Supplementing oestrogen as the levels fall, whether naturally or other reasons such as switching off the ovaries or surgical removal, can be achieved with different types of oestrogen replacement:
Transdermal (through the skin)
Brands of twice weekly patches include:
You can also get weekly patches such as FemSeven- 25mcg,50mcg, 75mcg and 100mcg.
Tablets – Oestradiol
Oestrogen tablets convert via the gut wall and liver to a different type of oestrogen from transdermal or oestrone. Tablets can be extremely effective at delivering steady levels of oestrogen into the circulation with better absorption in some cases than just other types of oestrogen. These can be used on their own or in conjunction with transdermal. Because oral oestrogen delivers via the liver, some studies indicate a more beneficial effect on cholesterol lipid profile compared to transdermal alone.
Although many doctors (general practitioners and even gynaecologists) advise avoiding oral oestrogen because of potential clotting risk, this in fact relates to outdated studies regarding Premarin (horse oestrogen) which was reported 20 years ago in the WHI study. The study therefore no longer relates to modern prescribing which uses bioidentical - oral oestradiol which is a completely different molecule and much weaker than Premarin and does not increase the risk of clotting significantly and certainly only a tiny fraction of that compared to smoking, being overweight and other lifestyle factors.
Therefore, taking oral oestrogen, with or without transdermal, may be a beneficial addition to your HRT regimen, depending upon your absorption and symptom response to transdermal alone. This will depend upon whether you can continue to have symptoms and the FSH response.
Brands of oestradiol tablets include:
Dosages of these tablets start from 1mg per day up to 8mg, starting at the lowest dose and increasing in increments, monitoring symptom response and FSH to indicate whether absorption is adequate. SHBG may need to be checked when doses greater than 2mg per day. SHBG is a protein produced in the liver in response to oral oestrogen and can block the effects of oestrogen in circulation.
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