Menopause news

Is HRT Patch better than pill?

27 February 2007

Huge debate followed the Women’s Health Initiative trial that was halted after older post-menopausal women taking combination hormone therapy were thought to be at higher risk of heart attacks, blood clots, strokes and breast cancer. Although this study has since been largely accepted as having major limitations, it did trigger a move away by many women from HRT as a treatment for menopause symptoms.

Now, recent research by a French group suggests that the real problem may not be the hormone itself, but the fact that it is regularly swallowed as a pill. The study was funded by the French government health agencies but it also received support from drug companies that produce patch treatments. The United States medical journal Circulation reports that there is strong evidence to suggest that the risks of taking hormones are dramatically reduced when the drugs are absorbed through the skin in patches or taken as gels rather than as pills.

The researchers suggested that blood clots, one of the risks connected with hormone use, could be virtually eliminated if women use a skin-delivery system such as the patch. Of the 881 studied in the report, researchers found that women who took hormone pills in the shape of estrogen-only or an estrogen/progestogen combination were four times as likely to suffer a blood clot compared to women who did not take HRT. Women who used hormone patches or gels were at no higher risk for blood clots than women who didn't take hormones at all. It must be noted however, that this study simply observed the effects of HRT in women, rather than randomly allocating them to various treatments.

The patches have been a popular method of taking HRT by British and European women for years but they are less commonly used in the United States. The reason for this appears to be that doctors are used to prescribing hormones in pill form and that for women the patches, worn on the abdomen, buttocks or thighs have to be changed once or twice a week and can get dirty or collect lint around the edges. Skin irritation may occur and some women see them as a constant reminder of their menopause treatment.

The Circulation study noted that women in France had different risks depending on the type of progestogen and delivery system they used and ultimately it signals that far more research is needed to understand the differences in the various hormones now prescribed to women.

One theory put forward is that hormones delivered through a patch, gel or cream do not pass through the liver before entering the blood stream and instead enter the bloodstream directly. When a pill is swallowed, the liver will process it before it enters the bloodstream and this can stimulate the liver into producing factors which can affect the circulation. However, the lower clotting risk of patch therapy hasn't been shown with birth control patch probably because contraceptives use far higher doses of estrogen.

Harvard professor JoAnn E Manson, a WHI researcher who co-authored an editorial about the Circulation study, says the new data suggests that the balance of risks and benefits shown in the WHI might have been dramatically different if patches were studied instead. In the WHI estrogen and progestogen study, at least 44% of the adverse events were related to blood clots, suggesting that a woman who uses a patch instead of a pill can eliminate nearly half the risks associated with the drugs.

This interesting report should lead to more research on the specific effects of different types of hormone therapy. However, it must be remembered that even with the tablet form of HRT used in the WHI trial, the risks have now been shown to be very small and mostly apply to older women who, although took part in the trial, wouldn't be the usual age group of women who take HRT for controlling menopausal symptoms. For many women, tablet HRT would be the usual type to start with and, when used appropriately, would be effectlive and safe but some women will be better suited to patch or gel therapy. Treatment should be individualised; we are all unique!
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