From the Guidelines
For perimenopause hormone replacement therapy (HRT), estradiol patches are generally recommended over pills due to their ability to provide more stable hormone levels and bypass first-pass liver metabolism, reducing clotting risks 1. Patches are preferred because they:
- Provide more stable hormone levels
- Bypass first-pass liver metabolism, reducing clotting risks
- May have a lower risk of side effects However, some women may prefer pills for convenience. If choosing pills, start with a low dose like 1-2 mg daily, as indicated by the study 1. Regardless of form, estradiol should be combined with cyclic progesterone (if you have a uterus) to protect the endometrium. The study recommends using progestins like medroxyprogesterone (MP) as the first choice, with a dose of 200 mg for 12-14 days each month 1. It's essential to start with the lowest effective dose and increase as needed for symptom relief. Regular follow-ups with your healthcare provider are crucial to monitor effects and adjust treatment. The dose of 17βE (estradiol) should be adjusted according to each woman's tolerance and feeling of wellbeing, and HRT in perimenopause should be continued until the average age of spontaneous menopause (45-55 years) 1. Ultimately, HRT decisions should be individualized based on your symptoms, medical history, and preferences, and it's crucial to consult your doctor before starting any HRT regimen.
From the Research
Comparison of Estradiol (E2) Pill and Patch for HRT in Perimenopause
- The efficacy and safety of oral and transdermal estradiol in alleviating menopausal symptoms have been compared in several studies 2, 3.
- Transdermal estradiol (TE) application is now a preferred route of hormone therapy (HT) in menopausal women, as it reduces various risks such as venous thromboembolism, stroke, and unwanted hepatic effects compared with oral HT 4, 5.
- A study comparing oral estradiol versus transdermal estradiol found that both treatments were effective in relieving menopausal symptoms, with little difference in treatment efficacy and safety 2.
- Another study compared the efficacy, safety, and tolerability of an oestradiol gel with those of an oestradiol delivering patch and found that both treatment regimens were equally effective in alleviating climacteric symptoms and preserving bone mineral density 3.
- Transdermal hormone replacement therapy has been shown to be effective in reducing vasomotor symptoms in perimenopausal women, with a significant decrease in the average number of vasomotor symptoms per day 6.
- The choice between oral and transdermal estradiol may depend on individual patient factors, such as the presence of an intact uterus, which requires concurrent administration of progestogen for endometrial protection 4, 5.
Key Findings
- Transdermal estradiol is a preferred route of hormone therapy due to reduced risks compared with oral HT 4, 5.
- Both oral and transdermal estradiol are effective in relieving menopausal symptoms 2, 3.
- Transdermal hormone replacement therapy is effective in reducing vasomotor symptoms in perimenopausal women 6.
Considerations for HRT
- The selection of the most appropriate progestogen and dosing for individual combination therapy can be difficult due to the variety of progestogens available and differences in their clinical effects 4.
- Transdermal preparations are worth consideration due to less adverse effects, such as the avoidance of liver metabolism and accumulation of metabolites with antiestrogenic activity 5.