Many people use HRT patches to help reduce their menopause symptoms, but how do they work and what are the pros and cons? Stella’s clinical advisor Dr Lucy Wilkinson explains.
What are HRT Patches?
HRT patches are a type of transdermal hormone replacement therapy. This means that they help with your menopause symptoms by supplying hormones into the body through your skin. They contain oestrogen and sometimes progesterone too. These are known as oestrogen-only and combined HRT respectively.
The HRT patch looks like a small sticking plaster.
How do HRT patches work?
Each patch contains a fixed dose of hormones. The HRT patch is placed on your body and delivers medication using a specialised adhesive that allows it to stay in place for three days at a time.
The hormones enter your bloodstream through tiny blood vessels below the patch and then circulate throughout your body, where they get to work on relieving your symptoms.
Patches contain oestrogen – which is needed to relieve your menopause symptoms – and sometimes progesterone too.
If you still have your womb, you will need to take a patch which combines both oestrogen and progesterone. This is because if used alone, oestrogen can cause abnormal thickening and even cancer of the womb lining (endometrium). Taking progesterone alongside the oestrogen protects the womb lining and effectively removes this risk.
HRT patches can be continuous or sequential, meaning that they can be used whether or not you still have periods. On continuous HRT you will have no periods. On sequential HRT you will have a period-like bleed every 1 or 3 months due to the variable amount of hormones contained in the patches.
Benefits of HRT patches
HRT is the most effective treatment available for menopause symptoms, including hot flushes, disturbed sleep and mood changes. HRT has other beneficial effects, including the prevention of osteoporosis (thinning of the bones) and – in some cases – cardiovascular disease.
HRT patches can be a great alternative to oral HRT (tablets). They are convenient and easy to use; you just need to stick a new patch on your skin every few days.
If you struggle to remember to take daily tablets, or are unable to take medication by mouth, then patches could be a good option for you. Because of the way the hormones are absorbed into the body, patches also come with fewer risks (including fewer risks of serious blood clots or venous thromboembolism). This means that patches may be suitable for you even if you have medical conditions or other risk factors that make HRT tablets risky.
Start your free online menopause assessment to see if HRT is right for you
How do you use HRT patches?
When you’ve opened the packaging, remove your patch and carefully apply it to a clean, dry area of skin, making sure the skin is also free from oils before application.
If you suffer from any skin conditions, avoid applying the patch to those particular areas of skin as this can affect absorption.
For full instructions, see the leaflet in your pack.
Where is the best location for the HRT patch?
The HRT patch should be applied to a hairless area below your waist. For many people, this means applying the patch to your buttocks or thighs, although the lower abdomen is another option.
Do not apply the patch on or near your breasts.
Avoid placing the patch under tight waistbands or in other places where your clothing could rub and cause it to fall off. You should also avoid applying it over areas with a lot of hair, as this can increase the risk of the patch falling off, and make removing it more difficult too.
What are the side effects of HRT Patches?
This depends on the type of hormone in your patch: whether oestrogen or a combination of oestrogen and progesterone.
Side effects of oestrogen can include:
- Sore breasts
- Bloating
- Nausea
- Cramps
- Indigestion
- Irregular vaginal bleeding
Side effects of progesterone can include:
- Tender breasts
- Headaches
- Acne
- Mood changes and depression
- Vaginal bleeding
These usually settle within the first 12 weeks of starting treatment. If they are severe or persistent, see your doctor. They may be able to advise a change in the dose or type of hormone in your HRT.
Skin patches specifically may also cause skin irritation due to the adhesives used. If this happens, your doctor may be able to suggest an alternative product including an oestrogen gel or spray.
See a doctor urgently if you have any:
- Vaginal bleeding if it has been over 1 year since your last period
- Bleeding after sex
- Breast lumps or other changes (see here for more information on how to check your breasts)
- Any severe pain
- Any unusual headaches, including headaches which have any associated symptoms like vision changes, dizziness or other sensory changes
- Any leg swelling, tenderness or redness
- Any other persistent, severe or worrying symptoms
What are the risks of HRT patches?
This depends on the type of hormone contained in your patch, and on your own personal background.
Patches are generally a lower-risk way of taking HRT when compared to tablets. They are not thought to increase your risk of serious blood clots in the same way that oral HRT does.
However, patches which contain progesterone can cause a slight increase in your risk of breast cancer. For a thousand women using this type of HRT over a five-year period, an extra four cases of breast cancer will be diagnosed when compared to those not on HRT.
To put this into context, an additional five cases would be diagnosed among those same thousand women if they all drank two or more units of alcohol per day. An additional 24 cases per thousand would be diagnosed if all of the women were overweight or obese.
This risk falls after stopping HRT, and after 5 years is back to the background risk. Oestrogen-only HRT patches aren’t thought to bring an increased risk of breast cancer.
Read more about the risks and benefits of HRT.
What are the best HRT patches?
There is no single best HRT patch – the best patch is the one which works for you!
Your doctor will guide you to choose the best HRT patch for your needs. There are a range of hormones and doses available, and it can sometimes take a while to find the best prescription that’s right for you.
If you like the idea of transdermal HRT but can’t find the right patch, you might like to try a gel or a spray.
Final word
HRT patches are a convenient and relatively safe way to take HRT. If you would like to find out more about your options, speak to your doctor or take Stella’s free online assessment to find out which treatment is best for you.
Find out more about menopause on our blog or in our symptoms library.
National Institute for Health and Care Excellence (2019) Menopause: diagnosis and management (NICE Guideline 23). Available at: https://www.nice.org.uk/guidance/ng23 [Accessed 28th December 2022]
Hillard, T. et al (2017). Management of the Menopause. ed. London: British Menopause Society, pp. 82-99
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