Patches For Hormone Replacement Therapy (HRT)

What are HRT patches?

Skin patches are a common way of taking HRT –  They are available as oestrogen only or combined patches, which contain both oestrogen and progesterone.

What is HRT? – HRT is a way of treating conditions like menopause. Menopause causes your hormones to drop gradually – symptoms mainly occur due to the decline in the main female sex hormone, oestrogen. HRT helps women to manage their symptoms better by replacing the declining hormones.

How does an HRT patch work? – an HRT patch contains a fixed dosage of hormone, which is absorbed into your bloodstream once you stick it to your skin. The dosage of hormone is released at a gradual rate throughout the day until you apply the next patch after a few days.

What are the dosages of HRT patches – for Evorel Conti, a popular brand of HRT patch, each patch contains 3.2 mg of estradiol hemihydrate (oestrogen) and 11.2 mg norethisterone acetate (progesterone). The 3.2 mg strength of estradiol is equivalent to the patch releasing 50 mcg of estradiol per 24 hours and the 11.2 mg strength of norethisterone is equivalent to the patch releasing 170 mcg per 24 hours. 

Can I buy HRT patches online?

Yes, you can buy Evorel Conti patches online – these patches are combined as they release two hormones; oestrogen and progesterone.

Who can buy HRT patches? – Evorel Conti patches are prescribed if you are either: 

Reordering your HRT patches saves time as you avoid ordering a repeat prescription from your GP and collecting it from a local pharmacy.

How do you use HRT patches?

Applying the patch:

• An Evorel Conti patch is most commonly applied to your thigh or bottom – it is always applied to a hairless area below your waist

• Using the notches as a guide, tear along two edges of the pouch and remove the patch

• With the protective backing facing you, bend and peel off half the backing. Don’t touch the sticky side as it may not stick properly if you do

• Apply the open half of the patch to your skin 

• Remove the remaining backing and press down the rest of the patch with the palm of your hand to make sure its firmly stuck

Removing the patch:

• Peel the edge of the patch smoothly away from the skin

• Fold the patch in half so that the sticky side sticks to itself

• Put it in with the household rubbish and make sure it is safe from children and pets

Tips on when to use patches:

• Apply the patch to a clean and dry area of the skin

• You should leave the patch on when in the shower, bath or when exercising

• If a patch falls off, replace it with a new one, but also replace it again during the week when you would normally

• If you forget to change your patch, do it as soon as possible, or wait until the next patch if it’s close to switching time

• When you remove your patch, some glue may remain on your skin. It will disappear with some soap and water, or you can use baby oil to remove it

What should I avoid when using them?

• Do not flush used patches down the toilet

• Do not use scissors to open the patch but use your fingers instead

• Avoid touching the sticky part of the patch while putting it on

• Don’t apply patches to the same area of your skin – switch the area around your hips and upper thighs

• Don’t apply the patch near or on your breasts

• Avoid applying any oil, cream, lotion or powders on the area of your skin where you will be applying your patch

• Avoid choosing an area of your skin that is damaged or irritated

Are patches the best choice?

Personal preference – the best choice of HRT treatment depends on your preference, your medical history and symptoms.

Advantages of HRT patches – patches have a number of advantages which are:

• They are discreet

• Easy to use

• Non-invasive

• You only need to apply them weekly or after a few days

• They are available in different strengths making it easy to adjust the dose

• They stick well in the shower, bath or when exercising

• They may be used in women with migraines

Non-invasive application – HRT patches are an alternative way of getting the hormones into your body in a non-invasive way. They can be a good alternative if you have difficulty using other preparations

Whole-body treatment – HRT patches like tablets are for menopause symptoms that can occur anywhere in your body and vaginal creams, gels or pessaries are specifically for treating vaginal symptoms.  Patches can be applied after a few days but the other treatments are usually prescribed for daily use 

The disadvantages of patches are:

• You may easily forget to take them off as you use them every few days

• They may leave glue on your skin

• They may irritate your skin

• They can fall off your skin, but this is rare if they are applied correctly

Patches vs tablets – in comparison to menopause tablets, HRT patches may be a better option as:

• They are easier to use than swallowing tablets daily

• They may avoid certain side effects such as indigestion, as the hormones do not have to be digested

• They have less chance of interacting with other medicines known as enzyme inducers – these include certain antiepileptics and antibiotics

• Oestrogen only patches don’t increase your risk of a clot or stroke when prescribed at a standard dose

• Oestrogen only patches do not worsen your sex drive

Patches vs others – HRT gels usually require you to wait for 5 minutes until your skin is dry and to wait for an hour before skin contact with another person. This is not required with the patches making them easier to use in comparison. Patches are easier to use in comparison to vaginal creams and pessaries as they are less invasive.

Are HRT patches used for other treatments?

'HRT' patches are for menopause only – they are currently licensed to be used only for treating menopause symptoms in women and for preventing osteoporosis that is related to the menopause. They are not prescribed for other treatments.

What is used for testosterone deficiency? – this can be treated with other hormonal patches, tablets, gels, implants or injections, which all contain the main male hormone, testosterone. Patches for testosterone deficiency normally mimic your body’s natural production of testosterone, which varies throughout the day.

What is used for gender reassignment? – gender reassignment can be treated in both children and adults. Hormone therapy is one part of treatment. 

• Children under 18 – if you are under 18 you could be referred to a specialised Gender Identity Clinic (GIC). Once puberty is reached, they can be treated with gonadotrophin-releasing hormones (GnRH analogues). These are man-made hormone medicines, which suppress the hormones naturally produced by the body 

• Treatment for adults – this also involves referral to a specialised GIC. Hormone therapy depends on your preferred gender and involves taking either oestrogen or testosterone therapy. It aims to make you more comfortable with yourself in terms of how you feel and your appearance.

Are HRT patches similar to nicotine patches? – both are patches designed to release their active ingredients over a different period of time. They may appear similar but are used for different medical reasons. HRT patches are designed to release a fixed dosage of hormones over a day and are usually replaced after a few days.   

Nicotine patches are used to help you quit smoking – the patches are replaced daily and usually release a fixed dosage of nicotine over a period of 16 or 24 hours. The dosage depends on how many cigarettes you smoke and is adjusted as you continue on your stop smoking programme.

Sources

Janssen Pharmaceutica (2016). Evorel® Conti. EMC. [online] Available at: https://www.medicines.org.uk/emc/files/pil.5591.pdf [accessed 16th July 2018].

Janssen-Cialg Ltd (2017). Evorel 25 patches. EMC. [online] Available at: https://www.medicines.org.uk/emc/product/1492/smpc [accessed 16th July 2018].

Joint Formulary Committee (2016). British National Formulary, 70 ed. London: BMJ Group and Pharmaceutical Press.

Newson, L. R. (2018). What is the difference between oestrogen pills, patches and gel? menopausedoctor.co.uk. [online] Available at: https://menopausedoctor.co.uk/early-menopause/oestrogen-patches-gels/ [accessed 16th July 2018].

NHS Choices (2016). Gender dysphoria. NHS. [online] Available at: https://www.nhs.uk/conditions/gender-dysphoria/treatment/ [accessed 16th July 2018].