How long do HRT patches take to work? – It takes a variable amount of time for HRT patches to work, just like other forms of HRT. Some will see the first signs of improvement within days or weeks, while others may need to wait a couple of months.
- 1 Does HRT patches speed up your metabolism?
- 2 Can you drink alcohol on HRT patches?
- 3 Do HRT patches help you sleep better?
- 4 Why do HRT patches go below the waist?
- 5 Can you feel the effects of HRT on the first day?
How quickly does HRT patch work?
How long HRT takes to work – It usually takes a few weeks before you feel the benefits of HRT. It can take up to 3 months to feel the full effects. If you have not felt the benefit of HRT after 4 to 6 months, it may help to try a different type. It can take your body time to get used to HRT.
How long after starting HRT do you feel a difference?
How soon will I feel better? – Some women notice a difference within a few days, but for the majority it is a slow and steady improvement over weeks and months. You may notice physical symptoms get better first, for example, at the correct dose of estrogen, hot flushes and night sweats are often much better after 4-6 weeks.
How do I know if HRT patches are working?
How long have you been taking HRT? – Don’t lose faith if you don’t see an immediate improvement after starting HRT. It can take several weeks for your symptoms to settle, and sometimes up to three months. This is why your doctor will usually wait until three months have passed before checking in to see how things are going.
- If you are in the early days and weeks of HRT treatment, hang in there! It really is worth persevering before stopping or changing your prescription.
- However if you have recently started HRT and feel awful, contact your doctor before your three-month follow-up.
- This is especially important if you have heavy vaginal bleeding or have noticed any breast lumps or changes.
Get medical help urgently if you have any signs of:
A blood clot like deep vein thrombosis (DVT) Pulmonary embolism ( PE ), including chest pain, leg swelling or shortness of breath Stroke Other serious concerns
Do HRT patches give you more energy?
Short terms benefits and longer term benefits – HRT works really well to ease the symptoms of the menopause and will give you relief. That is the short term benefit of HRT. Many women find that all the symptoms of the menopause improve within a few months of taking HRT and feel that they have their “old life” back again.
- They often notice that their sleep improves, their mood improves and their concentration recovers.
- They also often notice that their energy is much greater than it was before they started taking HRT.
- HRT usually works to stop hot flushes and night sweats within a few weeks.
- In addition, HRT will reverse many of the changes around your vagina and vulva, usually within 1-3 months.
However, it can take up to a year of treatment in some cases. You may also find that any aches or pains in your joints improve and that the texture of your hair and skin improves when taking HRT. HRT is a safe and effective treatment for most healthy women with symptoms who are going through the menopause at the average age in the UK (about 51 years).
Does HRT patches speed up your metabolism?
Can HRT help to lose weight? Does HRT make you gain weight? A women’s risk of developing metabolic syndrome and insulin resistance increases as she goes through the menopause. Postmenopausal women therefore become more at risk of developing conditions such as cardiovascular disease and Type 2 diabetes.
- Dr Lydia Robertson The perimenopause and menopause can cause weight gain due to the metabolic effects of declining and fluctuating oestrogen.
- Many women are concerned about weight gain during the perimenopause and are also concerned that HRT makes you put weight on.
- All of the data that we have suggests that HRT does not cause weight gain and it is in fact menopause that causes weight gain.
Of course weight gain is very multifactorial. Many women actually find that they lose weight by using HRT as it shifts the metabolism back into a pre-menopausal metabolic state. Progesterone can sometimes cause fluid retention which can mimic weight gain, but there are alterations that can be made to the regime to minimise this impact.
High blood pressure Blood fat (lipid) abnormalities Abdominal weight gain (central obesity) Impaired glucose tolerance Coagulation disturbances (increased risk of blood clots)
These all increase your risk of developing heart and vessel diseases and Type 2 diabetes. Central to all of these is insulin Resistance. Medicine has advanced considerably in the last century. In 1900 the top 3 killers were lung infections, tuberculosis, and gastrointestinal infections.
Today 5 of the 7 top causes of death are related to metabolic syndrome (heart disease, cancer, cerebrovascular disease, Alzheimer’s disease, and diabetes). Over the past few decades, all these conditions have been on the rise. The one root cause is insulin resistance. A women’s risk of developing metabolic syndrome and insulin resistance increases as she goes through the menopause.
Postmenopausal women therefore become more at risk of developing conditions such as cardiovascular disease and Type 2 diabetes.
Why do I feel worse on HRT patches?
Progestogens – Some women feel more side effects when they are taking the progestogen part of their HRT. This includes taking Utrogestan, or norethisterone in the Evorel Conti patches of the Evorel Sequi or Conti box. You may feel ‘premenstrual’ with bloating, headaches and/or irritability.
Can you drink alcohol on HRT patches?
Alcohol and HRT If you’re taking any amount of hormone therapy, think before you drink-even just a glass of wine with dinner could be a health risk. A new Danish study of more than 5,000 women found that HT users who had one to two drinks a day increased their breast cancer risk threefold; among HT-taking women who average two daily drinks or more, the risk was five times higher.
What are the first noticable effects of HRT?
Overview of Feminizing Hormone Therapy UCSF Transgender Care UCSF Health System University of California – San Francisco July, 2020 Hi, I’m Dr. Maddie Deutsch, Associate Professor of Clinical Family & Community Medicine at the University of California – San Francisco (UCSF), and Medical Director for UCSF Transgender Care.
- In this document I will review various aspects of feminizing hormone theray, including, choices, risks, and unknowns associated with feminizing hormone therapy.
- As you prepare to begin treatment, now is a great time to think through what your goals are.
- Do you want to get started right away on a path to the maximum degree of medically appropriate feminizing effects? Or, do you want to begin at a lower dose and allow things to progress more slowly? Perhaps you are seeking less-than-maximal effects and would like to remain on a low dose for the long term.
Thinking about your goals will help you communicate more effectively with your medical provider as you work together to map out your care plan. Many people are eager for hormonal changes to take place rapidly – which is totally understandable. It is important to remember that the extent of, and rate at which your changes take place, depend on many factors.
These factors primarily include your genetics and the age at which you start taking hormones. Consider the effects of hormone therapy as a second puberty, and puberty normally takes years for the full effects to be seen. Taking higher doses of hormones will not necessarily bring about faster changes, but it could endanger your health.
And because everyone is different, your medicines or dosages may vary widely from those of your friends, or what you may have seen on YouTube, or read in books or in online forums. Use caution when reading about hormone regimens that promise specific, rapid, or drastic effects.
While it is possible to make adjustments in medications and dosing to achieve certain specific goals, in large part the way your body changes in response to hormones is more dependent on genetics and the age at which you start, rather than the specific dose, route, frequency, or types of medications you are taking.
While I will speak about the approach to hormone therapy in transgender women, my comments are also applicable to and inclusive of non-binary people who were assigned male at birth and considering femininzing hormone therapy. There are four areas where you can expect changes to occur as your hormone therapy progresses.
Physical, emotional, sexual, and reproductive. The first is physical. The first changes you will probably notice are that your skin will become a bit drier and thinner. Your pores will become smaller and there will be less oil production. You may become more prone to bruising or cuts and in the first few weeks you’ll notice that the odors of your sweat and urine will change.
It’s also likely that you’ll sweat less. When you touch things, they may “feel different” and you may perceive pain and temperature differently. Probably within a few weeks you’ll begin to develop small “buds” beneath your nipples. These may be slightly painful, especially to the touch and the right and left side may be uneven.
This is the normal course of breast development and whatever pain you experience will diminish significantly over the course of several months. It’s important to note that breast development varies from person to person. Not everyone develops at the same rate and most transgender women who begin hormone therapy after puberty, even after many years of treatment, can only expect to develop an “A” cup or perhaps a small “B” cup.
As with all other women, the breasts of transgender women vary in size and shape and will sometimes be uneven with each other. It is usually a good idea to wait until you have been on hormones for at least a year before pursuing breast augmentation surgery.
- Your body will begin to redistribute your weight.
- Fat will collect around your hips and thighs and the muscles in your arms and legs will become less defined and have a smoother appearance as the fat just below your skin becomes a bit thicker.
- Hormones may not have a significant effect on the fat in your abdomen, also known as your “gut”.
You can also expect your muscle mass and strength to decrease. To maintain muscle tone, and for your general health, I recommend you exercise. Overall, you may gain or lose weight once you begin hormone therapy, depending on your diet, lifestyle, genetics and muscle mass.
Your eyes and face will begin to develop a more feminine appearance as the fat under the skin increases and shifts. Because it can take two or more years for these changes to fully develop, it is a good idea to delay a decision on seeking facial feminization surgery until you have been on hormone therapy for at least 1 year.
What won’t change is your bone structure, including the bones of your face as well as your hips, arms, hands, legs and feet. The hair on your body, including your chest, back and arms, will decrease in thickness and grow at a slower rate. But it may not go away all together, and some may choose to pursue electrolysis or laser treatment.
- Remember that all cisgender women also have some body hair.
- Your facial hair may thin a bit and grow slower but it will rarely go away entirely without electrolysis or laser treatments.
- If you have had any scalp balding, hormone therapy will usually stop it, however the extent to which it will grow back is variable.
Some people may notice minor changes in shoe size or height. This is not due to bony changes, but due to changes in the ligaments and muscles of your feet and spinal column. Feminizing hormone therapy does not have any effect on voice pitch or character.
For those of you seeking to modify your speaking voice, I recommend you consult with a speech and language specialist who has expertise in this area. Emotional state changes The second area of impact of hormone therapy is on your emotional state Your overall emotional state may or may not change, this varies from person to person.
Puberty is a roller coaster of emotions, and the second puberty that you will experience during your transition is no exception. You may find that you have access to a wider range of emotions or feelings, or have different interests, tastes or pastimes, or behave differently in relationships with other people.
- For most people, things usually settle down after a period time.
- I encourage you to take the time to learn new things about yourself, and sit with new or unfamiliar feelings and emotions while you explore and familiarize yourself with them.
- While psychotherapy is not for everyone, many people find that working with a therapist while in transition can help you to explore these new thoughts and feelings, get to know your new body and self, and help you with things like coming out to family, friends, or coworkers, and developing a greater level of self-love and acceptance.
Sexual changes The third area of impact of hormone therapy is sexual in nature. Soon after beginning hormone treatment, you will notice a decrease in the number of erections you have; and when you do have one, you may lose the ability to penetrate, because it won’t be as firm or last as long.
You will, however, still have erotic sensations and be able to orgasm. For those who are concerned about reduced erections, medications such as slidenafil (Viagra) may be helpful. You may find that you get erotic pleasure from different sex acts and different parts of your body. Your orgasms may feel like more of a “whole body” experience and last longer, but with less peak intensity.
You may experience ejaculation of a small amount of clear or white fluid, or perhaps no fluid. Don’t be afraid to explore and experiment with your new sexuality through masturbation and with sex toys such dildos and vibrators. Involve your sexual partner if you have one.
Though your testicles will shrink to less than half their original size, most experts agree that the amount of scrotal skin available for future genital surgery won’t be affected. Reproductive system changes The fourth area of impact of hormone therapy is on the reproductive system. The impact of feminizing hormone therapy on fertility is unclear.
While some data suggest that stopping hormones for 3-6 months can allow sperm counts to return, it is best to assume that within a few months of starting hormone therapy you could permanently and irreversibly lose the ability to create sperm. Some people may maintain a sperm count on hormone therapy, or have their sperm count return after stopping hormone therapy, but it is best to assume that won’t be the case for you.
If there is any chance you may want to parent a child from your own sperm, speak with your medical provider about preserving your sperm in a sperm bank. This process generally takes 2-4 weeks and costs roughly $2000-$3000. It is best to store your sperm before beginning treatment, to avoid any risk of reduced sperm count due to hormone therapy that could impact your ability to conceive a child.
Storing sperm in advance also avoids the stress of having to stop hormones at a later time to allow testosterone levels and sperm counts to come up; often this involves a return of some masculine characteristics during the time off of hormones. On the flip side, because feminizing hormone therapy does not always lower sperm count, If you are sexually active with someone who is able to become pregnant, you should always continue to use a birth control method to prevent unwanted pregnancy.
- Risks The risk of things like blood clots, heart attacks, strokes, diabetes, and cancer as a result of hormone therapy are minimal, but may be elevated, especially for those with co-existing health conditions or starting hormone therapy after age 50.
- Generally, the size of any increase in risk for those in good health is small, and may be offset by improvements in quality of life and reductions in stress levels once they taking hormone therapy has begun.
The biggest increase in risk when taking estrogen is when it is combined with cigarette smoking. In this case there is an increased risk of blood clots, and probably strokes and heart attacks. For those with an elevated risk of these conditions, or over the age of 50, forms of estrogen that are delivered through the skin, such as a patch, are generally the safest option.
There is not much scientific evidence regarding the risks of cancer in transgender women. We believe the risk of prostate cancer will go down, but we can’t be sure. The risk of breast cancer may increase slightly, but will still be at less of a risk than a non-transgender female. Since there is not a lot of research on the use of estrogen for feminizing treatment, there may be other unknown risks, especially for those who have used estrogen for many years.
In particular for those trans women over the age of 50, it might be appropriate to use testosterone blockers only, or with a lower dose of estrogen. Since most non-transgender women go through menopause with declining estrogen levels at age 50, this approach is similar to the natural female life course, and may be of particular value in those with other health risks.
If your testicles are removed through an orchiectomy or vaginoplasty, you will be able to stop taking testosterone blockers, and may be able to take a lower dose of hormones, but should remain on at least a minimal dose hormones until a minimum age of 50. This will help prevent a potentially severe weakening of the bones, otherwise known as osteoporosis, which can result in serious and disabling bone fractures.
While gender affirming hormone therapy usually results in an improvement in mood, some people may experience mood swings or a worsening of anxiety, depression, or other mental health conditions as a result of the shifts associated with starting a second puberty.
If you have any mental health conditions it is recommended you remain in discussion with a mental health providers as you begin hormone therapy. Other medical conditions may be impacted by gender affirming hormone therapy, though research is lacking. These include autoimmune conditions, which can sometimes improve or worsen with hormone shifts, and migraines, which often have a hormonal component.
Ask your medical provider if you have further questions about the risks, health monitoring needs, and other long term considerations when taking hormone therapy. Modern, healthy approaches to estrogen therapy have no risk of causing liver injury. However, in some cases, the flow of bile from the liver through the gallbladder may be slowed which can lead to an increased risk of gallstones.
- The degree of this increased risk is small.
- Many of the effects of hormone therapy are reversible, if you stop taking them.
- The degree to which they can be reversed depends on how long you have been taking them.
- Some breast growth, and possibly reduced or absent fertility are not reversible.
- Treatments Feminizing hormone therapy may include three different kinds of medicines: Estrogen, testosterone blockers, and progesterones.
Estrogen Estrogen is the primary “female” hormone. It is involved in many of the physical and emotional changes seen in transition. Estrogen may be given as a pill, by injection, or by a number of skin preparations such as a gel, spray or a patch. Pills are convenient, cheap and effective, but are less safe if you smoke or are older than 35.
Patches can be very effective and safe, but they need to be worn at all times. In a small number of cases they can cause some skin irritation. Many trans women are interested in estrogen through injection. Estrogen injections tend to cause very high and fluctuating estrogen levels which can cause mood swings, weight gain, hot flashes, anxiety or migraines.
Additionally, little is known about the effects of these high levels over the long term. If injections are used, it should be at a low dose and with an understanding that there may be uncomfortable side effects, and that switching off of injections to other forms may cause mood swings or hot flashes.
- Some trans women have encountered difficulties obtaining a consistent supply of injected estrogen due to ongoing problems with the supplier.
- Realistically, there is no evidence that injections lead to more rapid or a greater degree of feminization.
- In my practice, I generally avoid prescribing injections unless under very specific circumstances.
Contrary to what many may have heard, you can achieve the maximum effect of your transition with doses of estrogen that result in your blood levels being similar to those of a pre-menopausal, cisgender woman. Taking high doses does not necessarily make changes happen quicker.
It could, however, endanger your health. You may encounter claims of complicated and at times questionable dosing regimens, or intensive monitoring of various blood tests, that make promises of drastic, almost magical effects. High doses of estrogens or other complicated hormonal regimens are not given to cisgender women who are seeking more exaggerated feminine features.
In reality, beyond getting your hormone levels into the somewhat wide range of levels seen in pre-menopausal non-transgender women, there is no evidence at this time to support higher doses or complex regimens over straightforward and appropriate dosing schemes, as recommended by the Endocrine Society and our own UCSF Transgender Care Guidelines.
- The bottom line is that the primary predictor of feminizing effects is likely the lack of testosterone rather than levels of estrogen.
- Blood tests for estradiol, the most important estrogen in the body, and testosterone will be performed periodically to insure your treatment is aligned with your goals.
Testosterone blockers Testosterone blockers are also known as anti-androgens. Androgens are the class of hormones that cause male or masculine features. There are a number of medicines that can block testosterone. Spironolactone is the most commonly used anti-androgen in feminizing hormone therapy.
Spironolactone works by both blocking the production of and action of testosterone. Spironolactone can cause you to urinate excessively and feel dizzy or lightheaded, especially when you first start taking it. It’s important to remain well hydrated when taking this medication. Potassium levels should be monitored while taking this medication, though elevated potassium levels with spironolactone is very rare and usually only in people with kidney disease or taking certain kinds of blood pressure medication.
For people with no history of kidney disease or high potassium levels, there is no need to reduce the amount of potassium in your diet when taking spironolactone. Contrary to what you may read in chat groups or hear from others, spironolactone is a widely used, safe medication that is well tolerated by most.
- If spironolactone is not tolerable to you, it can be stopped and all of the side effects will resolve; none are permanent.
- Your medical provider will monitor your blood testosterone level while taking spironolactone to help guide dosing and meet your goals.
- Spironolactone is taken as a pill, usually twice per day.
A family of medications known as gonadotropin-releasing hormone (GnRH) analogs, such as leuprolide, brand name Lupron, may be used in cases where spironolactone is not appropriate or well tolerated. These medications work at your pituitary gland, and cause it to shut down the signals being sent to your testicles that tell them to make testosterone.
These medications are very effective and well tolerated, but can be expensive, and not all insurance plans cover their use. In addition to monitoring your blood testosterone levels while taking this medication, your provider will monitor other tests to insure this medication is being dosed appropriately.
In adults, GnRH analogs are most commonly injected, and sometimes taken as a nasal spray. Depending on insurance requirements, in-office injections by a nurse may be necessary. Bicalutamide is an anti-androgen that some transgender and non-binary people ask about.
- This medication is typically used in the treatment of prostate cancer.
- This medication blocks the action of testosterone in cells, but does not block the production of testosterone.
- Because of this, testosterone levels in the body remain high, and measuring blood testosterone level is not useful for tailoring treatment.
This makes it difficult to monitor whether this medication is being optimally dosed. Because bicalutamide has a risk of liver injury and because spironolactone and GnRH analogs like leuprolide are so safe and effective, bicalutamide is not recommended for use as part of a feminizing hormone regimen.
- Finasteride and dutasteride are medicines which prevent the production of dihydrotestosterone, a specific form of testosterone that has action on the skin, hair, and prostate.
- These medicines are weaker testosterone blockers than spironolactone but have few side effects, and may be useful for those who can not tolerate spironolactone and are unable to use GnRH analogs.
It is unclear if there is any added benefit to taking one of these medicines once your testosterone levels have been reduced into the female range through the use of other blockers. Progesterone Progesterone is a hormone present in cisgender women that is involved in maintaining balance in the uterine lining and supporting pregnancy.
- Though it’s commonly believed to have a number of benefits, including: improved mood and libido, enhanced energy, and better breast development and body fat redistribution, there is very little scientific evidence to support these claims.
- Nevertheless, some say they experience some or all of these benefits from progesterone.
Progesterone may also be useful as a partial blocker of testosterone production in cases where other blockers can not be used or have not been effective. Progesterone should be used with caution as it can cause mood symptoms such as anxiety, depression, or irritability, and can cause weight gain.
Progesterone can have a negative impact on blood cholesterol, though this is usually of minimal significance unless there is a pre-existing and poorly controlled cholesterol or cardiac condition. Progesterone is usually taken as a pill. Generally, progesterone would be added to a regimen after hormone levels have been stabilized after the initial startup period on estrogen and testosterone.
Final thoughts Please remember that all of the changes associated with the puberty you’re about to experience can take years to develop. Starting hormone therapy in your 40s, 50s, or beyond may bring less drastic changes than one might see when beginning transition at a younger age, due to the accumulated lifetime exposure to testosterone, and declining responsiveness to hormone effects as one approaches the age of menopause.
Taking higher doses won’t result in faster or more dramatic changes, however they can result in more side effects or complications. Now that you have learned about the effects of feminizing hormone therapy, medication options, and risks, the next step will be to speak with your provider about what approach is best for you.
I am so happy you’ve chosen to trust UCSF Transgender Care with providing for your health and gender transition. Please visit transcare.ucsf.edu for more information about our program and services. I wish you all the best as you begin this exciting new life phase of self-realization.
Do HRT patches help you sleep better?
Research says yes. Many studies have consistently shown a benefit of HRT on sleep in women who have vasomotor symptoms, when the vasomotor symptoms are causing the sleep disturbance. The main part of HRT is estrogen, to treat symptoms caused by estrogen deficiency.
Why do HRT patches go below the waist?
Another reason why HRT should be applied below the waist is because the hormones are absorbed better by fatty tissue, such as the lower abdomen, thighs, and buttocks.
How do I know if my HRT is strong enough?
What you need to know about hormone replacement during the perimenopause and menopause Hormone replacement therapy (HRT) is usually the first-line treatment to improve symptoms of the perimenopause and menopause, It works by topping up or replacing your missing hormones.
- All types of HRT will usually contain estrogen, progesterone if you have a uterus and sometimes testosterone.
- But what are these hormones, why are there different doses and why do absorption rates vary from person to person? This article tackles these key questions and more.
- What is estrogen and what do I need it for? Estrogen is a hormone produced predominantly by your ovaries with small amounts coming from your adrenal glands.
It helps to regulate your menstrual cycle and the development of female characteristics during pregnancy, such as breasts. It also plays important roles in bone health, memory and cognition and cardiovascular health and is essential for many bodily functions, including:
- temperature regulation
- maintaining healthy and strong muscles and joints
- helping your nerves work correctly
- maintaining a healthy metabolism
- improving the way your immune cells work and function
- reducing inflammation throughout your body
- improving the way other neurotransmitters (such as serotonin) work in your brain
- keeping the lining of your vagina and vulval tissues healthy and lubricated
Estrogen is actually an umbrella term for three types: estradiol, estrone and estriol. Estradiol is the main type of estrogen produced by your body in your reproductive years. You have estrogen receptors in cells throughout your entire body, so when levels fluctuate and fall, this can trigger wide-ranging and varying symptoms including low mood, anxiety, memory problems, poor sleep, joint aches and pains, brain fog, hot flushes and vaginal dryness.
Transdermal HRT is absorbed directly through your skin into your bloodstream. This means that it bypasses your liver and causes less side effects. In addition, your liver produces clotting factors, which means that if a tablet of estrogen is taken, there is a small increased risk of a blood clot occurring.
There is no risk of clot for women who use transdermal estrogen. Transdermal estrogen can also be taken by women who suffer from migraines (women with migraine should not take estrogen in tablet form) and women who have had a clot in the past. Another benefit of transdermal estrogen is that doses can be altered more easily, allowing you to be treated individually and have your HRT dose and type tailored to your symptoms.
What is HRT made from? In the past, estrogen was only given as a tablet which was derived from pregnant horses’ urine. However the majority of estrogen and progesterone in the HRT that is now prescribed is derived from yam plants. When hormones have the same molecular shape as the hormones your body naturally produces itself, they are called body identical hormones.
- This form of estrogen most commonly used is called 17-β estradiol.
- All types of transdermal estrogen contain this type of estrogen.
- The brand of progesterone most commonly used is Utrogestan which is another body identical hormone derived from yam plants.
- There are some other brands of body identical versions of progesterone available.
Sometimes, synthetic versions of this hormone are used which are called progestogens. This will be discussed in more detail below. Body identical testosterone is also derived from yam plants. I’ve started taking HRT. How will I know how much estrogen I need? A consensus statement by the British Menopause Society states that HRT dosage, regimen and duration should be individualised, with annual evaluation of advantages and disadvantages,
- We prescribe doses according to symptoms and some women have more symptomatic improvement with higher doses than other women.
- Prescribing HRT at the right dose improves symptoms and also reduces future risk of heart disease, osteoporosis, clinical depression and type 2 diabetes.
- Hormone blood tests are not usually needed to make a diagnosis of the perimenopause or menopause, as they are unreliable especially as the levels fluctuate so much during the perimenopause.
However hormone blood tests can be useful for some women to monitor the absorption of hormones from your HRT. As your hormone levels vary from day to day, it’s always important to consider the whole picture, taking into account how you feel and if your symptoms have changed since starting to take HRT and this information will be considered to help decide if you need a change in your dose or type of HRT.
Estradiol levels are most useful for monitoring how well a type of HRT is being absorbed. They are not that accurate if you take estrogen as a tablet, as the estrogen becomes metabolised into different types of estrogen when it is digested. However, they can be helpful if you take transdermal HRT to confirm if it is being adequately absorbed through your skin into your bloodstream, especially if you are still experiencing symptoms.
If you are having symptoms despite taking HRT, then it may be that there are other causes for your symptoms so it is always important to discuss any symptoms with a healthcare professional. Generally, to offer the health benefits of estrogen replacement, estradiol blood levels need to be over 250pmol/L.
Few women need to have a level above 1000pmmol/l. Levels can really alter rapidly during the perimenopause and it can be common for women to transiently have higher levels. This is the usual range of estrogen when you are menstruating. In comparison, during pregnancy levels of estrogen can be around 17,000pmol/l.
However, the dose of estrogen needed to relieve the symptoms of the perimenopause and menopause can really vary between people. Studies have shown that younger women experiencing symptoms of the perimenopause or menopause often tend to need higher levels of estradiol (and therefore usually higher doses of HRT) than older women do.
- It is important to have adequate estrogen to improve symptoms as well as to improve future health.
- If amounts of estrogen are too low then it is likely you will experience symptoms and also the health risks of the menopause (such as increased risk of heart disease, osteoporosis, clinical depression and dementia) will still be present.
My friend is on a lower dose than I am. Does that mean my dose is too high? Some women need higher doses than other women to achieve the same benefits, especially as estrogen can often be absorbed differently through the skin. For example, some people find they absorb estrogen much more effectively through gels rather than patches, whereas for other women they find they absorb more effectively using patches compared to gels.
Other people find they absorb some brands of gels or patches better than others, despite them all containing the same type and dose of estradiol. Because of this, to achieve a specific estradiol level, some women may only need a very low dose and some may need a higher dose. Is it safe to use a higher than licensed dose of estrogen? There is no current maximum licensed dose of estrogen in the British National Formulary (BNF),
The BNF states that doses of estradiol should be adjusted according to response. Some women need higher doses to achieve a physiological level of oestradiol. It is more common that younger women with premature ovarian insufficiency (menopause before the age of 40) need higher doses to achieve a physiological response.
While many women will respond well to lower doses of estrogen, some will require higher doses such as 200mcg or 300mcg of estradiol patches to provide adequate symptom control. Why do some people absorb female hormones differently to others? There are so many reasons why you may absorb hormones through your skin differently to others.
There are many tiny blood vessels, called capillaries, which supply blood and nutrients to your skin and also absorb the hormones from the patches or gels. The depth and numbers of these capillaries varies between women, Other factors that affect absorption of hormones through your skin into your body will be the thickness of the layers of your skin, how well hydrated it is and also the temperature of your skin.
- The fact the skin works as a barrier is relevant too and some people’s barriers will be better than others even to hormones in patches and gels that are designed to penetrate your skin,
- In addition, there are many proteins and enzymes that help make up the five layers of your skin.
- These enzymes can affect the amount of hormones that are available in your bodies (bio-availability) from the patches and gels and there is evidence this composition of proteins and enzymes alters with time too,
Some studies have found that your ethnicity can affect how much of a drug is absorbed through your skin. One study found people from a Hispanic background had the best absorption rate, followed by White people, Asian people and people from an Afro-Caribbean background,
- In summary, there are many different factors affect the dose of estradiol you need to ensure you have adequate estrogen for your perimenopause or menopause.
- You should talk to a healthcare professional if you feel your dose or type of HRT needs changing.
- Progesterone doses If you still have your uterus (womb), taking estrogen can cause the lining (endometrium) to thicken.
To prevent this thickening, you will be required to take either body identical progesterone (Utrogestan, Cyclogest or Lutigest) or a synthetic progestogen tablet or have the Mirena coil. The regime in which you take your progesterone will depend on the type and whether you are still having periods or not.
- If you are still having periods, the usual recommended dose is 200mg Utrogestan every evening for two out of four weeks.
- Once periods have stopped, the dose of Utrogestan is usually 100mg every evening.
- If you experience progesterone intolerance symptoms (such as low mood), the capsules or an alternative progesterone can often be used vaginally.
The dose of progesterone needed does not always depend on your dose of estrogen. There is no strong evidence to suggest that if you are prescribed a higher dose of estrogen that you also require a higher dose of progesterone. Some women are prescribed a higher dose as they absorb estrogen through their skin less easily than other women who are prescribed lower doses.
- Other women need higher doses to improve their symptoms.
- If you are experiencing bleeding when you shouldn’t be bleeding, regardless of your dose of estrogen, you should discuss this with your healthcare provider to see if any other investigations are needed.
- Bleeding commonly occurs in the first 3-6 months after starting or altering the dose of HRT and can occur with both higher and lower doses of estrogen.
Sometimes a higher dose of progesterone is recommended to improve any bleeding. A recent audit of patients at Newson Health found that abnormal vaginal bleeding occurs in fewer than 1% of our patients. Moreover, there was no correlation between oestradiol dose levels and the incidence of problem bleeding.
- Testosterone doses When commencing testosterone replacement, the starting dose is usually 5mg of cream or gel daily.
- Generally, after 3-6 months a blood test is done to check the level of testosterone and often also your sex hormone binding globulin (SHBG) to determine your Free Androgen Index (FAI).
If your levels are low despite treatment with testosterone and you are still experiencing symptoms of testosterone deficiency (reduced libido, low energy, reduced motivation) then you may be recommended to increase the amount of testosterone gel or cream you are using and then repeat the blood test again after a few months.
Can HRT patches cause belly fat?
Will I Put on Weight with HRT? One of the most common reasons given by women for not starting Hormone Replacement Therapy (HRT) is concern that it will make them gain weight. However, evidence and scientific studies says that this isn’t true.
Can you feel the effects of HRT on the first day?
What about side effects? – When you first start HRT you may feel a little ‘discombobulated’ and not quite yourself. You might feel a bit sick or nauseous, or experience breast tenderness, bloating or headaches, particularly in the first few days. You can see a full list of side effects of the different hormones in HRT here,
Bloating is a common side effect of HRT and can be a result of taking oestrogen or progestogen. It usually improves with time but it can feel uncomfortable. If your bloating is there all the time, if there is pain, increased frequency of passing urine, a change in bowel habit or if it is accompanied by unscheduled vaginal bleeding, please speak to your GP as this may need further investigation to check for other causes.
Generally, side effects will settle in the first 3 months – often more quickly. However, they may occasionally linger for longer. If the side effects are severe or not settling, please schedule another appointment with your doctor as it may be that changing your HRT type or dose would be helpful.
How long does it take for estradiol patch to start working?
How long does it take the estradiol patch to start working? By 2 weeks, most women start to really feel the benefits of the treatment, including a reduction in hot flashes and night sweats, better sleep, and decreased vaginal dryness. This is normal, and will even out over time.
Do you lose or gain weight on HRT patches?
Weight gain and HRT – There’s little evidence that most types of HRT make you put on weight. You may gain some weight during the menopause and as you get older, but this often happens whether you take HRT or not. Exercising regularly and eating a balanced diet should help you to manage your weight,
Where is the best place to stick the HRT patch?
Put your patch on below your waist, for example buttock, thigh or lower abdomen. Avoid places where tight clothing may rub it off. Do not apply the patch over a skin fold or on hair. Your skin should be clean and dry.