HRT patches prices

Types of HRT patches:

Oestrogen only HRT patches

For women without a womb (having had a hysterectomy) or with an active Mirena IUS (or other 52mg levonorgestrel coil eg Benilexa or Levosart).

Sequential (or cyclical) combined HRT patches

For women who have had periods within the previous 12 months. All patches contain oestrogen but there are also combined patches containing progestogen as well. There is a sequence of patches and they must be used following the order advised in the pack. Regular bleeding occurs for a few days after using the patches containing progestogen.

Continuous combined HRT patches

For women who have not had a period for over 12 months^* or over age 54. All patches contain the same quantity of oestrogen and progestogen and there should be no regular bleeding.

*If on contraception that stops your periods it is usually recommended to use cyclical HRT for 5 years or until age 54. You can try continuous combined HRT but should be aware that this may cause irregular bleeding and if this continues for more than 3 months you should change to sequential /cyclical combined HRT.

There is a further subdivision of HRT patches depending on the dose of oestrogen (estradiol) and type of progestogen. The progestogen used in combined patches is either norethisterone or levonorgestrel.

HRT patches available from Dr Fox:

Table showing HRT patches available in the UK

Patch	oestrogen per 24 hours	progestogen	no. days progestogen is taken per month	no. patches per week
Oestrogen only
Evorel 25	estradiol 25 mcg	none	none	2
Evorel 50	estradiol 50 mcg	none	none	2
Evorel 75	estradiol 75 mcg	none	none	2
Evorel 100	estradiol 100 mcg	none	none	2
Sequential combined
Evorel Sequi	estradiol 50mcg	norethisterone 170 mcg	14	2
Continuous combined
Evorel conti	estradiol 50 mcg	norethisterone 170 mcg	every day	2
Femseven Conti	estradiol 50 mcg	levonorgestrel 7mcg	every day	1

Who can use HRT patches?

Patches can be used by many women and the benefits are:

• Wide variety of doses.
• Patches only need to be changed once or twice a week.
• HRT is absorbed directly into the bloodstream without going through the liver, so does not increase the risk of blood clots.

HRT patches are usually advised when:

• Starting HRT over 60.
• Overweight with a BMI over 30.
• Side effects with HRT tablets.
• Raised blood pressure.
• Increased risk of blood clots.
• High blood triglyceride levels.
• Taking other medications which stimulate the liver enzymes e.g. carbamazepine.
• Gut problems which affect absorption of tablets.
• Migraine.
• Gallbladder disease.
• Lactose intolerance - most HRT tablets contain lactose.

Is there anyone who cannot use HRT patches?

Women who have a sticky plaster allergy, an allergy to other medicinal patches, or inflamed skin are recommended to use an alternative form of HRT.

Women usually advised not to take any form of HRT because of increased health risks include those who have:

• Current, previous or strong family history of breast cancer or any other hormone dependent cancer.
• Vaginal bleeding that hasn't been investigated by a doctor.
• Untreated thickening of the womb lining (endometrial hyperplasia).
• Active liver disease.
• Pregnancy.
• Porphyria.
• Systemic Lupus Erythematosus.
• A strong family history of blood clots, or hereditary thrombophilia.

Specialists may sometimes prescribe outside this guidance after individual assessment.

Other medications and HRT patches

There is a possibility that some medicines may affect the blood levels of HRT and may therefore trigger irregular bleeding. These include:

• Epilepsy medication (phenobarbital, phenytoin, carbamazepine).
• Antibiotics for tuberculosis (rifampicin, rifabutin).
• HIV treatments.
• Hepatitis C treatments.
• Bosentan for raised blood pressure in the lungs.
• St John's Wort.

HRT in patches may interfere with the action of some other medications making them less or more effective. Discuss with your regular doctor if taking:

• Lamotrigine (epilepsy).
• Tacrolimus, cyclosporin (immunosuppressants).
• Fentanyl (pain killer).
• Theophylline (asthma).
• Levothyroxine (underactive thyroid).

Safety of HRT patches

Endometrial (womb lining) cancer

Taking oestrogen alone is known to increase the risk of developing over thickening of the womb lining which can lead to endometrial cancer. Anyone who still has a womb MUST take protective progestogen as well as oestrogen in their HRT.

If there is irregular vaginal bleeding at any time after the first 6 months of using HRT, or after 3 months of changing HRT, this needs to be checked with a doctor as it may be an indication of over thickening of the womb lining.

Breast cancer

There is a small increased risk of breast cancer in women over 50 taking HRT, especially if taking HRT tablets containing progestogens. The risk with patches is similar. The effect on breast cancer risk gradually reduces after stopping HRT.

Ovarian cancer

Ovarian cancer is less common than breast cancer. HRT use is associated with a slightly increased risk of ovarian cancer, particularly with longer durations of use. This risk gradually reduces on stopping.

How to use HRT patches

The patch should be applied to clean, dry, healthy skin, on a different area to the previous patch below the waistline such as the thigh or buttock area. The patch can be left in place whilst showering, bathing or swimming. Replace the patch on the same day, once or twice a week depending on the brand used.

If you forget to replace the patch on time, change it as soon as you remember and then apply the next patch at the normal time. Hormone levels may drop and trigger bleeding if a patch is not replaced on time.

Possible side effects from HRT patches

Remove the patch and stop HRT and consult a doctor if any of the following occur:

• Jaundice - yellow eyes or skin.
• Sudden raised blood pressure.
• First ever migraine type headache.
• Suspected blood clot which may cause swelling in one leg, sudden chest pain, or sudden breathing difficulty.

Other common side effects from oestrogen include headache, abdominal pain, vaginal discharge or discomfort.

Patches may cause skin irritation. Alternative HRT should be used if the skin becomes red and sore.

Further information is in the manufacturers' patient information leaflets.

Other options for symptoms of menopause

General healthy lifestyle measures can help with symptoms of the menopause. Eat a balanced diet, low in saturated fats and salt, with high calcium and vitamin D content. If you cannot obtain the recommended amount of calcium and vitamin D from your diet, you might wish to consider taking supplements.

Regular exercise helps to maintain bone and muscle mass. Alcohol is a known trigger for flushes and sweats, so cutting down can help, as will reducing caffeine. Losing excess weight can also reduce symptoms.

Smoking contributes to osteoporosis and heart disease risk. Smoking also increases the risk of breast cancer and many other cancers, so stopping smoking at the menopause will improve long term health.

Anxiety and mood symptoms, and also hot flushes and night sweats, may respond to Cognitive Behavioural therapy (CBT) either in person or online. St John's Wort, a herbal remedy for low mood, helps some women, but this cannot be used if taking HRT.

Herbal remedies which have been shown to help with menopausal symptoms are red clover, other soya based isoflavones, and also black cohosh. Black cohosh is effective but some black cohosh products have been linked to mild liver damage, which may recover on stopping. There are, however, some reports of more serious, irreversible liver failure.

Pregnancy and breastfeeding

HRT patches should not be used during pregnancy or when breastfeeding. If you become pregnant whilst taking HRT you should stop this immediately.

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