1. Oestrogen
The safest way of delivering oestrogen is through the skin. This may be with a patch, gel or spray. The oestrogen in these products is 17β oestradiol. This is identical in structure to the oestrogen produced in our bodies.
Patches are applied below the waist – usually on the hip or tummy. They are changed twice a week. They stick well for most people, and you can shower and swim with them on. Patches are available in a variety of doses.
Gel is applied daily to the upper arm. Spray is applied daily to the forearm. The dose of gels and sprays is adjusted by simply using more pumps / sprays per day. This should only be done on the advice of your doctor.
Oestrogen may also be taken in tablet form. Oestrogen tablets have to be metabolized by the liver. This is where clotting factors are made, so the risk of a blood clot is higher with oral HRT.
2. Progestogen
In women who have a womb, oestrogen may overstimulate the lining of womb, which can lead to womb cancer. To protect the lining of the womb, women must take a progestogen.
One option is to use a Mirena coil. This has the added advantage of providing contraception. For the purposes of HRT it is licensed for just 5 years.
Progestogen tablets which are taken at night may also be used. If a woman is still getting periods the progestogen should be used sequentially i.e. take it 2 weeks on, 2 weeks off. During the 2 weeks off, a woman will usually get her period. If periods have stopped for a year it may be taken every day at a lower dose. If it is used continuously too soon, the risk is that the woman will have unpredictable bleeding. There are a number of oral progestogen products available. The safest form is micronised progesterone as this is a progestogen that is identical in structure to the progesterone produced in our bodies.
Combination products
There are tablets available that have both oestrogen and progestogen in the same tablet. If still having periods these products come with 2 weeks of tablets that have both hormones in them, and 2 weeks of tablets that have just oestrogen. There are a number of doses available.
There are also patches that have both oestrogen and progestogen in the same patch. Their use is limited by the fact that there is only one dose preparation available. So if you need to increase your oestrogen dose it means changing to another product or adding in something else like a gel.
These products use older types of progestogen which aren’t body identical and so carry more risk.
The brands shown in the pictures are the main ones available in Ireland, but there are more.
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