Different forms of HRT
As well as deciding on the best combination of estrogen and progestogen, you and your doctor will need to choose the form of HRT most suitable for you. The choices include:
-
Tablets to be taken by mouth. This remains the most commonly prescribed form of HRT and there are many different HRT tablets available containing different combinations of estrogen and progestogen
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Skin patches. These deliver the hormones straight through the skin into the bloodstream
-
Local HRT. This includes tablets, creams, vaginal rings and pessaries which are inserted into the vagina to help relieve the vaginal symptoms of the menopause
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Implants. Small estrogen pellets are inserted under the skin using a local anaesthetic. They then gradually release estrogen into the bloodstream over a period of several months
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Gels. An oestrogen-containing gel is applied to the skin and absorbed directly into the bloodstream
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Spray. An oestrogen containing nasal spray
Advantages and disadvantages of different forms of HRT
|
HRT |
Advantages |
Disadvantages |
|
Tablets |
Easy to take Easy to stop Discreet Easy to adjust dose |
Need to remember to take every day May interfere with other medication |
|
Patches |
Low dose hormones go straight into bloodstream No need to take tablets Easy to stop |
May cause skin irritation May be visible May fall off Need to remember when to change |
|
Implants |
Long-lasting No need to remember to take anything |
Not easy to remove or stop Surgical procedure needed for insertion May cause hormone levels which are too high at first |
|
Vaginal tablets |
Non-messy Deliver estrogen straight to the vagina Easy to use and stop |
Only recommended for vaginal dryness |
|
Vaginal creams |
Deliver estrogen straight to the vagina Easy to stop |
Only recommended for vaginal dryness Can be messy to apply |
| Vaginal ring |
Non-messy Lasts for three months |
Needs to be inserted by healthcare professional |
| Pessaries |
Simple to use Simple to stop |
Suitable only for vaginal dryness |
|
Gel |
Delivers estrogen straight into bloodstream Easy to stop |
Can be messy Need to apply correct amount |
If you have only vaginal symptoms, it is worth trying one of the local preparations. However, if your symptoms are more general, you will need a form of treatment which circulates throughout the whole body (known as systemic treatment).
Most women will start off taking HRT tablets. Reasons for choosing or changing to an alternative form of HRT, for example, patches, could include:
-
Personal preference
-
Unsatisfactory control of symptoms with HRT tablets
-
Side effects such as nausea with tablet
-
History of migraine (patches tend to produce more constant hormone levels than tablets which may be beneficial in patients with migraine)
-
Sensitivity to lactose (all tablet preparations of HRT contain lactose)
-
Current use of medicines such as anti-epileptic therapy which may affect the breakdown of tablet HRT
