Hormone replacement therapy involves replacing one, or more of the hormones oestrogen, progesterone and testosterone. Systemic oestrogen absorbed into the bloodstream is the most effective treatment for menopausal symptoms. Oestrogen can be taken as an oral tablet every day absorbed through the gut into the bloodstream, or it can be absorbed into the bloodstream through the skin, transdermally, as a gel, a patch or a spray. This article covers how to use transdermal oestrogen in gels, patches or a spray.
The type of oestrogen most commonly given in HRT now is called 17β-oestradiol, it is derived from the yam plant and is bioidentical, which means it has the same molecular structure as the most active type of oestrogen made in the ovaries. This type of oestrogen is also called body identical.
There is no best oestrogen product to use, so choosing a product that works well for you, and that you will remember to take as has been prescribed, is the most important thing. Stopping and starting, or forgetting will cause your hormone levels to rise and fall and that may not help you feel well. You can try one and if you don’t get on well with it, you can try a different one.
How do I use the oestrogen patches?
There are five types of oestradiol patch in the UK, currently. They are matrix patches come in doses of 25mcg to 100mcg and are changed once or twice a week. The actual dose delivered in each woman may be different, and oestrogen blood tests taken in women using the same strength patch vary. When a patch is applied the absorption of oestrogen reaches a peak at 12 hours, remains stable over the next 7 days, and will drop to the baseline level within 24 hours of it being removed, if no replacement patch is applied.
The patches are stuck onto dry clean skin, usually to the waist or buttock, avoiding the breast and genital area. They should stick on well and stay in place in the shower, bath or when exercising, however about 10% fall off, so if this is the case the oestrogen hormone will not be absorbed so please speak to your Dr. A plaster mark will occur when they are taken off the skin, which can be removed using baby oil or eye make-up remover and a dry flannel. Replace the patches once or twice a week, as prescribed. There should always be one patch stuck well to the skin.
How do I use the oestrogen gel?
There are two gel preparations available. They contain 17β-oestradiol in an alcoholic base which absorbs quickly into the skin. The two gel preparations are bioequivalent.
- Oestrogel comes as a pump dispensing pack of 64 doses, one dose supplies 0.75mg of 17β-oestradiol. The usual dose varies from ultra-low, at half a pump daily, to high dose, at 4 pumps daily.
- Sandrena gel preparation is available as single dose sachets in doses of 0.5mg or 1mg of 17β-oestradiol. The usual dose varies from ultra-low, at 0.25mg daily to high dose, at 3mg daily.
The daily application of the gel leads to peak 17β-oestradiol levels within 3–5 days and after discontinuation of treatment, 17β-oestradiol levels return to pre-treatment levels by 6 days.
Gel is applied daily and both preparations take 2-5 minutes to dry. Skin should be kept dry after application ideally for 2 hours, without showering or applying other products to the area of application. Wash your hands after application and take care during not to transfer the gel to others, including your pets.
The dose prescribed, and absorption varies from person to person. The dose can be split into half and applied morning and evening or applied at once. Generally, younger women need more oestrogen than older women. Your prescriber can discuss which dose is right for you.
How do I use the Oestrogen spray?
The transdermal spray technology incorporates 17β-oestradiol, octisalate and alcohol into a unique drug delivery system. After it has been applied to the skin on the underside of the forearm or the inner thigh, 17β-oestradiol and octisalate form a reservoir depot underneath the skin, and there is a slow diffusion of 17β-oestradiol through the skin layers, into the microcirculation at a steady rate over 24 h before it declines. The dose varies from ultra-low at one spray daily to high dose at 6 sprays daily.
When you receive a new pump applicator it needs to be primed by spraying three times with the cap on, and each device has only 56 sprays so a note needs to be made of how many sprays are used before the carton is empty. The ability to reply on blood tests levels for 17β-oestradiol is not known, because of the reservoir absorption method.
The spray should be applied every day to clean, dry, healthy skin of the inner forearm or inner thigh, in circular areas that do not overlap, using the same area each day. It dries completely in about one minute and you can wash 30 minutes after application.
What are the advantages of using transdermal 17β-oestradiol in a gel, patch or spray?
Benefits of oestrogen through the skin instead of taking it orally include:
- There is no evidence of increased risk of clot or stroke in healthy women using moderate doses of transdermal oestrogen.
- The dose of transdermal oestrogen can be changed easily, either adjusting the strength of the patch, or the amount of gel or spray used.
Don’t forget progesterone!
If you still have your uterus (womb), or for some women who have had a hysterectomy, for example with a history of endometriosis, you will also need to take progesterone or a progestogen to protect the lining of your womb, as taking oestrogen by itself can thicken the lining of the womb and increase the risk of uterine cancer. Progesterone can be taken as a micronised bioidentical progesterone capsule, also known as body identical, or as a synthetic version of that hormone as part of a patch, as an oral tablet or as part of a 52mg Levonorgestrel Intrauterine System, commonly known as a Mirena IUS, which can be used for 5 years for this purpose, as recommended by the FSRH.
It is vital you take the progesterone or progestogen as it has been prescribed. It is also necessary and safe to balance the dose of oestrogen and progestogen, so if you are using higher doses of oestrogen you will need a discussion with your Dr about using higher doses of progestogen.
If you have any questions about your HRT and would like an individual appointment please visit the Rowena Health booking page.
Rowena Health Dr Carys Sonnenberg, correct on date of writing June 17 2024