The tides have turned when it comes to HRT. Whilst each person needs an individualised discussion with risks vs benefits discussed, there are very few occasions when HRT cannot be safely prescribed.
It was the older types of oestrogen, taken in tablet form, which were associated with an increased risk of blood clots. These tablets were metabolised by the liver, which in turn activated clotting factors and increase the risk of blood clots, high blood pressure, heart attacks and strokes.
To negate this risk oestrogen tends to be given through the skin, by the transdermal route. This bypasses the liver and there is no increased risk of blood clots associated with this. Blood pressure is not impacted from using oestrogen in this way.
Types of transdermal oestrogen are patches, gel and spray.
Oestrogen patches need to be changed twice weekly. They are applied below the waist, typically to the hip or bottom area. They stick really well, showering, having a bath, swimming etc should not cause it to come off. Examples are Evorel or Estradot patches.
Oestrogen gel tends to be prescribed as a pump, you will be advised how many to use, the typical amount is 2-4 pumps daily. With each pump applied to a separate area to aid absorption, the most common sites are the outer arm and inner thigh areas. It takes about 5 minutes for the gel to dry and we advise avoiding showering or washing for 30 minutes after application. An alternative type of gel comes in sachets, there are two different sizes of this. Examples are Oestrogel and Sandrena
Oestrogen spray is applied to the inner arm area, to clean healthy skin. If more than one spray has been advised the areas should not overlap. Typical dosing is 1-3 sprays a day. It takes 2 minutes to try and we advise waiting 60 minutes after application before washing or showering. Lenzetto is the name of the current spray which is available.