By: Red Hot Mamas
Published: June 25, 2010
In February 2006, the findings from a recently published study, gave a bit of hope to women taking hormone therapy. Hormone skin patches and gels, it seems are far less likely than pills to cause blood clots. Women who used the transdermal (through the skin) delivery method were at no higher risk for blood clots than women who did not even take hormones.
The Estrogen and Thromboembolism Risk Study (also called ESTHER) was conducted by French researchers and presented in the medical journal Circulation. Eight hundred and eighty-one women took either estrogen only or an estrogen-progestin combination. Women who took hormone pills were four times as likely to suffer a serious blood clot.
This is great news for those of us who once thought the option of hormone therapy was a “dead end”. When the Women’s Health Initiative (WHI) study was halted in 2002, our concern for blood clots greatly increased. WHI found at least 44 percent of the adverse effects of HT were related to blood clots. The WHI study left us wondering if results would have been different if they changed the type of estrogen and/or delivery method.
Many professionals criticize WHI because they used one type of estrogen pill (conjugated equine estrogen). An alternative type of estrogen is used in hormone patches, gels and creams (17-beta estradiol). The two delivery methods of the hormone are very different.
When taken in pill form, the hormones pass through the liver. When the drug is metabolized, the liver produces too many triglycerides and blood-clotting factors causing the negative side-effects we commonly see. Transdermal delivery methods avoid these unwanted effects by absorbing estrogen through the skin.
Estrogen patches are placed on the abdomen or buttocks. Once the patch is placed on the skin, it releases the hormone. A variety of patches are available. Some are worn for 3 days, others are left on for a week. Some are the size of post-it-notes, others the size of postage stamps. In the US, the patches are available in doses ranging from 1.125 to 0.1 milligrams per day.
Estrogen creams and gels also contain 17-beta-estradiol that is also absorbed transdermally, through the skin. They are often rubbed into the skin on the hands but can also be absorbed through the skin on the stomach, thighs or inner arms. Creams and gels are usually applied one to two times per day.
The following FDA-approved estrogen and combination estrogen-progestin skin patches/gels/emulsions are currently available in the United States:
- Climara Pro
- Various generics
Bottom line: if you have severe menopausal symptoms, hormone therapy should be considered as an option. Discuss your risks and benefits with your doctor. Your doctor may recommend using the lowest effective dose for the shortest time necessary. While this study gives hormone therapy a positive outlook, far more research needs to be conducted. More studies are investigating risks and benefits of various hormone drugs and delivery systems including the KEEPS study (Kronos Early Estrogen Prevention Study).
Parker-Pope, T. (2007). Hormone Patch Shows Benefit Over Pill. The Wall Street Journal. Retrieved February 20, 2007.
The Hormone Therapy Story. (2006). The North American Menopause Society’s Early Menopause Guidebook: Helping Women Make Informed Decisions. Pp. 56, 58.