From the FDA Drug Label
Estradiol Tablets should not be used during pregnancy (See CONTRAINDICATIONS). Known or suspected pregnancy. There is no indication for estradiol tablets in pregnancy
The use of estrogen and progesterone in Hormone Replacement Therapy (HRT) is generally contraindicated in pregnancy. Pregnancy is a contraindication for the use of estradiol tablets. However, the labels do not directly address whether a patient on HRT with an estrogen patch and progesterone can become pregnant.
- The labels state that estrogens should not be used in individuals with known or suspected pregnancy.
- They also mention that there is no indication for estradiol tablets in pregnancy.
- It can be inferred that pregnancy is not expected to occur while on this medication, but this does not directly answer the question of whether pregnancy can occur.
- The labels do not provide information on the effects of HRT on fertility in childbearing-age women. 1 1
From the Research
Yes, a patient of childbearing age on Hormone Replacement Therapy (HRT) with an estradiol patch and progesterone can still become pregnant. HRT is not a contraceptive method and does not prevent ovulation or fertilization, as supported by a study from 2. While HRT supplements hormones and may affect menstrual cycles, it doesn't reliably suppress ovulation like hormonal contraceptives are designed to do. The estradiol patches and progesterone used in HRT are typically prescribed at physiologic replacement doses rather than the higher doses found in contraceptives specifically formulated to prevent pregnancy. Some studies, such as 3, have shown that patients on HRT can achieve high ongoing pregnancy rates with appropriate management, highlighting the potential for pregnancy in these patients. If pregnancy prevention is desired, patients on HRT should use a reliable form of contraception such as barrier methods, hormonal contraceptives, or intrauterine devices. Additionally, becoming pregnant while on HRT could potentially expose a developing fetus to hormone levels that aren't recommended during pregnancy, so patients should discuss family planning with their healthcare provider to determine appropriate hormone management if trying to conceive. Key considerations for patients on HRT who wish to become pregnant include:
- The potential need for adjusted hormone management to support a healthy pregnancy
- The importance of discussing family planning with a healthcare provider to determine the best approach
- The use of reliable contraception to prevent unintended pregnancy until the patient is ready to conceive. It's also worth noting that some studies, such as 4, have explored the use of transdermal contraceptive patches, which may be a convenient option for some patients, but are not directly relevant to the use of HRT for pregnancy prevention. Overall, patients on HRT should be aware of the potential for pregnancy and take steps to prevent or plan for it as needed, prioritizing their morbidity, mortality, and quality of life outcomes.