When it comes to menopause, there’s some good news and some not-so-good news. While waving goodbye to your period no doubt feels liberating, all the other stuff that can come with this particular stretch of life, from hot flashes and mood swings to brain fog and sleep issues, aren’t exactly what we’d call a fun time. Now, for the good news: You don’t have to struggle through symptoms as the years go by. These days, there is a wide variety of science-backed options to treat menopause symptoms, including estrogen patches, that can work wonders for your body, mind, and mood.
Hormone replacement patches, also called estrogen patches, are one form of hormone replacement therapy (HRT) that has been proven to be effective at managing many of the more frustrating symptoms of menopause.
While there are several different types of HRT, you may hear about it as a pill or a patch first. “The decision to take an oral estrogen versus using a patch, or even a skin gel or spray, is not just about personal preference, insurance coverage and convenience, it’s also about safety,” says Midi’s Medical Director of Community Education and Outreach Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. “It’s about potential risks and your personal medical history. And you should know those differences so you can participate in that decision.”
Read on to learn more about the benefits of estrogen patches for menopause.
Hormone replacement therapy, sometimes referred to as menopausal hormone therapy or MHT, is a treatment used during perimenopause and menopause to replenish hormones, namely estrogen and progesterone, that naturally decline as your reproductive years wind down. The name is a bit misleading—you’re not replacing any hormones in your body as much as you’re supplementing them as they decline. HRT is the most effective treatment for managing menopause symptoms that result from the rapidly fluctuating changes in estrogen and progesterone.
What many women don’t realize is that we have estrogen receptors all over our bodies. So it’s not just wonky periods or breast changes we’re contending with. There are estrogen receptors in our brains and bones as well as our skin and hair. That’s what can make estrogen withdrawal so frustrating—as our levels rise and fall unpredictably, we’re met with a confounding array of symptoms that deserve our attention.
Enter HRT. It works by releasing estrogen into the bloodstream or vaginal tissue, and is available in many forms, including:
Unless you’ve had a hysterectomy, clinicians add progesterone or progestin to estrogen. This is necessary because, while estrogen is effective in alleviating symptoms, it can also thicken the uterine lining (which is called endometrial hyperplasia), increasing the risk of uterine cancer. Adding progesterone to HRT for any patient with a uterus is key because it controls thickening and sends the risk for developing uterine cancer back to baseline. For those without a uterus, certain forms of progesterone may still be recommended to help improve symptoms like sleep issues and night sweats.
Tune in as Midi’s Chief Clinical Officer, Mindy Goldman, MD, a practicing OB/GYN at the University of California, San Francisco (UCSF) for almost three decades, answers the most common HRT questions she gets from patients, including top patch questions.
Hormone replacement patches, sometimes called estradiol patches or HRT patches, are thin, adhesive patches applied to the skin. They can contain only estrogen (estradiol) or a mix of estrogen and progestin (norethindrone). HRT patches are one of the most commonly prescribed first-line therapies for many women beginning HRT for menopause because they may have milder side effects than you might experience with other delivery methods, like estrogen pills.
Estrogen patches are a form of transdermal (which literally means “through the skin”) hormone therapy—the patch is placed on the lower abdomen or upper buttock area, and delivers hormones through the skin and into the bloodstream at a consistent level.
There are two main types of menopause patches:
HRT patches come in a variety of doses and are usually applied once or twice a week, depending on your treatment plan. Place your patch on your lower abdomen on clean, dry skin (no powder or lotion, please). When it’s time to change your patch, move it to another spot in the same general area for best absorption. Do not place a patch in the same exact location for at least a week.
Some patches can be applied to the upper buttocks (check the package insert to see if this is true for the patch you’re using). But once you’ve chosen an area of the body to use for your patch—either the lower abdomen or the butt—stick with that area for consistent absorption.
“Most of the oral, and all of the transdermal estrogens have the exact same form of estrogen—a plant derived, bioidentical beta estradiol,” says Dr. Streicher. “The differences between the two comes down to how your body metabolizes the estrogen, which is determined by if it is absorbed through the skin as opposed to making the trip through your gastrointestinal system.”
Oral estrogens travel through the stomach, into the intestines, and then get metabolized by the liver. Transdermal estrogens, on the other hand, get absorbed through the skin when applied to your thigh or arm and then are released directly into the bloodstream. They are not metabolized by the liver. That trip through the liver is what results in risk factors that are unique to oral estrogen.
Risks that are specific to oral estrogen products, that do not occur in transdermal estrogen, according to Dr. Streicher, include:
An Increase in triglyceride levels, which in turn increases the risk of blood clots including:
But this information isn’t intended to scare you off pills.
“Most low-risk women do just fine taking pills,” says Dr. Streicher. “The risk of developing a blood clot when taking postmenopausal estrogen is really small—and much smaller than if someone is taking birth control pills, which most women don’t hesitate to do.”
HRT patches offer several advantages over other forms of hormone therapy. Here’s how they may benefit you:
All forms of HRT can come with some side effects. While using patches, some women may experience:
Skin irritation can happen due to the adhesive used in patches. Let your healthcare professional know if you’re noticing skin changes or discomfort. One simple way to combat this is to apply a small amount of 1% hydrocortisone cream where you plan to put your patch. Let the cream absorb completely before placing your patch so it doesn’t slide off.
It’s possible your HRT patch could fall off, but transdermal patches are made to withstand these types of activities. It’s perfectly okay to swim, sweat, shower, go in a sauna or jacuzzi while wearing a transdermal patch. However, if you exercise frequently, check your patch every day to be sure it hasn’t fallen off. If it has, you can replace it in the same area with a new one.
It’s a common worry, but you don’t need to stress. You can try re-sticking it or wait to apply a new one when it’s time for your next patch. Midi’s Chief Brand Officer and patch user, Jill Herzig, explains why there's no reason to panic:
@midihealth It’s no sweat if your estrogen patch falls off 😅 While Midi’s Chief Brand Officer *and* patient Jill Herzig was traveling, she goofed and forgot to bring an extra patch, so when hers fell off, she had to go without for a few days. That triggered an immediate wave of mild symptoms like trouble sleeping and a hot flash after her morning coffee. The good news: She was met with immediate relief when she replaced her patch. Estrogen patches are a type of transdermal hormone therapy that ensures a consistent release of estradiol (a form of estrogen) through the skin. One of the advantages of that skin contact: The estradiol is absorbed directly into your bloodstream, meaning stable estrogen levels and quick symptom relief. Important reminder: Every menopause journey is different. Your HRT prescription should be tailored to your specific symptoms and needs – including your lifestyle and habits. Book your virtual Midi visit today to start the conversation about the best HRT routine for you. #JoinMidi #MidiHealth #midlifecare #perimenopause #perimenopausehealth #womenshealth #perimenopausesymptoms #perimenopausal #womenover40 #womenover35 #hormonetherapy #estradiolpatches #estradiol #hrt #menopausesymptoms ♬ original sound - Midi Health
Need more tips on getting your patch to stay put? Board-certified OB/GYN Mary Claire Haver, MD, a fellow of the American Congress of Obstetricians and Gynecologists (FACOG) and author of the bestselling book The New Menopause, shares her best advice::
@drmaryclaire #answer to @jennfmikels #hrt #hrtiktok #hormones #hormonesupport #menopause #womenover40 #pauselife #galvestondiet #menopausesupport ♬ original sound - The Pause Life
Nope, there’s no major difference between a brand name patch and a generic one, though some patients report differences in the adhesive used. The biggest difference you’ll see is with cost. Patches can range in cost from less than $40 per pack to more than $250, depending on the brand and dosage. That said, if you do notice issues, talk to your healthcare team about switching to a different brand or trying a different dose to see if that provides better relief.
It happens! And unlike birth control pills, missing a single swap isn’t a big deal. Just swap it out as soon as you remember and return to your usual schedule. You might experience a temporary uptick in symptoms (sometimes as soon as one day after a missed dose), but you should normalize quickly once you’re back on track.
Estrogen patches are generally considered safe for most women when used as directed. The transdermal delivery method offers several safety advantages, including a lower risk of blood clots compared to oral estrogen. However, like all medications, estrogen patches are not without risks, and they should be used under the guidance of a healthcare professional.
Estrogen patches are a convenient and effective solution for many women experiencing menopausal symptoms. They provide several benefits, including reducing the risk of postmenopausal osteoporosis and heart disease, as well as potential cognition benefits. They’re easy and convenient to use, all while delivering a consistent release of hormones that can help you feel like you again.
While hormone replacement therapy, including estrogen patches, carries some risks, these are generally lower with HRT patches compared to pills.
Ultimately, the decision to use estrogen patches or any form of hormone therapy should be made in consultation with a healthcare professional, like a Midi clinician, considering individual health factors and preferences.
Many women report that they love using patches for their HRT.
If you’re in perimenopause or menopause and want guidance from clinicians who specialize in women’s midlife health, book a virtual visit with Midi today.
Hormonal change is at the root of dozens of symptoms women experience in the years before and after their period stops.
Our trained menopause specialists can help you connect the dots to guide you towards safe, effective solutions.
Whether you need personalized guidance or a prescription routine to tackle symptoms—including brain fog, hot flashes, sleep trouble, mood swings, irritability and weight gain—we’ve got you covered. Learn more here.
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