HRT has been available to women in the UK to treat menopause symptoms since 1965 although the road to making it widely available and gaining trust from women and doctors has been a bit of a bumpy road.
Today we have access to both continuous combined hrt ( both oestrogen and progesterone supplementation) and oestrogen only hrt.
In this article we're going to look at a brief history of hrt, the different ways of taking hrt, hrt patches, how they're used, which type of hrt may be more suited to you, associated risks and benefits and what to do when they come unstuck!
A short history of hormone replacement therapy
HRT was first introduced to the USA public as Premarin, and was marketed to women ( and men) as pills which could help to make women 'pleasant to live with again'. Yeah..charming...
Hormone replacement therapy was made available in the UK
The Women's Health Initiative in the USA started a clinical trial investigating the effects of women taking hrt. The study compared women taking either oestrogen-only HRT or continuous combined HRT, compared to women taking an identical placebo. The Million Women Study in the UK also starts, collecting questionnaires on HRT use and its effects on certain issues of women’s health.
The WHI study stopped the combined HRT arm of the study's stopped prematurely based on the findings and concern about the increased risk of heart disease, breast cancer, heart disease, stoke and blood clots.
The Million Women Study published it's findings that the use of HRT, specifically oestrogen-progestogen combinations is associated with an increased risk of incident and fatal breast cancer. The Women's Health Institute in the USA finishes the oestrogen-only part of the HRT study, finding a small risk of stroke but beneficial downward trends re breast cancer and heart disease.
Both doctors and women are confused regarding safety issues and what followed was women being encouraged to come off hormone replacement therapy hrt. The resulted in women stopping hrt immediately which caused severe reactions. Imagine being plunged right back into menopause symptoms with hot flushes, night sweats and other symptoms - must have been tough !
HRT users fall from 2 million to less than 1 million in the UK because both women and doctors are wary of the risks. New findings based on an investigation of the WHI studies show women 50-59 using Hormone replacement therapy hrt or for those less than 10 years past the menopause have a LOWER risk from heart disease and no increased risk from stroke.
Further studies show use of combined hrt for 10 years by menopausal women shows a reduced risk of heart disease and death. Another report from The Million Women study showed no increased risk of deep vein thrombosis (blood clots) with use of transdermal (skin patch or gel) oestrogen HRT.
Experts from the British Menopause Society, the International Menopause Society and others, based on the findings of these studies which overturned the previous findings re risk factors of the WHI and MWS studies and considered them flawed.
The different ways of taking hormone replacement therapy (HRT)
HRT consists of two hormones – oestrogen (estradiol) and progestogen. Oestrogen manages most menopause symptoms, and progestogen, the synthetic form of progesterone, protects the lining of the womb.
Hormone replacement therapy hrt can be taken in many different combinations and dosage strengths as every woman's menopause will be unique. Products can be used to address needs at any stage.
These include oestrogen pumps, oestrogen patches, oestrogen gels, can be administered via a vaginal ring, a spray or an oral tablet , though this is now much less common.
Vaginal creams and vaginal tablets ( localised oestrogen) can be bought in chemists without a prescription to combat vaginal dryness. Hrt over the counter, how effective is it?
If you are taking combined hrt the oestrogen and progestogen units are taken separately. Eg mirena coil and oestrogen spray. There are some patches and pills that have both oestrogen and progestogen but can cause bloating, breast tenderness and mood swings because they contain synthetic progestogens.
Progestogen can be taken as a pill/tablet or via the Mirena coil which is an intrauterine system which sits in the uterus and releases progestogen over 5 years.
Sequential or cyclical progesterone
This is where HRT is taken in 28 day cycles. Oestrogen is used every day but progestogen is only used for 10-14 days of the cycle along with the oestrogen.
Testosterone can be taken as a cream or a hrt gels and is helpful for women who are still struggling with a low sex drive, brain fog and fatigue. 2023 testosterone for women is still unlicensed in the UK although GPs and menopause specialists do prescribe testosterone for men to women.
The National Institute for Health and Care Excellence has recommended it for low sex drive as part of an HRT program. Testosterone for women - Androfeme - has been licensed in Australia and is available in the UK via some private hospitals or a specialist doctor.
HRT tablets are taken once a day and are available as oestrogen only tablets and combined tablets. Tablets an carry a higher risk of blood clots than other forms of hrt like gels and patches. Consult your doctor about the risks of hrt tablets.
Hormone replacement therapy risks
HRT treatment is not totally risk free.These diseases are reported more often in women using HRT compared to women not using HRT BUT levels of risk are based on HRT combinations, personal history, when you start hrt and how long you are on HRT.
- breast cancer
- endometrial hyperplasia or cancer
- blood clots
- heart disease
If you still have a womb (you haven’t had a hysterectomy) and you take oestrogen by itself, it can thicken the lining of your womb, increasing your risk of womb cancer.
There is a small risk of breast cancer but this needs to be balanced with the decreased risk of heart disease and osteoporosis, dementia and strokes. Talk to your doctor about the risks.
What are hormone replacement therapy HRT patches?
HRT skin patches deliver hormones transdermally - through your skin. They are applied below the waist and release a small amount of oestrogen in oestrogen-only patches or both oestrogen and progestogen in combined patches.
Are all hrt skin patches the same?
Oestrogen only patches help to improve menopause symptoms and the combined patches help to improve menopause symptoms and protect the lining of the womb.
What are the benefits of HRT patches?
HRT patches replace the hormones you lose during perimenopause and menopause. They are an effective treatment and help to relieve symptoms which arise when progesterone, testosterone and oestrogen levels decline and there is a hormone deficiency.
Which menopausal symptoms can patches alleviate?
Menopausal symptoms which can be improved if not stopped by hrt patches include hot flushes and night sweats, fluid retention, mood swings, breast tenderness, anxiety, stress and bloating. Every woman is different though.
Women taking HRT patches have some added protection for their long term health. Protection of the womb lining ( the combined patch) and a decreased risk of osteoporosis, diabetes, dementia and cardiovascular disease.Read more about menopause and heart health.
What about the side effects of HRT patches?
Common side effects of patches affecting around 10% of women include
- red skin or irritation at patch location
- breast pain
- rashes and itchy skin
- feeling dizzy
- joint pain
- weight gain
How do you use HRT patches?
Patches are changed twice a week on the same days of the week, on a 3 and 4 day cycle. So Mondays and Fridays for example. There is no break between one box and the next - you start a new pack as soon as you have finished an old one so you have a steady supply of hormone.
Patches need to be put on clean dry skin which is free from moisturisers. Do not use patches on damaged skin, anywhere near the breasts, on cuts or spots. Patches need to be rotated on the skin - so keep changing the areas where you apply the patch. Read the instructions that come with your patches.
What do you do if they become unstuck?
It's quite common for patches to come unstuck. Although they are to withstand daily showering and swimming they can become unstuck. This happens especially if you are in a humid environment or a hot climate. If you patch comes off - try sticking it back on immediately - sometimes it will adhere to your skin. If it doesn't then replace the patch with a new one BUT stick to your normal changing routine.
Are adverse reactions common with skin patches?
Irritation on the area of application is common with skin patches.To keep skin irritation to a minimum keep rotating patches so one area isn't constantly the area you use to absorb the hormones.
Why are patches used below the waist?
HRT patches are applied below the waist because
- There is a small risk that HRT can cause breast cancer in women so patches need to be kept away from breast tissue.
- The inner thigh and buttocks have more fatty tissue which absorbs the hormones better.
Using patches after a hysterectomy
If you have had a full hysterectomy where your womb and ovaries were removed you will be prescribed oestrogen only hrt and wont need the progestogen hormone.
How long do HRT patches take to work?
You may feel a little different during the first few weeks of using hrt patches but as with most HRT, it can take up to 3 months to feel the full benefits.
You can use HRT patches for years
It's common to take HRT for between 2 and 5 years to treat menopause symptoms, but you may need to take it for longer. To protect against osteoporosis you need to take HRT for 5 years. Talk to your doctor about the benefits and risks of using the HRT patches for longer.
Patches won't be the best choice for all women
No, a hrt patch may not suit some women based on their medical condition or medical history.
They are not suitable for women who have or have had breast cancer, who have cancer of the womb lining (endometrium) or an excessive thickening of the womb lining ( endometrial hyperplasia).
Patches are not suitable for women with unexplained vaginal bleeding, those who have had heart attacks, strokes or angina. Consulting with your doctor is the best way to decide whether you are a suitable candidate for patches.
And if you're not a suitable candidate? There are options to help you to fight menopause weight gain and target symptoms by changing your diet and making sure you get enough exercise.
How to access HRT patches
Hormone replacement HRT patches need to be prescribed by your doctor or health professional. They cannot be bought over the counter like other hrt medication ( vaginal dryness can be addressed with oestrogen based suppositories which can be purchased in a chemist)
Common brands of HRT patches available in the UK
Common oestrogen patches in the UK include Evorel conti patch , Everol patch, Estraderm Patch, FemSeven and Progynova patches.
Non-medicinal alternatives for the symptoms of Menopause
Some women can't use hormone replacement therapy or hrt patches but there is plenty you can do to improve symptoms of low oestrogen without replacing hormones. Exercise, natural supplements and diet can help to minimise symptoms and manage weight gain in menopause.These can include
- Knowing how many calories your body needs to stay healthy and to avoid becoming overweight
- Eating less red meat to manage cholesterol and the risk of heart disease which increases with age
- Have plant based diet days to ensure your diet is nutrient rich
- Increasing your fibre intake to manage constipation and bloating
- Limiting coffee and alcohol to aid better sleep and help to minimise hot flashes.
- Using intimate moisturisers or pessaries to keep vaginal tissue supple and comfortable.
- Exercising to offset lean muscle mass loss and to counteract a slower metabolism
Eve Biology Meal Replacements have been formulated to help women in menopause fight weight gain and target menopause symptoms. A clinically proven prebiotic fibre helps to increase good gut bacteria to specifically support hormone regulation and immunity. 100% plant based and made to EFSA standards, they can be used with or without HRT.
The bottom line
Hormone replacement therapy for women has many benefits although the medical establishment has had its challenges re research and risk management. HRT patches are a good option if you are struggling with menopause symptoms and their risks outweigh the benefits for some women, although this needs to be evaluated with a medical professional or doctor. Be sure to read the patient information leaflets so you are aware of and side effects and risks.