As HRT is the most effective treatment at relieving hot flashes, night sweats, mood swings, vaginal atrophy, joint pains and other symptoms …. I am often asked about the different methods of taking it and their relative safety.
Methods of taking conventional HRT and bioidentical HRT
- a pill or tablet taken daily is the most frequently utilized method of hormone therapy in the world. We have become accustomed to taking pills and it is easy to take
- transdermal (through the skin) patch is a delivery system that allows the hormone to be gradually absorbed by the skin. It is applied to the skin and replaced once or twice weekly as contrasted to the daily estrogen pill
- transdermal gel – A measured amount of gel is rubbed on the skin once daily. It is absorbed and the skin, acting as a reservoir, releases it gradually into the bloodstream
- transdermal cream – It acts much in the same way as transdermal gel. It has to be put on thin areas of the skin, such as the inner arms, to get into the blood stream. If put on fatty areas such as the buttocks, the hormones may sit in the fat cells, immediately beneath the skin, and not get into the bloodstream.
Some women apply it to the vagina. When used in that way, it acts as a lubricant during intercourse. It also strengthens the walls of the vagina, which become weaker during menopause because of lower levels of estrogen
- pellets – They are inserted into the fatty tissue directly under the skin of the abdomen or buttock, usually at 3-6 month intervals. It is a convenient delivery system, inasmuch as you dont need to bother with taking your hormones regularly.
There is a downside to using this method. Once they are injected under the skin, they don’t come out. A woman is stuck with those hormone dosages for months. If she’s getting too much of a particular hormone, she may suffer months of unwanted side effects such as bloating, breakthrough bleeding, insomnia, weight gain and so forth
- intramuscular injection is a common method of hormone replacement and is used by many physicians. It is usually given at 2-4 week intervals.
It has the disadvantage of relatively high levels soon after the injection, which decline rapidly after a week or so. Unfortunately, this may perpetuate menopausal symptoms which are often associated with declining hormone levels
Health risks associated with the different methods of HRT delivery
- pills or tablets, taken orally, carry the highest health risks. If you swallow hormones, only 10-15 percent will eventually reach the target tissues and you will need to take an oral dose that is 500 percent higher than you need. A hormone pill has to travel through the digestive system and liver before being delivered to the blood, so as much as 80 to 90 percent of it is lost in this process.
HRT taken orally carries a higher risk of heart attack and stroke. Oral hrt increases risk of thrombosis, whereas transdermal does not
- creams, gels and patches are presently the most effective hormone delivery system, because hormones enter the bloodstream directly and gradually. Virtually all of the hormone in the cream, gel or patch gets into the bloodstream.
Transdermal delivery of HRT permits the correct dosage of hormones to be administered, whereas hormone therapy taken orally requires higher dosages than needed…..because only 10%-15% of the dosage makes it into the bloodstream.
It is the safest way to take hormone replacement therapy. HRT taken orally carries 2-3 times higher risk of blood clots and strokes than transdermal HRT. Studies have found that there is no increase of blood clot and stroke risk when HRT is taken transdermally