects of Oral Estrogen:
Nausea
Bloating
Breast tenderness
Headaches
Mood swings
Vaginal bleeding
Benefits of Transdermal Estrogen Therapy:
Estrogen bypasses the Liver: Avoids first-pass metabolism, potentially leading to more stable estradiol levels
Lower Blood Clot Risk: Decreased risk of venous thrombosis compared to oral estrogen in menopausal HRT
Flexible Dosing: Easy to adjust doses based on individual needs and response to therapy
Cardiovascular Health: May have a lower impact on triglycerides and blood pressure
Body Composition: Potential for favorable changes in body composition, such as increased lean body mass
Steady Hormone Levels: Provides a more consistent level of estrogen throughout the day
Risks of Transdermal Estrogen:
Skin Irritation: Possible redness or rash at the application site, particularly with patches
Adhesion Issues: Patches might not stick well during physical activities or in hot weather
Cost: Can be more expensive than oral estrogen treatments in some cases
Potential Transfer: Care must be taken to avoid transferring the hormone to others through skin contact
Potential Side Effects of Transdermal Estrogen:
Skin irritation at the application site
Breast tenderness
Headaches
Nausea (less common than with oral estrogen)
Factors to Consider When Choosing Between Oral and Transdermal Estrogen for Menopausal HRT
When deciding between oral and transdermal estrogen for your menopausal hormone replacement therapy, it's important to consider several factors:
Medical History: If you have a history of blood clots, liver issues, or high triglycerides, transdermal estrogen might be a safer option for your menopausal HRT.
Lifestyle: Active lifestyles might favor oral estrogen if patch adhesion is an issue, but transdermal gels or creams could be a good alternative.
Cost and Insurance: Some insurance plans may favor one form of estrogen delivery over another.
Other Medications: Oral estrogen can interact with other drugs metabolized by the liver. If you're taking multiple medications, this could be an important consideration in your choice of menopausal HRT.
Age and Time Since Menopause: Risks and benefits of HRT can vary based on these factors. Women who start menopausal hormone replacement therapy closer to the onset of menopause may have a different risk profile than those who start later.
Personal Preferences: Some women prefer the simplicity of taking a pill, while others like the idea of absorbing hormones through the skin. Your comfort with the administration method can impact your adherence to the menopausal HRT regimen.
Severity of Symptoms: The intensity of your menopausal symptoms may influence the choice between oral and transdermal estrogen. Some women find that one method provides better symptom relief than the other.
Cardiovascular Risk Factors: If you have risk factors for cardiovascular disease, the choice between oral and transdermal estrogen in your menopausal HRT could be significant.
Latest Guidelines for Menopausal Hormone Therapy
Recent guidelines from reputable health organizations emphasize a personalized approach to menopausal HRT. These recommendations include:
Shared decision-making between patients and healthcare providers when considering therapy
Assessing breast cancer risks
Assessing cardiovascular risks such as myocardial infarction and atherosclerosis
Considering individual health profiles, risk factors, and preferences when choosing between oral and transdermal estrogen
Regular reassessment of the need for continued hormone therapy
Considering the "timing hypothesis," which considers the years of menopause. It suggests that starting treatment closer to the start of menopause may be safer
It's important to note that these guidelines are aren't rules that are set in stone. They are recommendations that the healthcare providers must consider while evaluating your situation.
Conclusion: Making the Right Choice for Your Menopausal HRT
Choosing between oral and transdermal estrogen is a personal decision that should be made in consultation with a healthcare provider experienced in menopausal health. Both methods have their advantages and potential risks, and the best choice depends on your individual needs, medical history, and preferences.
Mehta, J., Kling, J. M., & Manson, J. E. (2021). Risks, Benefits, and Treatment Modalities of Menopausal Hormone Therapy: Current Concepts. Frontiers in Endocrinology, 12. https://doi.org/10.3389/fendo.2021.564781
*Disclaimer: This blog post is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding your health or a medical condition before making any changes.
Call 918-518-1636 For Your Appointment Today
We are conveniently located in Tulsa, Oklahoma. However, we also serve South Carolina, Texas, and Florida through telehealth. We take a holistic approach knowing that you are unique and the hormone treatment for you must be safe, effective, and affordable. Before starting bioidentical hormone therapy, we begin the process with a thorough detailed assessment that identifies your symptoms and the hormone deficiencies involved. Then, we order extensive laboratory testing and present you a specialized treatment plan.
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