Skin patches provide a means of delivering the hormones directly to the bloodstream through the skin. As they do not pass through the stomach and the liver first, as tablets do, the required dose is much lower, reducing side effects. Patches are applied once or twice weekly, depending on the brand. They are generally well tolerated although some, particularly the older style patches containing alcohol, can cause skin irritation.
To use patches, remove the patch from its backing sheet and stick onto clean, dry skin, free from talcum powder, bath oils or body cream. The best site is the upper buttocks. Press the patch firmly on the skin for about 10 seconds, then run your fingers around the edges to ‘seal’ it. Keep the patch on when you have a bath or go swimming, although it can be removed temporarily for half an hour or so if you prefer – keep the backing sheet to stick the patch onto until you need it again.
Cover the patch when sunbathing and remove the patch if you are using a sunbed. When replacing patches, change the site so that you are not sticking the patch in the same place each time.
Double patches are available either as separate pouches of oestrogen and progestogen or combined in a single patch. Use oestrogen-only patches twice weekly for the first 2 weeks of the cycle, followed by the double patches for the last 2 weeks of the cycle.
- Advantages of patches: The main advantage of the patches is that side effects are minimised because the dose of hormones is much lower than oral therapy. The hormones from patches are gradually released into the bloodstream producing minimal fluctuations.
- Disadvantages of patches: The disadvantage is that, at present, the doses of oestrogen and progestogen in the combined patches are fixed, so dose adjustments are difficult.
Occasionally, patches do not stick very well, particularly in hot, sticky weather, but you can easily remedy this by covering the patch with two inch surgical tape.
Although it is normal for the skin underneath the patch to redden, a few women develop a severe skin reaction that prohibits further use. Switching to a different brand can occasionally help.