If you’ve decided to try HRT, you might assume the next question is simply what dose you need. But there’s another decision to make: how should you take it?
HRT comes in several forms, including tablets, patches, gels and sprays. Two of the most familiar are tablets and patches, and although both can be effective at treating menopausal symptoms, there are some important differences.
How do HRT patches and tablets work?
HRT replaces some of the hormones that decline around menopause, particularly oestrogen.
With a tablet, the medication is swallowed and passes through the digestive system and liver before reaching the circulation.
A patch delivers oestrogen through your skin directly into the bloodstream. This is known as transdermal HRT. Oestrogen gels and sprays work via the skin too.
That difference in route might sound fairly insignificant, but clinically it can matter.
Are HRT patches safer than tablets?
This is where the distinction between the two becomes particularly important.
Oral HRT containing oestrogen is associated with an increased risk of venous thromboembolism, blood clots such as deep vein thrombosis (DVT), whereas transdermal oestrogen is not associated with an increased risk of VTE.
For this reason, transdermal HRT is often particularly appropriate for women who already have an increased risk of blood clots, including women with a BMI over 30.
There are also differences in stroke risk. Current NICE guidance says that stroke risk is unlikely to increase with HRT containing transdermal oestrogen, while the risk increases with oral oestrogen, although the baseline risk of stroke in women under 60 is very low.
That doesn't mean that tablets are automatically an unsafe or inappropriate choice. For many women, the absolute risks associated with HRT are small. What matters is looking at those risks in the context of you.
So why would anyone choose tablets?
Because there isn't one form of HRT that is automatically “best” for every woman.
Your symptoms, medical and family history, age, lifestyle, other medication and personal preferences can all influence the decision.
There are practical considerations too fo all forms of HRT, for example, patches can occasionally cause skin irritation or fail to stick properly, while some women simply dislike wearing them.
What about progesterone?
This is another reason HRT can feel confusing.
If you still have your womb, you will usually need progesterone or a progestogen alongside systemic oestrogen to protect the lining of the womb.
Depending on your individual HRT regime, this may be provided separately in a tablet form or as part of a combined patch.. A 52mg levonorgestrel intrauterine system, such as a Mirena, can also provide the progestogen component of HRT for appropriate women.
So choosing between a “patch and a tablet” isn't always as simple as it sounds.
What if my current HRT isn't working?
HRT isn't necessarily something we prescribe once and never revisit.
If your symptoms aren't sufficiently controlled, you're experiencing side effects, you're having unexpected bleeding or you're simply finding your current method inconvenient, it is worth discussing it with your doctor or menopause specialist.
Sometimes the answer may be a different dose. Sometimes it may be changing the type or route of HRT. And sometimes we need to look again at whether all of your symptoms are actually being caused by menopause.
HRT should fit the woman, not the other way around
The most important question isn't simply “Are patches better than tablets?”
It is “Which form of HRT is most appropriate for me?”
At Jaya Life, Dr Lucy Mather is a GP and British Menopause Society Registered Menopause Specialist. She takes the time to look at your symptoms, medical history, individual risk factors and preferences before discussing the treatment options that may be appropriate for you.
If you're considering HRT, or you're already taking it but don't feel you've found the right treatment yet, you can book a consultation with Jaya Life in North Wales or online.