Different Ways to Take HRT

HRT can be taken in a variety of ways. There are advantages and disadvantages to each of the different methods.

Pills

The most often prescribed and easiest method of taking HRT is via a tablet or capsule. This traditional method of taking the drug can create a problem. After you swallow the pill, the hormone enters the stomach and intestine, where it is absorbed into the circulatory system that leads to the liver. A problem can occur because the hormone undergoes change within the bowel before absorption and is absorbed as an altered substance with either reduced potency or different ef­fects. Once transported directly to the liver in large amounts, the hormone can again be changed by the liver. It can also stimulate various actions in the liver itself, some potentially good and some possibly harmful. Either way, the hormone, metabolized in the liver, enters the general circulation of the body and begins to work. Its benefits and risks depend on whether its composition was changed in the liver and to what degree. Pros and cons of tablet HRT.

Shots (Intramuscular Injections)

One method of bypassing the liver is to inject the hormone directly into the muscle. The hormone can be mixed into other substances that will cause it to absorb into the system slowly, which helps to lengthen the intervals between shots from daily to once a month. There are some disadvantages to this method. The main one is that there is a high level of hormones in the blood shortly after the injection, which diminishes over time. Thus, there is an imbalance in the treatment‘s overall benefit, because there may be too much hormone in the blood right after the shot is administered and too little later in the cycle. At present, shots cannot be spaced more than a month apart, and some women find that having to go to the doctor’s office to get an injection that often is disadvantageous because of the extra expenditure of time and money.

Implants (Subcutaneous Pellets)

Implants were popular in the 1960s and 1970s. They are outdated today. Since they may return in a new form, you should know how they work. The hormone combines with a solid material and is shaped into a pellet. The physician inserts the pellet into the subcutaneous fat through a small incision in the woman’s lower abdominal wall or the top of her buttock. The pellets dissolve slowly and the hormone is absorbed through the fatty tissue. Over the years, there were many different strengths and mixtures of hormones used as implants. There are potential disadvantages. First, they may be difficult to remove, if removal becomes necessary because of possible side effects such as infection at the site of insertion. Further, the lifespan of the implant is capricious, so it is very difficult to know how long they will work and when they should be replaced. Research is underway to create better release mechanisms for implants, and it is likely that implants will be one of the practicable methods of the future. Pros and cons of HRT implants.

Vaginal Creams (Vaginal Application)

Hormones can be applied directly to the vaginal area. Women who experience localized vaginal discomforts, such as dryness or itching, can obtain relief with this method. When women take estrogen vaginally, the hormone is absorbed through the vaginal epi­thelium into the blood system, which can be an advantage if the estrogen is needed, or a disadvantage if they should not be taking estrogen anyway, as is the case with women who have breast cancer and who therefore are not candidates for HRT. Because of this absorption, vaginal creams are not prescribed for women who should not take estrogen, but they can even be a problem for women who can take estrogen. These creams are impractical, because the amount of estro­gen absorbed is so variable and the body may absorb too much.

Patches and Creams (Transdermal Systems) Research in France in the early 1970s led to a breakthrough in the understanding of the absorption of hormones. It proved that estrogen creams rubbed onto the skin would be absorbed easily, enter into the circulatory system, and work well. The result is the availability of two newer ways to replace estrogen: a cream and a transdermal, or through-the-skin, patch.

The percutaneous cream contains specific strengths of hormones to be applied over a specified area of the body. In this way, a specific dose of the hormone can be administered on a daily basis. The hormone gets into the circulatory system without going through the liver so that the side effects generated by liver metabolism can be avoided. One disadvantage is that it can be messy. Moreover, a woman may acciden­tally vary the amount of skin she covers when applying the cream, which would result in a dose that is different one day from the next. Or the cream could be rubbed off before it is fully absorbed, with the same poor result.

Interestingly, there were early complaints by male partners of women using these creams because the men began to notice breast growth in themselves! This growth was presumably from couples lying close together and the cream accidentally being rubbed onto the man’s chest. The newer formulations of the cream have a rapid drying property that practically eliminates these rubbing-off and transfer problems.

Transdermal skin patches are the most recent breakthrough in estro­gen therapy. These specially devised patches place estrogen directly on the surface of the skin without the messiness or uneven coverage/ dosage of creams. The patches are similar in appearance to those that heart patients wear containing ever-ready nitroglycerin. The estrogen transdermal patch is a multilayered system. Beneath an outer imper­meable layer of plastic lies a reservoir of estrogen dissolved in alcohol, covered by a layer of permeable plastic.

This design is ingenious: It prevents the estrogen from seeping through the outside of the patch, while permitting it to seep inside to the skin, which gradually absorbs it. A ring of adhesive holds the patch onto the skin. The amount of estrogen given to a woman can be controlled by the size of the patch and the amount of estrogen that is inside the reservoir. These quarter-sized patches must be changed twice each week, every three to four days, so that they deliver a constant amount of estrogen. Women change these quickly them­selves. They are worn on the hip, upper thigh, or lower abdomen.

One disadvantage of the patch is that it may irritate the skin under it, which is a problem for about one in twenty women. This problem can often be alleviated by moving the patch to a new spot on the skin each time a new one is applied. The advantage of the patch and the skin cream is the ease with which the doctor can check the amount of estrogen in the blood at subsequent follow-up visits to fine-tune the dosage to meet the needs of each individual woman. Pros and cons of HRT skin patches.