Oral vs Transdermal Menopause Treatment

Oral vs Transdermal



The 2 common ways of administering menopausal therapy are oral and transdermal. While different, their efficacies are notable in treating various menopause symptoms.


Mayo Clinic's published study showed oral estrogen therapy is effective in reducing hot flashes and night sweats by 70%-80%. Also, the British Journal of General Practice published study revealed transdermal estradiol had the highest probability of being the most effective treatment for vasomotor symptoms compared with placebo.


However, these treatments come with side effects and associated health risks. Read on to learn more about oral and transdermal menopause therapy.


Availability


Oral menopause therapy products are available in the United States, Canada, United Kingdom, European Union, Australia, India, China, Japan, and South Africa.


Transdermal menopause hormone therapy products are licensed in most European countries, North America, Australia, New Zealand, and several Asian countries (China, India, and Pakistan).


Routes, Risks, and Side Effects


When taken orally, it dissolves in the stomach and intestines, allowing the hormones to be absorbed in the bloodstream. Then, the hormones enter the blood vessels and pass through the liver. There, they are processed and broken down. This is called the "first-pass."


The liver metabolizes or absorbs substances (including hormones) before reaching the rest of the body to take an effective action. This means that higher doses of hormones are needed to achieve the desired efficacy.


This type of medication has risks of gallbladder diseases, blood clotting, inflammation, and imbalanced SHBG levels (sex hormone-binding globulin).


Transdermal therapy is given through patches, gels, or creams. They are applied directly to the skin and the hormones penetrate the skin's layers and enter the blood vessels. This method allows the hormones to bypass the liver and go directly into the bloodstream.


However, 50% to 60% of users reported skin reactions. These are mild-to-moderate redness, irritation, and itching on the site where patch, gel, and cream are applied. Some women experience breast tenderness due to estrogen dosage and abnormal bleeding for most non-hysterectomized women are reported.


Efficacy


Blood Clotting - Mindy Goldman, MD (a practicing OB/GYN at the University of California, San Francisco) noted that oral therapy increased blood clotting risk than transdermal. As a result, women with cardiovascular risk factors (deep vein thrombosis (DVT) and a history of hypercholesterolemia, hypertension, or diabetes) prefer patches.


Heart Health - A study published in the New England Journal of Medicine (Vascular Effects of Early vs Late Postmenopausal Treatment with Estradiol) showed oral estradiol therapy was linked to less progression of subclinical atherosclerosis (hardening of the arteries) compared to a placebo when started within six years of menopause. On the other hand, transdermal therapy has minimal effects in improving blood lipids (good and bad cholesterol and blood fats).


Bone Health - Studies noted oral and transdermal therapy help in maintaining bone density and reduced postmenopausal osteoporosis risks.


Cognitive Health - KEEPS (Kronos Early Estrogen Prevention Study) noted that transdermal estrogen is good for younger women’s sleep and cognition ability in their postmenopausal years (women aged 42-58 years who are within 36 months of their final menstrual period).


Experts' Recommendation

  • Women who are more than 60 years and haven’t taken oral estrogen are advised to take transdermal estrogen to avoid heart attack or stroke.
  • Transdermal estrogen is best (low doses) for women who have blood clotting history.
Overall, there is no one-size-fits-all therapy. Visit your doctor to have a complete assessment so you can be guided with the right medication.

Sources

Transdermal or oral - Which is better for hormone administration?

Contrasting Effects of Oral versus Transdermal Estrogen

Clinical Efficacy of Estradiol Transdermal System in the Treatment of Hot Flashes in Postmenopausal Women

Transdermal Estrogen Benefits Cognitive Functioning in Perimenopausal Women

Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol







 

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