How HRT Is Administered: Application
Estrogen may be given in five ways:
- Oral pills
- Intramuscular injections
- Transdermal Patches
- Subcutaneous pellets
- Vaginal Hormone Creams
Each method has its advantages and disadvantages. These are discussed below.
|Micronized estradiol (Estrace)|
|Esterified estrogen (Estratab)|
|Conjugated equine estrogens (Premarin)|
|Estropipate (Ogen, Ortho-Est)|
|Ethinyl Estradiol (Estinyl)|
Estrone (Premarin, Ogen and other brands) is the most popular oral estrogen, but
estradiol (Estinyl, for instance) is gaining in popularity. Both are effective and
generally well-tolerated. For a variety of reasons some women are unable to take oral
estrogen. And in some rare cases, oral estrogens are ineffective and useless.
Many people find the pill form very convenient as it is something they are comfortable
with. However, it may not be the most efficient form of introducing hormones where you
want it to be.
Many pills disintegrate in the stomach, and may not enter into your system. Newer
micronized products in oil base help protect the product from the acids in the stomach and
helps the hormone make its way intact into your system for a better blood level.
The daily dosage is much higher than in the cream form. The higher amount is necessary
to compensate for the large percentage that is excreted by the liver. The absorption of
the pills depends on many factors including how well your digestive system is operating
and the health of your liver. All these factors requires that the oral dose be higher than
the transdermal doses to create the equivalent biologic effects.
|Highly effective in combating physical and emotional symptoms.|
|Tablets containing estrogen, progesterone, and testosterone are available.|
|The appropriate dose will offer a high level of protection against osteoporosis.|
|You can stop taking it immediately if it doesn't suit you.|
|You are responsible for your own medication.|
|You may experience side effects such as breast tenderness, nausea, headaches and
digestive irritation and swelling|
|You may experience breakthrough bleeding if you forget to take a tablet.|
|May be unsuitable if you have a history of high blood pressure, blood clotting, or liver
|estradiol cypionate (Depo-Estradiol )|
|estradiol valerate (Delestrogen , Estraval)|
Estradiol in oil is most commonly used since it is absorbed slowly and needs be given
only at 2 to 4-week intervals. Injected estrogen goes directly into the circulation
without first passing through the liver. This has both good and bad effects. There is also
some question about the predictability of absorption rates. The main drawbacks of
intramuscular injections, however, are the discomfort of regular injections plus the peaks
and valleys of estrogen levels that such a system inevitably produces.
|transdermal estradiol (Estraderm, Climara)|
A medicated adhesive is attached to your abdomen, where it releases estradiol, a pure
form of estrogen thought to be less cancer causing. Estradiol bypasses the liver and is
best for women who can't take HRT orally but who have severe hot flashes and vaginal
problems. The patches are worn constantly (below the waist and, by many women, on the
buttocks and flanks) and are changed twice weekly. With this method, the estrogen is
released through the skin in a consistent manner. The alcohol in the patch drives the
hormone through the skin and into the blood vessels.
Their distinct advantage of the patch form is that it introduces a relatively constant
and even flow of estrogen into the body day and night, with no peaks or valleys and, thus,
fewer side effects related to over or undersupply. Early studies indicate that the patch
may protect the bones and heart.
The major problem with patches at this time is that a significant number of women
develop skin irritation and may be forced to discontinue their use.
|As effective as oral HRT in treating most menopausal symptoms.|
|Preserves bone in 85-95 percent of women. Easily changed and simple to stop using if you
decide to discontinue treatment.|
|Since the dose of hormone is absorbed very gradually, the patch has fewer side effects
than some other routes of administration.|
|A very few women develop red, itchy skin at the site of the patch. This may get worse in
a hot climate.|
Pellets of estradiol are inserted beneath the skin- subcutaneously-under a local
anesthetic. There are several problems inherent in this technique.
The duration of action is variable. Could be as long as 6 months. The pellets are
difficult to remove should they prove disagreeable in any way.
|Excellent relief from physical symptoms. Some women find that problems such as
depression and irritability disappear more readily than with other forms of
|You can forget you are on HRT because the implants are changed so infrequently.
Testosterone can also be given as an implant. Protection against osteoporosis is high.|
|Wrong doses cannot be adjusted.|
|Some women experience symptoms at ever-decreasing intervals too frequent implants
lead to hormone overdose. If you decide to stop using HRT, implants are difficult to
|You need a minor surgical procedure for insertion of the implant.|
|Some people experience severe side reactions that may not be correctable - excessive
weight gain, extreme inflammation of the breast, etc.|
Vaginal Hormone Creams
|17 beta-estradiol (Estrace)|
|Vaginal Cream estropipate (Ogen)|
|Vaginal Cream conjugated equine estrogens (Premarin)|
|Vaginal Cream dienestrol (Ortho Dienestrol Cream)|
|dienestrol (Estragard Cream)|
The creams are the most convenient form of application. It can be often applied locally
to the vaginal wall making it thicker, more elastic, and less susceptible to infection. It
increases lubrication and relieves dryness and itching. Effects may be noticed in less
than a week. You can use cream on and off and resume treatment when symptoms return. Even
though it is applied locally, the estrogen is still absorbed into the system and carries
the same risks as estrogen taken in pill form. The amount absorbed will be relatively low
if the cream is used infrequently (two or three times per week) or for short periods of
time. There is evidence that at low doses, as little as one-eighth of that usually
recommended for vaginal dryness, the estrogen cream can be effective. For women using
estrogen cream who have not had a hysterectomy, progesterone may still be necessary to
cause menstrual bleeding and prevent uterine cancer.
|Helps to alleviate slight incontinence.|
|Creams containing estrogen and progesterone are available. Easy to apply.|
|Eliminates vaginal dryness and irritation.|
|Does not protect against osteoporosis.|
|Not effective in combating hot flashes and night sweats. |
Next Topic: How HRT
Is Administered: Application of Progesterone/Progestin
[Menopause and HRT
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