What are the different types of Hormone Replacement Therapy (HRT)?

Hormone replacement therapy is an umbrella term for a group of medications that are used to treat menopausal symptoms. It is a very popular treatment option that can improve the quality of life for people who are affected by menopause or peri-menopause. 

Different types of hormone replacement therapy include: 

• Skin Patches
• Gels
• Creams
• Implants
• Pills or tablets
• Mirena coil

There are lots of different types of HRT and lots of different ways to take HRT too! It can all get a bit confusing, so we’ve put together this guide which breaks down each form of HRT and how it is used. Every person will respond to HRT in their own unique way. One person might respond well to a low dose of one type of HRT, but not to a high does of another type. It’s always really important to discuss the different options and which might work best for you with your doctor or Fertifa Patient Advisor.

Some types of HRT get absorbed into the bloodstream and work to treat symptoms all over the body

HRT that gets absorbed into blood and treats symptoms of menopause that affect the whole body. These can include menopausal symptoms like hot flushes, brain fog, mood changes or sleep problems. Hormone therapy that gets absorbed into your blood is also good for prevention of long term health conditions, like heart disease, bond disease and neurodegenerative disorders. NICE guidelines recommend that people who experience Premature Ovarian Insufficiency should take HRT that gets absorbed into the blood stream to protect against some of these long term heath conditions. 

Pills or tablets

One of the easiest and most common forms of HRT to take is a pill or tablet that is usually taken once per day. HRT tables can be oestrogen only or combined oestrogen and progesterone, your doctor will help decide which is best for you. Some people take tablets in combination with other forms of HRT like patches, gel or creams. If you take an oestrogen only HRT tablet, you should also take some form of progesterone HRT, this it to protect your uterus and keep your hormones in balance. 

Skin patches

There are lots of different types of HRT patches made by different brands but they tend to be around the size of a quarter of a sticky note, or a large postage stamp. HRT patches stick onto your skin and constantly release a small amount of hormone into your bloodstream. The patches stick onto your skin and should be replaced around twice every week, and you should replace the patch immediately with no break in between each new patch.

You should apply the patch to a clean, dry hair-free area of skin below the waist. Most people stick it on the tummy, thighs, or buttock. When it’s time for a new patch, put it on a different area of skin from your last one.

You can carry out normal day-to-day activities whilst wearing an HRT patch. It’s ok to wash, swim, exercises, play sports and sunbathe with a patch on, but there are a few things to keep in mind if you use or are thinking of using a patch. It’s best not to apply the patch on or near you breast, on irritated skin (if you have cuts or spots for example) and try to avoid putting it under tight clothes or waistbands.

HRT patches can also leave a sticky residue when you take them off, some people can have allergic reactions or get skin irritation because of this. If you do get irritation, you should stop using the patch and try a different type of HRT. Otherwise, the sticky residue can be removed with a small amount of oil.

Oestrogen Gel

HRT gel comes from a bottle and needs to be rubbed into your skin once a day. Similarly to skin patches, HRT gel gets absorbed into your skin and enters your bloodstream. Lots of people like oestrogen gel as it is easy to use, you don't have to change a patch every few days, is less likely to irritate your skin, and it generally carries fewer risks than HRT tablets.

You should not apply HRT gel to your breast or vaginal areas. Some good places to apply the gel are shoulders, thighs or arms. Once you've rubbed the gel in, it's important to wash your hands and make sure you don't touch other people with the area of skin that's got the gel on it for around an hour. If you do touch other peoples skin after you have used HRT gel (with your hands or other area of you body), the medication can also be absorbed into their body and system! 

Implants

HRT implants are a form of HRT that is inserted under your skin by a doctor and they slowly release oestrogen. They last around 6-10 months before they need to be replaced, and the implant is usually put in the upper arm or buttocks. The slow release of oestrogen from the implant means you don’t have to remember to take your HRT every day like with tablets or patches, and some people find this really helpful if they forget easily.

‍

Other types of HRT can be grouped together as vaginal oestrogens. They relieve symptoms like vaginal dryness, itching and pain during sexual intercourse

Vaginal oestrogen only treat symptoms that affect the vagina, but not things that affect the rest of your body. They can be a great option of people how are badly affected by things like itching, dryness, pain during sex and low libido, but don't experience some of the other symptoms throughout the rest of the body. Vaginal oestrogens don't pose the same risks of things like breast cancer, so they are also a good option to use in conjunction with holistic treatments if you don't want to, or can't use other types of HRT due to person medical history or family medical history. 

Cream

Creams can be applied directly to the vagina or vulva area. The cream is absorbed into the skin, where it releases oestrogen slowly over a few days. Creams can help relieve symptoms such as itching and dryness, but they don't help with low libido (sex drive) as much as other forms of HRT.

Vaginal Tablet

Vaginal tablets can be inserted into the vagina with an applicator, they dissolve and release oestrogen which gets absorbed. The tablet can help with symptoms such as vaginal dryness, itching and pain during intercourse. Vaginal tablets are recommended if you have a low libido, or if other treatments like creams aren't working.

Vaginal pessary

A vaginal pessary is a device that is inserted to the vagina and releases hormones to help relieve symptoms such as vaginal dryness, itching and pain during intercourse. Pessaries can be inserted using an applicator, into your vagina as far as it comfortably goes.

Vaginal Ring

A vaginal ring is a small plastic device that you can insert into your vagina and it slowly releases oestrogen. It needs to be changed every 4-6 weeks. Vaginal rings help relieve symptoms like vaginal dryness, itching and pain during intercourse. Once in place, it should not be felt by either partner during sex, but if you do feel it then you should remove the ring. 

The final type of HRT is the Mirena coil, it is usually used to treat heavy periods - which 25% of menopausal women experience

Mirena coil

The Mirena coil is an intrauterine device and a type of HRT that gets inserted to your uterus by a doctor. It slowly releases progesterone and only needs to be replaced every 3-5 years. The Mirena Coil often used to treat some of the heavy period symptoms that some women have during peri-menopause. This can help reduce the amount of vaginal bleeding and make your periods shorter and lighter. The Mirena coil is also beneficial as it acts as a contraceptive and can be used alongside other types of HRT like, gels, tablets or patches. 

Your doctor will help you work out which type and method of application of HRT is best for you

Usually, doctors will start you on the lowest does of HRT with the lowest health risks, and then increase it if it's not working for you. Lots of people feel the positive effects of HRT soon after they start taking it, but healthcare professionals usually recommend you keep taking HRT for around 3 months to notice the full effect. If at this point it's still not working, you should try different doses of oestrogen and progesterone, or a different type of HRT. Sometimes it does take a while to trial which is best for your and your personal circumstances.

If you're a Fertifa patient looking to understand more about HRT, get in touch via the app. Our doctors and nurses can talk you through HRT and give you a prescription if they agree it's suitable for your menopause symptoms.