HRT Patches: a simple guide

HRT Patches: a simple guide about what they are, the types of patches available and how to use them. HRT patches are one of the most popular and effective ways to take Hormone Replacement Therapy (HRT). They deliver hormones through the skin directly into the bloodstream and can help relieve many menopausal symptoms including hot flushes, night sweats, anxiety, low mood, brain fog, sleep disturbance, vaginal dryness and joint aches.

Many women choose HRT patches because they are convenient, provide steady hormone levels. You can read more about perimenopause or menopause symptoms on our Rowena Health article by clicking here. You can read more about hormone replacement therapy by clicking here.

What Are HRT Patches?

HRT patches are small adhesive patches that stick to the skin and gradually release hormones into the bloodstream. This is known as transdermal HRT.

There are two main types of HRT patches:

1. Oestrogen-only patches (only contain the hormone oestrogen)
2. Combined patches (containing the hormones oestrogen and progestogen)

The type of oestrogen used in HRT patches is estradiol, which is chemically identical to the main oestrogen produced by the ovaries before menopause. This is often referred to as body identical oestrogen. The type of progestogen used in combined patches is either norethisterone or levonorgestrel (synthetic, androgenic progestogens).

What Are the Different Types of HRT Patches?

Oestrogen-Only Patches

These are commonly prescribed for women who:

• Have had a hysterectomy and do not need to take a progestogen
• Use a 52mg LNG IUD (such as a Mirena®) for endometrial protection
• Take separate progesterone such as micronised progesterone, dydrogesterone, desogestrel, drospirenone, norethisterone or medroxyprogesterone acetate in a balanced dose to protect the lining of the uterus (the endometrium) from the thickening effect of oesteogen.

All patches within each pack contain the same dose of estradiol and the doses available range from 25mcg to 100mcg.

Oestrogen and progestogen patches (both hormones in one patch)

These patches contain estradiol (at a range of doses) and a type of progestogen (either norethisterone or levonorgestrel).

There are two ways of using the combined patches.

Continuous Combined HRT Patches

Continuous combined HRT provides daily oestrogen and daily progestogen. It is recommended for women with a uterus (and those who require a progestogen) and is suitable for women who have had more than 12 months since their last period (post menopause). It can also be used in women who have had no bleeding for over a year whilst using a progestogen only method of contraception, or who have had an endometrial ablation.

Brands available:

• Estradot conti 30/95 (estradiol 30mcg/24h + norethisterone 95mcg/24h) – change the patch twice a week – 8 patches in each pack
• Estradot conti 40/130 (estradiol 40mcg/24h + norethisterone 130mcg/24h) – change the patch twice a week – 8 patches in each pack
• Evorel conti (estradiol 50mcg/24h + norethisterone 170mcg/24h) – change the patch twice a week – 8 patches in each pack
• Femseven conti (estradiol 50mcg/24h + levonorgestrel 7mcg/24h) – change the patch once a week – 4 patches in each pack

All the patches in the box are identical with continuous combined HRT.

Using continuous combined HRT means you should not have any bleeding (although you might have some irregular bleeding on initiation of HRT) Please report bleeding that continues for longer than 3 months, and any bleeding which is persistent or heavy.

Sequential HRT Patches

Sequential combined HRT usually recommended for women who are still having periods or whose last period was within the previous 12 months (perimenopause) when they start HRT. This provides daily oestrogen with progestogen for part of the month (usually 12-14 consecutive days a month). This regime gives a monthly bleed lasting 3-7 days at the end of the progestogen phase.

Brands available:

Evorel sequi: the box contains four Evorel 50mcg patches (estradiol 50mcg/24h patches – oestrogen only) and four Evorel conti patches (estradiol 50mcg/24h +norethisterone 170mcg/24h patches – oestrogen + progestogen).

8 patches are in each box and you need to check carefully to ensure you use them in the right order.

Use four Evorel 50mcg patches in a row (oestrogen only) – change them twice a week. Then use four Evorel conti patches in a row change them twice a week.

This usually results in a monthly withdrawal bleed, lasting 3-7 days at the end of the progestogen phase.

Using sequential combined HRT means you should have one bleed each month (although you might have some irregular bleeding on initiation of HRT) Please report bleeding that continues for longer than 3 months, and any bleeding which is persistent or heavy.

You change from sequential combined HRT (one bleed a month) to continuous combined HRT (no bleed) if you are over the age of 45 and have been using sequential HRT for a maximum of 5 years (you can change earlier), or by the age of 54, whichever comes first. Note: the bleed on sequential combined HRT is not a natural period, it is a hormonal bleed due to the hormones in the patch.

How to Apply HRT Patches

Apply the patch to:

• Clean, dry skin
• Hairless areas below the waist
• The lower abdomen, buttocks or upper thigh

Avoid applying patches to:

• The breasts
• Broken skin
• Irritated skin
• Areas where tight clothing may rub

Most HRT patches are changed twice weekly. Many women find it helpful to choose two regular days each week, such as Monday and Thursday.

Rotate the application site each time you change your patch to minimise skin irritation.

Patches are designed to remain in place during everyday activities including showering, swimming, bathing and exercise.

What If My HRT Patch Falls Off?

If your patch falls off, apply a new patch as soon as possible.

Continue following your original patch change schedule.

What If I Forget to Change My Patch?

Apply a new patch as soon as you remember.

Continue with your usual patch change schedule rather than starting a new cycle.

Benefits of HRT Patches

• Effective Symptom Relief
• Lower Risk of Blood Clots: unlike oral oestrogen tablets, transdermal oestrogen does not increase the risk of venous thromboembolism (blood clots).
• Suitable for Women With Migraine: because patches provide more stable hormone levels, they are often recommended for women with migraine, including migraine with aura.
• Bone Protection: oestrogen helps preserve bone density and reduces the risk of osteoporosis and fractures after menopause.
• Flexible Dosing: patch doses can be adjusted relatively easily, allowing treatment to be tailored to individual symptom control.
• Minimal impact on testosterone: transdermal oestrogen (as a patch, gel or spray) has less impact on sex hormone-binding globulin (SHBG) than oral oestrogen and may therefore have less effect on free testosterone levels.

Downsides of using an HRT patch

• Skin Reactions: occasionally patches can cause redness, itching, mild irritation at the application site. Changing the location of the patch regularly often helps. If this is a problem consider switching to a different brand, as the adhesive may be causing irritation or allergy symptoms.
• Patches are visible on the skin

Frequently Asked Questions About HRT Patches

Where should I put an HRT patch?

Apply your patch to clean, dry skin below the waist, usually on the lower abdomen, buttocks or upper thigh.

Can I shower with an HRT patch?

Yes. HRT patches are designed to remain attached during showering, bathing and swimming.

Can I exercise while wearing an HRT patch?

Yes. Most patches remain securely attached during exercise and normal daily activities.

Which is better: HRT patches or gel?

Neither is universally better. Both are transdermal forms of HRT and have similar benefits. The best choice depends on your lifestyle, preferences and symptom control.

Do HRT patches cause weight gain?

There is no good evidence that HRT patches directly cause weight gain. Many women notice body composition changes during menopause due to hormonal changes and ageing rather than HRT itself.

Can I use HRT patches if I have migraine?

Yes. HRT patches are often the preferred form of HRT for women with migraine because they provide stable hormone levels.

Do HRT patches increase the risk of blood clots?

Current evidence suggests that transdermal oestrogen does not increase the risk of blood clots, unlike oral oestrogen tablets.

When Should I Seek Medical Advice?

Contact your GP or menopause specialist if:

• Bleeding becomes heavy/persistent
• New bleeding develops after being bleed-free
• Irregular bleeding continues beyond six months
• Side effects remain troublesome
• Symptoms are not improving
• You have concerns about your HRT treatment

Looking for Personalised Menopause Support?

Every woman experiences menopause differently. The best HRT patch for one woman may not be the best option for another.

At Rowena Health, we provide evidence-based menopause care tailored to your symptoms, medical history and treatment preferences, helping you find the right approach for your menopause journey. Book an online appointment.

Rowena Health Dr Carys Sonnenberg, correct on date of writing June 2026

References

British Menopause Society. Management of Menopause for Women with Cardiovascular Disease (2024). Covers transdermal HRT, cardiovascular risk and prescribing considerations.

British Menopause Society (BMS) & Women’s Health Concern. BMS & WHC Recommendations on Hormone Replacement Therapy in Menopausal Women (2020). This is the key UK consensus document covering benefits, risks and prescribing of HRT.

British Menopause Society. HRT Guide (2026). Summarises current evidence on symptom control, bone health and cardiovascular outcomes.

British Menopause Society. Prevention and Treatment of Osteoporosis in Women (2025). Provides evidence on HRT and fracture prevention.

NHS. Benefits and Risks of Hormone Replacement Therapy (HRT). Patient-friendly overview of the benefits and risks of HRT.