The Benefits of Transdermal Delivery vs Oral Delivery1

  • Transdermal administration of estradiol is unlikely to increase the risk of venous thrombosis or stroke and should be considered the first choice route of administration for women with risk factors.

  • Oral estrogen follows a first pass liver metabolism and as a result has a prothrombotic effect and adversely effects proinflammatory markers, compared with transdermal estradiol

  • The use of low dose transdermal estrogen was not associated with an increased risk of stroke compared with women not using HRT. This effect was noted whether it was estradiol alone or in combination with progestogens

  • Women taking oral HRT were noted to have a higher risk of stroke compared to those not taking HRT.

  • Transdermal administration of estradiol has a lower risk of VTE compared with oral administration and no increases risk above that noted with non-users of HRT.

The Benefits of Transdermal Patches vs Gels

  • Patients using gel could dispense extra gel or not enough or not spread evenly for effective absorption, so there is quite a lot of potential medicines wastage.

  • Patients using a gel must wait for it to dry before dressing (5 mins). Skin contact, particularly with a male partner should be avoided for one hour and washing should also be avoided for one hour.

  • Less risk of patient under or over-dosing as fixed delivery through the patch.

When to use Transdermals

The risk of venous thromboembolism (VTE) is increased by oral HRT compared with baseline population risk and is greater for oral than transdermal preparations2

Reference

  1. Adapted from the Management of the Menopause, Sixth edition, published by the British Menopause Society (BMS)
  2. https://thebms.org.uk/wp-content/uploads/2020/07/04-BMS-TfC-HRT-Guide-JULY2020-01D.pdf
  3. NICE Guidelines. Menopause: diagnosis and management. https://www.nice.org.uk/guidance/ng23/resources/menopause-diagnosis-and-management-pdf-1837330217413

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