Back To Top
Back To Top
When people talk about Hormone Replacement Therapy (HRT) for menopause, they may not be aware that there are actually a few forms of HRT. Additionally,...
When people talk about Hormone Replacement Therapy (HRT) for menopause, they may not be aware that there are actually a few forms of HRT. Additionally, each form of HRT works slightly differently and comes with its own pros and cons. The question of which form, hrt gel or patch or tablet works best is highly dependent on individual factors such as your health and personal preferences.
Approaching or experiencing menopause can come with some very uncomfortable symptoms. These characteristically include hot flushes, mood swings, vaginal dryness, and night sweats. The reason why you experience such symptoms is from the natural decline in certain hormones such as oestrogen and progesterone. Therefore, the principle of management for these symptoms is to supplement or replace the low levels of these hormones. This kind of treatment is hence understandably named ‘Hormone Replacement Therapy’ which you may have heard of also being called HRT. HRT can come in different delivery methods from tablets, patches, to gels. Each method will have its own pros and cons; if you are starting on HRT your doctor will evaluate the different options to help decide what is the best hrt option for you.
There is a wide range of HRT forms but the main ones are: HRT tablets, transdermal HRT patches, and topical HRT gels. Each method of delivery has its own pros and cons that can make it more or less suitable for someone depending on their health or health risks as well as personal preferences.
HRT tablets are widely available and easy to use. You take the medication as an oral tablet; for example, a standard dose of 1-2mg once a day to maintain steady levels of the hormone in the body. However, some people may find it difficult or annoying to remember to take a tablet every day and there is also an increased risk of systemic side effects (e.g gastrointestinal side effects) with oral HRT tablets.
Transdermal HRT Patches are stuck to the skin where they deliver a steady supply of hormones ‘transdermally’ or through the skin. As this form avoids the digestive system (unlike tablets), it may be more suitable if someone has experienced side effects from the HRT tablets. However, you will need to change the HRT patch every few days.
Topical HRT gels are applied to the skin, this not only allows for more flexibility in the treatment regime but can also directly target areas affected. As it is not ingested orally, a topical HRT gel carries a lower risk of systemic side effects unlike the oral tablet. However, some people may feel that it is inconvenient to use a gel every day.
So what is the best form of hrt? All three methods of HRT delivery: HRT tablets, transdermal HRT patches, and topical HRT gels are effective at managing menopause symptoms. The effectiveness of the treatment is more likely to be linked to the formulation of HRT or the dose rather than the form. The form of HRT is more important in personalising the HRT treatment plan to take into account the individual’s health needs, past medical history (e.g migraines, high blood pressure), any regular specialist or general health medicines, family history (history of cancer e.g endometrial cancer, breast cancer), side effect risk, convenience, and personal preferences.
Crucially, the best hrt method is the one that is the most beneficial and safe for you. There are certain general side effects like headaches or irregular vaginal bleeding that may occur when using any HRT form and breast tenderness is more likely if the HRT contains progesterone. However, some side effects associated with each HRT form (tablet vs patch vs gel) are slightly different even if the medication or active ingredient they contain is the same. For example:
| HRT form | Side effects and risks associated with this form of HRT |
| HRT tablet | As tablets have to pass through the digestive system, they may cause more systemic side effects such as nausea or indigestion. Some people report a decrease in libido as well.
There is also an increased risk of developing blood clots when taking oral HRT tablets; this is notable as it may increase the risk of stroke or pulmonary embolism. |
| Transdermal HRT patch | As the transdermal patch does not go through the digestive system, it is less likely to lead to stomach upset, however there is a risk of redness or irritation of the skin at the site the patch is applied. However, the patch does not increase the risk of blood clots. |
| Topical HRT gel | The HRT gel also does not go through the digestive system so it is unlikely to lead to nausea or indigestion. There is a risk of skin becoming irritated or itchy when the gel is applied. Some people report that the gel feels sticky or greasy which makes it uncomfortable. Similarly to the transdermal patch, using the topical HRT gel is not linked to a higher risk of blood clots. |
The approach to treatment of menopause symptoms with HRT is to start on the lowest effective dose and adjust depending on response to treatment (e.g benefits, side effects). Finding the best HRT treatment plan including which form to take is a decision that requires doctors to weigh up several factors including:
Overall, the question of which is the best hrt does not have one simple answer. There is a wide range of HRT formulations (e.g active ingredient and dose combinations) and you can browse through a selection here at Meds for Less. However in terms of method of delivery, there are three main ones. These are tablets, transdermal patches, and gels. As discussed in this article, there are several pros and cons to each one of the three forms of HRT. For example, tablets are simple and accessible but come with a risk of blood clots.
Before you start on any HRT, you should have a discussion with your doctor to go through different factors (e.g pre-existing medical conditions, personal preferences) that may affect the HRT option you take. After you start, you should have regular reviews with your doctor to assess your response to treatment and ensure that the benefits still outweigh the risks. At these reviews, you can discuss any concerns or questions you may have such as considering gel and tablet hrt in your case.