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Are you looking for a safe and effective way to reduce your perimenopause or menopause symptoms, maintain the health of your vulva, vagina and urinary tract, skin, and improve your sex life? Look no further than estrogen patches. This guide will teach you everything you need to know about estrogen patches for menopause and how to use them to your advantage.
What are estrogen patches?
Estrogen patches are small, adhesive patches that allow hormones to be absorbed directly into the blood stream via the skin. They are a form of menopausal hormone therapy containing estradiol, a hormone that is naturally found in the female body and helps maintain reproductive and cellular health.
Estradiol patches can be used to treat symptoms of any stage of menopause such as hot flashes, night sweats, mood and vaginal dryness and urinary health.
What Are The Benefits Of Using Estrogen patches For Menopause?
There are a number of benefits of using estrogen replacement therapy.
1. Reduce menopausal symptoms such as hot flashes, sweats and mood swings. Read more about 34 symptoms of perimenopause.
2. Increase bone density and reduce risk of osteoporosis
3. Alleviate vaginal dryness and discomfort
4. Improve sex drive and sexual function
5. Reduce the risk of heart attack and stroke
6. Reduce the risk of diabetes and liver disease
7. Improve cognition and memory
8. Reduce the risk of breast cancer (when used without progestogen for example if you have had a hysterectomy).
9. Reduce urinary tract infections
Everything You Need To Know About Estrogen Patches
Dive in and discover the answers to your questions about estrogen patches
1. Are Estrogen Patches Safe?
Estrogen patches are a safer form of estrogen than oral estrogen. Estrogen patches typically contains. Estradiol is the main female form of estrogen. When it is delivered through the skin, estradiol does not increase the risk of blood clots. This is because it can be delivered at a much lower dose through the skin as it does not have to first pass through your stomach and your liver where it can interfer with the production of clotting factors.
It is important to use your patches in the dose prescribed to you and discuss with your doctor or health care provider if you want to increase or decrease your dose or if you are having side effects.
If you have not had a hysterectomy (surgery to remove the uterus/womb), you must take another type of hormone called Utrogestan (natural progesterone) or a progestogen in addition to using estrogen patches.
Natural progesterone or progestogen helps to balance the effects of estrogen and protects the lining of the uterus from being overstimulated to grow. Progesterone or progestogens are given cyclically or continuously.
Women who have had a hysterectomy do not need to use progesterone or progestogen to balance the effect of estrogen in the uterus/womb.
According to current best practice, safest time to start using estrogen patches (or any form of HRT) is within 10 years of your final period.
2. What Is A Typical Estrogen Patch Dosage?
Estrogen patches come in 4 doses:
25 microgram patch
50 microgram patch
75 microgram patch
100 microgram patch
Most women start on 25-50 microg estradiol patches and increase upwards to find the dose that resolves their symptoms.
More is not always better.
The patches are changed twice per week or approximately every 3.5 days.
3. How Much Do Estrogen Patches Cost?
Estrogen patches have been funded through Pharmac in New Zealand since 2016. You will still pay a doctors visit fee/prescription fee and a pharmacy fee of between $0-15 dollars per prescription depending if your prescription is written by your GP or a specialist.
Currently you can only get a prescription for estrogen patches for 3 months.
Read more about HRT funding in New Zealand.
4. What is the Availability of Estrogen Patches?
Estrogen patches are available in New Zealand and Australia. At the time of writing in 2023, we are still having ongoing shortages of estrogen patches due in part to:
the disruptions to the global supply chain from the covid pandemic and
better recognition of the safety of modern HRT including estrogen patches and therefore an increase uptake in use.
the increasing unacceptability of women to just 'put up with' or 'suffer through' or 'feel crap' when there is a safe and effective way to manage symptoms.
Limited options for HRT in New Zealand. As estrogen patches are the only transdermal way of delivering estradiol that is funded in New Zealand most women use these rather that the estrogen gel which they would have to pay for out of pocket.
Strategies to cope with the current availability issues:
There are typically alternate brands of estradiol patches available meaning you may need to swap brands. Alternate brands may be absorbed differently.
Sometimes you may be instructed by the pharmacist to use 2 patches to get the correct estrogen dose or to cut a patch in half.
Some women opt to use an oral estrogen or self-fund topical estrogen gel.
5. How To Use Estrogen Patches
Estrogen patches can be used without any other HRT preparation if you have had a hysterectomy or Mirena IUD.
If you have a uterus and no Mirena, you will need to take a progestogen alongside using estrogen patches, which usually comes in the form of a pill.
Estrogen patches are simple to use as long as you are able to see them and remove the adhesive covering.
Estrogen patches need to be applied to clean, dry and hair-free skin. They are usually placed on the lower stomach or upper buttock.
Remove the backing from the patch and press firmly onto the skin for 10 seconds.
Apply each new patch to a different area of your lower abdomen/buttocks.
You can take a bath, shower, or swim as you normally do while using estrogen patches.
When you removed the patches fold them in half adhesive sides together and place in the bin.
Don't let children or pets get access to them.
Estrogen patches are changed twice per week. A estradiol patch twice-weekly schedule could look like this:
sunday morning & wednesday evening patch change or
friday morning & monday morning.
Writing your schedule in your diary, your online calendar or setting an alarm on your phone are useful ways to ensure you remember to change your estrogen patch.
6. What Do You Need to Monitor While Using Estrogen Patches?
While using estrogen patches you should see your doctor at least once a year for a check-up. Until you get your dose right you will need to be seen more frequently, usually every 6-12 weeks.
You can monitor your symptoms using an app such as Balance Menopause App.
While using estrogen patches you should:
check your own breasts and monitor for changes
participate in 2 yearly mammogram screening
have a 3-5 yearly cervical smear
have an annual blood pressure check and cholesterol level blood test.
7. Do You Need to Monitor Estrogen Levels When Using Estrogen Patches?
You do not need to monitor estrogen levels, however they will sometimes be checked if;
your symptoms are not improving to see if you are absorbing any of the estradiol or
we need to see if you are adequately estrogenised if you are considering using testosterone.
8. Who Should Not Use Estrogen Patches?
If you have the following conditions, estrogen patches may not be the best treatment for your peri/menopause symptoms:
cancer of the breast or uterus (womb),
blood clots in the veins or lungs,
a condition that increases the tendency for you to get blood clots,
abnormal vaginal bleeding or heavy periods that has not been investigated,
severe liver disease,
porphyria
You should talk with your medical provider to get individualised advice for you and your health risks.
9. Can I get Pregnant When Using Estrogen Patches?
Estrogen patches are not considered a form of contraceptive or birth control. They top up your own estradiol levels, so could potentially improve your fertility. If you are still having periods or are within the first 12 months of having had no period, and do not want to get pregnant, you will need to use contraception.
Many women use a Mirena as the progestogen component of HRT and this also doubles as contraception. You can also use condoms alongside estrogen patches.
10. What Are The Side Effects From Estrogen Patches?
Estrogen patches are not for everyone.
Common side-effects of using estrogen patches include:
skin irritation at the patch site
headache
breast pain, tenderness or enlargement
nausea and vomiting.
You could also get irregular bleeding if you have a uterus and your estrogen dose is not balanced with progesterone/progestogen as estrogen promotes growth of the uterus lining (endometrium). Some bleeding is expected when first adding or increasing a dose but should settle in 3-6 months.
Any unexpected or unexplained vaginal bleeding should be discussed with your doctor.
As with all medications, if you experience any serious side effects or symptoms or an allergic reaction, seek medical attention right away. These include:
sudden severe headache,
chest pain,
leg or arm swelling,
increase in blood pressure,
vision changes or
jaundice.
11. What Are The Long Term Risks of Using Estrogen Patches?
Risks of estrogen patch use depend mostly on whether or not a progestogen and the type of progestogen that is used. The following 3 conditions have historically been considered related to HRT use.
Heart Disease
In follow up analyses of the Women's health initiative study, there was no evidence of harm from heart disease for women who started menopause hormone therapy (MHT) close to the menopause. In fact, there was a trend towards a reduced risk for these women.
Breast cancer
Breast cancers are a complex cluster of diseases with a variaety of types. The relationship between estrogen exposures does appear to influence breast cancer risk. Those exposures are not limited to HRT, but include also include:
hormonal birth control exposure,
having pregnancies,
age at first pregnancy,
number of pregnancies, and
duration of breast feeding (Estrogen Exposure and Breast Cancer Risk).
In the Women's Health Initiative, women over 60 years who used only oral estrogens had reduced risk of breast cancer both while using estrogen and when they had discontinued at 20 year follow-up. Among women over 60 who started HRT using oral estrogens and synthetic progestogen, there were 4 additional cases per 1000 of breast cancer and this additional risk persisted at 20 years follow-up.
There is not much data to differentiate between breast cancer risk using estrogen patches vs oral estrogens. A study published in 2024 of 10 million women aged over 65 found both estrogen delivered through pills, patches and creams were protective against breast cancer when used without progestogen (Menopausal Hormone Therapy Beyond Age 65).
When used alongside a progestogen there was a small increased risk of breast cancer (smaller than the risk associated with breast cancer due to drinking alcohol or having a high body mass). Hopefully further studies will provide more safety data.
This same study found the risk of breast cancer was lower when natural progesterone such as utrogestan or prometrium was used alongside estrogen patches rather than a synthetic progestogen.
Blood Clots
Use of oral estrogens increases the risk of blood clots such as clots in the legs, lungs and strokes.
Estrogen patches are a safer way to deliver estrogen as it comes in smaller more constant doses and does not overload the liver and interfere with clotting factors.
According to guidance from the Australasian Menopause Society:
"transdermal menopause hormone therapy has little or no effect on coagulation factors or risk of venous thrombo-embolism."
12. How Long Should I Use Estrogen Patches?
You can continue to use estrogen patches as long it is helpful for you. There is no time-limit on use of HRT. Shared-decision making means having an ongoing and open discussion with your health provider about the benefits and risks of HRT/estrogen patches for YOUR health.
Many women use patches as they get through the perimenopause transition and reduce and stop using estrogen patches once they are through menopause. However symptoms of low estrogen can persist for life.
Forty-two percent of women are still having hot flashes after age 60 and a smaller percent continue to have these lifelong. Around 90 percent of post-menopausal women have genitourinary syndrome of menopause - which includes symptoms of vaginal dryness, vulva skin fragilty, urinary incontinence or recurrent urine infections, or pain with sex.
Women with these persisting symptoms they may choose to continue to use estrogen patches well beyond their final period.
If your symptoms have resolved or your develop a new medical condition or you become at high risk for serious medical conditions you may choose to discontinue using estrogen patches.
13. Estrogen Patches: Discontinuation
If you chose to stop using HRT, including estrogen patches, it is recommended that this should be done gradually, unless you are already on a low dose.
Sudden hormonal changes can exacerbate menopause symptoms and also increase disease risk.
14. How To Remove And Dispose Of Your Estrogen
To remove your estrogen patch, slowly peel it off from your skin. Where there is adhesive left on the skin, once it has dried you can remove it my gently rubbing the sticky residue with oil or lotion.
Fold your used patch into itself so it cannot inadvertently get stuck to anyone/anything else and dispose of it into the rubbish bin.
15. How To Track Your Symptoms When Using Estrogen Patches
One of the best ways to keep track of your perimenopause or menopause symptoms is through the Balance Menopause app which is specifically designed for tracking menopausal symptoms.
I hope this answers many of your questions about estrogen patches.
As a menopause doctor, Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you through the perimenopause and menopausal stages of life, supporting all aspects of your health and wellbeing.
Dr Deb Brunt is a menopause specialist in New Zealand and also provides menopause health coaching internationally to support the best health habits. She has a passion for supporting women adapt to their changing female physiology for optimum health so they are able to live their best lives.
Join our Meno Thrive program to optimise your health and wellbeing during perimenopause and menopause.
References
Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of Cardiovascular Disease by Age and Years since Menopause. JAMA. 2017; 297(13):1465-1477.
North American Menopause Society. Hormone Therapy Position Statement. 2022.
Travis RC, Key TJ. Oestrogen exposure and breast cancer risk. Breast Cancer Res. 2003;5(5):239-47. doi: 10.1186/bcr628. Epub 2003 Jul 28.
Al-Shami K, Awadi S, Khamees A, et al. Estrogens and the risk of breast cancer: A narrative review of literature. Heliyon. 2023 Sep 17;9(9):e20224.
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