How you take estrogen hormone replacement therapy can have a significant impact on your health. Many people prefer to simply swallow their medication because it is quick and easy, but taking certain hormones like estrogen and testosterone by mouth is not the best way to replace those hormones and can actually increase health risks.

Oral vs Transdermal/Topical Hormone Replacement Therapy

Estrogen, when taken either by mouth or topically, helps to maintain bone density, protect against cardiovascular problems, and helps to relieve menopausal symptoms like hot flashes, night sweats, vaginal dryness and pain, loss of libido, and sleep problems. When estrogen and most drugs are absorbed in the stomach, they are first transported in large quantities to the liver to be processed, referred to in medical terms as “first pass”, where it is metabolized or removed from the bloodstream before they reach the systemic circulation. Compared to a topical form of estrogen, a large dosage amount of estrogen must be swallowed by mouth (e.g. 1-2mg oral versus say 0.01-0.05mg topical) to get around the first pass mechanism that nature designed to help us break chemicals down. As the estrogen goes through the liver, it is converted to metabolites that can be more damaging to the body by causing estrogen-dominant symptoms and even increasing the risk for cancers in women.

The Topical Route

Whenever possible, estrogen hormone (and testosterone) must be administered topically to bypass the liver. When topically applied, estrogen can be prescribed in dramatically lower doses and there is less work for the liver to do, leading to decreased side effects from the hormone metabolites. Side effects like gallbladder disease, cancer, and the other health concerns of hormone replacement therapy can be reduced with smaller topical dosages. Topical estrogen and testosterone are available in creams and gels, patches and pellets. Creams and gel allow for infinite adjustments of dosage during treatment. Because patches are drug reservoirs and matrix meant to be slowly released into the body they cannot be cut and the dosage cannot easily be changed. Estrogen pellets dosages are especially difficult to change because once surgically implanted, they cannot be adjusted unless removed. Pellets are being heavily advertised these days as a convenient way to use hormone replacement therapy (HRT) but in my opinion, they are unnecessarily expensive and offer no additional benefit over creams, gels and patches.

At Towne Lake Family Pharmacy, our compounding pharmacists with a combined experience of over 5 decades, make hormone creams in various strengths and concentrations and we package them in easy-to-use containers that accurately dispense the medications. For additional questions about bioidentical hormone replacement therapy (BHRT or HRT) please call 770-635-7697 and ask to speak to one of the hormone specialists.

Reference links

  1. Goodman, M.P. (2002). Are all estrogens created equal? A review of oral vs transdermal therapy. Journal of Women’s Health, 21(2), 161-169.
  2. Smith P. (2010). What you must know about women’s hormones. Garden City Park, NY: Square One Publishing, 2010