HRT Tablets vs Patches: What's the Difference and Which Is Right for You?
HRT tablets and patches both deliver estrogen but in different ways. Compare the pros and cons of each form to help you have a better conversation with your doctor.
Why the Method of Delivery Matters
Hormone replacement therapy involves introducing estrogen, and usually a progestogen, into the body to compensate for declining hormone levels during perimenopause and menopause. The way in which hormones are delivered affects how they are metabolised, the risk profile, and the practical experience of using them. Tablets and patches are the two most established delivery methods, and both are widely prescribed. The choice between them is not simply a matter of convenience. For some women, the method of delivery has meaningful implications for their health. Understanding the differences helps you participate more actively in the decision-making process with your doctor.
How HRT Tablets Work
Oral HRT tablets are taken by mouth and absorbed through the gastrointestinal tract. From the gut, the hormones travel directly to the liver before entering the general circulation. This process, known as first-pass hepatic metabolism, means the liver processes the hormones before they reach other tissues. As a result, oral estrogen stimulates the liver to produce certain proteins, including clotting factors. This is clinically significant because it modestly increases the risk of venous thromboembolism, or blood clots, in women using oral HRT compared to those who do not use HRT. Oral tablets are straightforward to take, widely available, and familiar to most women who are accustomed to daily medication.
How HRT Patches Work
Transdermal patches deliver estrogen through the skin directly into the bloodstream, bypassing the liver entirely. Because the liver is not involved in the initial processing, transdermal estrogen does not stimulate the production of clotting factors in the same way as oral estrogen. Current evidence suggests that transdermal HRT does not carry the same increased blood clot risk associated with oral HRT, making it the preferred route for women who have a history of blood clots, known clotting disorders, high blood pressure, obesity, or migraines with aura. Patches are typically worn on the lower abdomen or buttocks and changed every three to four days, or weekly depending on the formulation.
Practical Differences in Daily Life
Tablets require daily administration and some women find a daily routine easier to maintain than remembering a patch change schedule. However, forgetting a daily pill has a more immediate effect on hormone levels than forgetting to change a patch by a day. Patches can occasionally cause skin irritation, redness, or itching at the application site, particularly in women with sensitive skin. Moving the site with each change, ensuring the skin is clean and dry, and avoiding the waistband area reduces these issues. Patches can be worn during swimming and bathing, though prolonged heat such as saunas or hot baths may affect adhesion. Some women find patches visible under close-fitting clothing, which matters to some and not at all to others.
Progestogen Considerations
Women who still have a uterus need a progestogen alongside estrogen to protect the uterine lining from the effects of unopposed estrogen. Progestogen can be delivered as a separate tablet taken alongside an estrogen patch, as a combined patch that releases both hormones, or as a hormonal coil, which delivers progestogen locally to the uterus. The hormonal coil combined with a transdermal estrogen patch is a popular option among those seeking transdermal delivery of both hormones. Oral progesterone tablets, often taken separately at night, are also increasingly prescribed and have a mild calming effect that some women find beneficial for sleep. The progestogen component should always be discussed alongside the estrogen delivery method.
Who Might Be Recommended Each Option
For most women without specific risk factors, either tablets or patches can be appropriate, and personal preference plays a legitimate role in the decision. For women with cardiovascular risk factors, a history of stroke or blood clots, migraines with aura, or liver disease, transdermal delivery via a patch or gel is the recommended route based on current clinical guidance. Women who have difficulty remembering daily medication may do better with a patch changed twice weekly or weekly. Women who experience skin reactions to patch adhesive may find tablets or gels more suitable. No single format suits every woman, and it is common to try more than one approach before settling on the most comfortable and effective option.
Having an Informed Conversation with Your Doctor
Knowing the basic distinctions between tablets and patches puts you in a much stronger position when discussing HRT with a GP or specialist. Bring information about your personal and family medical history, including any history of blood clots, strokes, or cardiovascular disease, as this is relevant to route of administration. Ask specifically about transdermal options if you have any of the risk factors mentioned above, rather than waiting for the doctor to raise it. If you have tried one form and experienced side effects or dissatisfaction, say so clearly. Tracking your symptoms before and after starting HRT in an app like PeriPlan gives you concrete data about what has changed, which supports ongoing adjustments to your prescription.
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