From the Guidelines
Hormone replacement therapy (HRT) patches containing estrogen and/or progesterone suppress luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels through negative feedback on the hypothalamic-pituitary axis. When applied to the skin, these patches deliver hormones that mimic natural estrogen and progesterone, causing the pituitary gland to reduce its production of LH and FSH. This suppression is particularly pronounced with estrogen-containing patches, which can significantly lower FSH levels from the elevated ranges seen in menopause (often >40 mIU/mL) to near-premenopausal levels. The degree of suppression depends on the patch's hormone concentration, with higher doses causing more substantial reductions. Patches typically contain estradiol in doses ranging from 0.025 to 0.1 mg/day, with some including progestins like norethindrone acetate.
Mechanism of Action
The mechanism of action of HRT patches involves the delivery of hormones that mimic the natural estrogen and progesterone produced by the body. This leads to negative feedback on the hypothalamic-pituitary axis, resulting in the suppression of LH and FSH production. The suppression of LH and FSH is a desired effect in some cases, such as in transgender individuals using HRT patches as part of gender-affirming hormone therapy.
Key Considerations
- The use of HRT patches should be individualized, taking into account the specific needs and health status of each patient 1.
- The lowest effective dose should be used for the shortest possible time to minimize the risk of adverse effects 1.
- Patients should be closely monitored for any changes in their health status, including the development of adverse effects or the presence of any underlying medical conditions that may be affected by HRT.
Conclusion Not Applicable - Direct Answer Only
As per the provided guidelines, the focus is on providing a direct answer based on the strongest and most recent evidence, without including a conclusion section. The information provided is intended to guide clinical decision-making, prioritizing morbidity, mortality, and quality of life as outcomes.
From the Research
Effect of Hormone Replacement Patch on LH and FSH
- The use of hormone replacement therapy (HRT) by transdermal estradiol patches has been shown to decrease luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in perimenopausal women 2.
- A study found that 6 months of HRT using transdermal estradiol patches and oral progestogens resulted in a significant decrease in LH and FSH levels, as well as an improvement in menopausal symptoms 2.
- In contrast, testosterone replacement therapy has been shown to suppress FSH and LH levels, with longer-acting formulations having a greater suppressive effect than shorter-acting formulations 3.
- The effect of hormone replacement therapy on LH and FSH levels can vary depending on the type and duration of therapy, as well as individual factors such as age and menopausal status 2, 4.
- Other factors, such as ghrelin, have also been shown to suppress LH and FSH secretion in women, highlighting the complex regulation of these hormones 5.
- Steroid hormones, including estradiol, can have a direct effect on the secretion of FSH and LH, with estradiol increasing pituitary sensitivity to gonadotropin-releasing hormone (GnRH) and altering the expression of genes involved in FSH and LH synthesis and secretion 6.