HRT Spray vs Gel for Perimenopause: Key Differences Explained

Why Transdermal HRT Matters in Perimenopause

Transdermal oestrogen (applied to the skin rather than taken as a tablet) has become the preferred form of HRT for most women and most menopause specialists. Unlike oral oestrogen, transdermal versions bypass the liver during first-pass metabolism, which means a lower dose achieves the same effect and the risk of blood clots is not meaningfully elevated. Two of the most commonly prescribed forms in the UK are oestrogen gel and oestrogen spray. Both deliver the same hormone but they differ in how they are applied, how the dose is adjusted, and what they feel like to use day to day.

How Oestrogen Gel Works

Oestrogen gel is applied once daily to a large area of skin, typically the inner arm, thigh, or lower abdomen. The gel absorbs within a few minutes and delivers a consistent amount of oestrogen transdermally over twenty-four hours. Dose is adjusted by changing the amount of gel applied, either by altering the pump size or the number of pump doses. This makes it relatively easy to titrate incrementally. Gel is widely available on NHS prescription and has been in use for many years, so there is a well-established understanding of dosing and tolerability. It should not be applied to breast tissue and hands should be washed after application.

How Oestrogen Spray Works

Oestrogen spray is applied to the inner forearm and delivers a precise metered dose with each pump. It dries quickly, usually within thirty to sixty seconds, and absorption is rapid. The main practical advantage is speed and discretion. It takes seconds to apply and leaves no residue. Dose is adjusted by increasing or decreasing the number of sprays. Like gel, it is transdermal and carries the same favourable cardiovascular and clotting risk profile. The spray format is particularly useful for women who find the texture of gel irritating or who want a faster application process.

Key Differences in Practice

Application area is the most notable practical difference. Gel typically requires application to a larger surface area, which helps with absorption but takes slightly longer. Spray is faster but applied to a smaller area. Both need to dry completely before contact with clothing or another person, particularly important if there are children or male partners in the household. Dose flexibility is comparable. Gel tends to offer slightly finer incremental adjustment in some formulations. Transfer risk, where oestrogen contacts another person through skin-to-skin contact, exists with both but is manageable with appropriate drying time and application site awareness.

Who Might Prefer Each Option

Gel tends to suit women who want a well-established, widely available product with a clear record of dosing guidance. It is often the first transdermal option offered on NHS prescription. Women who find the gel texture uncomfortable or who want the quickest possible morning routine may prefer spray. Women with very dry or sensitive skin sometimes find spray less irritating. If you are switching from patches and want more control over incremental dose changes, gel may offer a slightly easier starting point. Both require consistent daily application at roughly the same time for stable hormone levels.

Questions to Raise With Your Doctor