Which Type of Estrogen Hormone Therapy Is Right for You?

Even after you've decided to take estrogen replacement therapy (ERT), the decision-making isn't over. There are many types of estrogen therapy in many different forms -- pills, patches, suppositories, and more. The best type of hormone replacement therapy (HRT) depends on your health, your symptoms, and what you need to get out of treatment. Here's an overview.

Type of Estrogen Treatment: Pills

• What are they? Oral medication is the most common form of ERT. Examples are Estrace, Estratab, and Premarin. Follow your doctor's instructions for dosing. Most estrogen pills are taken once a day without food. Some have more complicated dosing schedules.
• Pros. Like other types of estrogen therapy, estrogen pills can reduce or resolve troublesome symptoms of menopause. They can also lower the risk of osteoporosis. While there are newer ways of getting ERT, oral estrogen medicines are the best-studied type of estrogen therapy.
• Cons. The risks of this type of estrogen therapy have been well-publicized. On its own, estrogen causes a slight increase in the risk of strokes, blood clots, and other problems. When combined with the hormone progestin, the risks of breast cancer and heart attack may rise as well. Oral estrogen -- like any estrogen therapy -- can also cause side effects. These include painful and swollen breasts, vaginal discharge, headache, and nausea.
  
  Because oral estrogen can be hard on the liver, people with liver damage should not take it. Instead, they should choose a different way of getting estrogen.

Type of Estrogen Treatment: Skin Patches

• What are they? Skin patches are another type of ERT. Examples are Alora, Climara, Estraderm, and Vivelle-Dot. Combination estrogen and progestin patches -- like Climara Pro and Combipatch -- are also available. Menostar has a lower dose of estrogen than other patches, and it's only used for reducing the risk of osteoporosis. It doesn't help with other menopause symptoms.
  
  Usually, you would wear the patch on your lower stomach, beneath the waistline. You would then change the patch once or twice a week, according to the instructions.
• Pros. In addition to offering the same benefits as oral therapy, this type of estrogen treatment has several additional advantages. For one, the patch is convenient. You can stick it on and not worry about having to take a pill each day.
  
  Regular estrogen pills can be dangerous for people with liver problems, because they stress the liver. But patches are OK because the estrogen bypasses the liver and goes directly into the blood. A 2007 study also showed that the patch does not pose a risk of blood clots in postmenopausal women like oral estrogen does, though more studies are needed before making definitive conclusions on whether patches are safer than pills. Right now, all estrogens carry the same black-box warning with respect to clot formation.
• Cons. While some experts believe that estrogen patches may be safer than oral estrogen in other ways, it's too early to know. So for now, assume that estrogen patches pose most of the same risks -- a very small increase in the risk of serious problems, like cancer and stroke. They also have many similar -- although perhaps milder -- side effects. These include painful and swollen breasts, vaginal discharge, headache, and nausea. The patch itself might irritate the skin where you apply it.
  
  Estrogen patches should not be exposed to high heat or direct sunlight. Heat can make some patches release the estrogen too quickly, giving you too high a dose at first and then too low a dose later. So don't use tanning beds or saunas while you're wearing an estrogen patch.