There are various ways that traditional HRT is taken: tablets, implants, skin patches, creams, vaginal pessaries, and gels.
Tablet: Oestrogens and progestagens are commonly given in combination, either as Cyclical Sequential therapy or Continuous therapy:
Cyclical Sequential therapy: In this form of treatment Oestrogens are given from day 1 to 21 and progestagen from day 9 to 21. There are seven days per month without medication during which time light 'withdrawal' bleeding occurs.
Continuous therapy: Oestrogen is given continuously and progestagens are added from the 14th to 25th day of the cycle. A withdrawal bleed, very similar to a period, occurs within two days of the progestagen being stopped. For convenience progestagens may be taken only at the end of three months so that the frequency of withdrawal bleeding is reduced. Continuous therapy maybe given using Tibolone (Livial), once the lining of the uterus has become non-secretory (about a year after finishing periods).
Implants: Up to six month’s supply of oestrogen can be given as a sub-cutaneous implant, usually into the abdominal wall. Absorption occurs directly into the blood-stream avoiding the potential hazards of passing through the liver. The dose of oestrogen is smaller but progesterone is still needed to avoid the effects of unopposed oestrogens. However, the dose can’t be varied once the implant is inserted and removal is difficult. Increasing doses may be needed to limit menopausal symptoms for reasons that are not clear.
Skin Patches: Oestrogen is contained in a patch, which is placed on the lower trunk and changed every three or four days. Progestagens are taken from the 14th to the 25th day either as a pill, or by means of a patch combining oestrogen and progestagen. The skin may become red and sore following the use of a patch. With patches of this type the oestrogen is contained in a reservoir of alcohol, which looks like a small bubble, against the skin.
A Matrix-patch in which oestrogen is impregnated in a sponge-like medium is more comfortable, less bulky, and lies flat against the skin.
Female HRT - Types of Traditional Applications
Creams and Pessaries: Oestrogen cream is placed in the vagina with an applicator for the treatment of vaginal symptoms. Only limited absorption of oestrogen occurs making it unsuitable as a way of treating other menopausal symptoms.
Oestrogen gel provides an effective alternative to the patch. The gel is used on the inner aspect of the upper thigh and rubbed in daily. The dose is adjusted according to individual need on the basis of oestrogen levels measured in blood or saliva.