Different Ways to Take HRT - Reduce Risks and Tailor What's Right for You

What I learned About the Menopause and Why HRT Was the Right Choice for Me

A couple of weeks ago I started the first of a series of posts in which I explain some of the rationale behind my decision to start HRT during peri-menopause. And I wanted to do this because over the past couple of decades, I feel like women have been sold down the river on the risks of HRT and many are not only having to put up with really unpleasant symptoms associated with The Menopause, but are also making decisions that could affect their long term health without knowing some of the more recent facts around HRT.

So another thing I didn’t realise about HRT is that there are a number of different ways of taking it that have varying benefits. Just to set the scene, if you still have a uterus, you will need to take combined HRT where you take a combination of estrogen and progesterone over the course of the month. If you’ve had a hysterectomy, you would just need to take estrogen.

Back in the day, you were really only able to take estrogen and progesterone in pill form and this had certain limitations. Nowadays, you can take HRT in pill form, transdermally (through the skin) either as a patch or gel, or as a spray. The fact that there are a variety of combinations that you can put together means that you can tailor your dose a lot more closely to what you need, compared to ‘the old days’ when your options were limited to pill form.

Estrogen still seems to be prescribed most frequently in pill form, but some doctors are savvy about the slight increase in the risk of clotting when taking it this way and the absorption levels are less reliable. The clotting risks with pill form are something I was conscious of when thinking about HRT and so I take estrogen as a patch which I have to change twice a week. For me that’s a bit of a bonus because I’m pretty lousy at remembering to take pills every day! When taken in patch form, your body absorbs the estrogen through the skin and it goes straight into the blood stream and so there are no clotting risks. This is the same for gel or spray.

When you take estrogen transdermally, you also have a greater range of dosage options which means you can increase or decrease your dose until you find what’s right for you. Personally, I think gels are great as a way of ‘topping up’ the estrogen, or taking a little more than one dose might give you without having to move up to the next highest dosage. This is recommended by doctors as a way of really trying to get the levels that are right for you. Gels are great for being able to alter the dose, but I personally wouldn’t want to use it as my main method as I would just struggle with being consistent in getting the right amount of gel each! Propensity to over or under-squirt and whether or not I’m rushing as I’m rubbing it in! time And you’d probably end up using a hell-of-a-lot of gel.

Progesterone comes either as a coil or in tablet form, though you can get a combine estrogen and progesterone patch. Initially I thought the combined patch would be best for me (as I said, rubbish at taking pills) but the thing with it is that they come in standard doses and so you have a lot less flexibility in adjusting dosage. The progesterone in the combined patch also contains older progestogens which are not body identical, whereas in pill form it is body identical. Someone once described hormones and receptors a little bit like a lock and key, and so if a hormone created synthetically doesn’t quite match what is produced in the body, then it’s not going to work as well. The risk of breast cancer through taking HRT is also reduced if you’re taking a body-identical progestogen. So I opted for progesterone in pill form and set a notification for days 1 – 12 each month to remind me to take it. So far so good.

So there you go, another category of information that I added to my list when I was weighing up the pros and cons of taking HRT and given the options for closely tailoring doses, and different ways of taking it, it was another positive for me. What I found very useful in reading up on all of this in advance was that I felt very confident going to the GP and talking about HRT and as a result I felt like it was done on my terms. You can have any combination of HRT you like, health conditions permitting so if you know you want a patch and someone is offering you the tablet, be strong, be confident and let them know what it is that you’d like.