Ok,first things first - do you still have a womb? It's a bit of a random question, but here's why it matters.
If you still have a womb, even if your periods stopped long ago or even if they're still around or being very erratic - having a womb in HRT terms means that you will require progesterone alongside oestrogen for your HRT. Oestrogen will work on your symptoms while progesterone will work mainly on your womb lining to keep it thin and healthy while you're using the oestrogen. Without progesterone your womb lining could over thicken and lead to cellular changes taking place which could progress (if left unchecked ) and lead to cancer.
Progesterone is available to use as a small, round capsule known as Utrogestan/Gepretix which you usually take at bedtime. It's also available in tablet forms - Provera and Dydrogesterone ( which has recently become available to be used as a standalone cyclical option ) and these are popular options for this. It also comes in the form of an IUS ( hormonal coil ) - sometimes called a Mirena although there are now other brand names for this which provide the same dose of progestogen. Whichever progesterone you choose, it's important that you use it consistently and as prescribed alongside your oestrogen.
Tablets
HRT tablets will contain oestrogen and sometimes progestogen too, making them suitable for women with or without a womb. Oestrogen tends to be the hormone which tackles your symptoms and makes you feel better overall while the progesterone part of HRT works to keep your womb lining thin and healthy and reduces the risk of it over-thickening which may lead to cellular changes.
Separate progesterone tablets/capsules are also available, and are used in conjunction with oestrogen
which can be taken by tablet or applied like a patch, gel or spray.
You can take HRT tablets at any time of the day or evening, with or without food.
Tablets containing oestrogen are low risk for most women but they do carry a very small increased risk of blood clot (thrombosis) and stroke which for most healthy women without any risk factors, is not significant.
Pre existing risk factors which you may have include being a smoker, being quite overweight, having high blood pressure ( and untreated ), recent blood clots or being physically less mobile.
If you have risk factors, you will be advised to avoid oestrogen tablets and to consider transdermal preparations instead ( patches, gels or the spray all of which are equally as effective )
Gel forms of oestrogen
HRT gel is applied daily to the upper arms or to the upper, inner thighs. You apply it as a thin wet layer and allow it to dry for several minutes before getting dressed. Your skin needs to be dry and un-moisturised before applying the gel, but once the gel is completely dry you can use any lotions or creams on top of it.
It takes 5-10 minutes to absorb usually. We normally advise waiting an hour or two before you go swimming or to have a shower. Some people prefer to apply their gel in the morning rather than just before bed, as they feel more alert and awake once they’ve applied it.
Gels only contain oestrogen so if you have a womb, you will need to add progestogen, either by tablet/capsule or by using a hormonal coil (such as the Mirena).
There are currently two types of oestrogen gel on the market - Oestrogel and Sandrena and they're as effective as each other.
One comes in a pump ( Oestrogel ) and Sandrena comes in sachets.
Patches
Patches can contain oestrogen alone or be combined to contain both oestrogen and progestogen, and they can be used by most people.
You apply one to the buttock, upper outer thigh or lower tummy ( anywhere below the waist ) and change it usually twice a week, depending on the brand.
They usually stick well and you can swim or shower/ bathe with them on and they rarely cause skin irritation. Patch size will depend on the dose and brand of the one you are prescribed.
Patches can leave behind a black residue around the edges after removal and this is best removed with baby oil or plaster remover such as Zoff wipes.
Occasionally women find the patches difficult to keep stuck onto the skin, resulting in the hormones not being absorbed as well as they should, and this can lead to the product being less effective for you. Should you feel that they're not sticking, or partially coming away from the skin, you could consider switching to something else like a gel or spray OR some people notice that a different brand of patch sticks better for them. Popular brands include Evorel and Estradot.
Look out for a new combined Estradot patch coming soon!! ( "Estradot Conti" )
Oestrogen Spray
Oestrogen spray is applied to the inner lower arm, and comes in a pre-filled device. It then absorbs into the skin, a bit like the gel but it dries more quickly.
Once applied to the skin simply give it a little waft of air to help it dry and then cover the area once it's completely dry to avoid any transference to the kids or to our beloved "furry kids"!
You can use it at different doses as prescribed. The maximum licensed dose for the spray is up to three sprays daily. The spray only contains oestrogen so again, progesterone is needed if you have a womb.
Be sure to use the little chart on the side of the box to tick off your sprays so that you know when you're running out as it can be tricky to tell how much is left in the device.
So which one is the best???
Each of the products above are equally as good as the other. It's all about finding the right product that suits you practically, and the product you feel you get the most out of in terms of symptomatic relief. We can absorb less or more from some products compared to others even when we use them at the same doses, so find which one suits you best and stick with it if you can.
While one woman might like to apply the gel once a day, others might not like waiting for it to absorb or even have the time to wait for that to happen.
Others might like the convenience of a patch which is applied twice a week, while some might not like the sticky mark they leave behind and having to remove them.
In all honesty, it's really just trial and error and if you don't like one - you can always look at choosing something different. Speak to us today about all the options. It's easy to book in with us - just visit www.yourmenopausenurse.co.uk and click on any Book a Consult boxes.
P.S We don't actually know why there's a sprout on one end of the lollipop in the picture. We liked the background colour.
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