Pros & cons of patch/gel HRT vs tablets?

[WonderWine]

I know this has been discussed in various menopause threads, but I just wondered if anyone can point me towards any official, clinical evidence about the relative benefits of transdermal HRT vs. tablets?

I've been on Elleste Duet 1 mg for about a year now and have to say it's been working fantastically for me however I've vaguely aware of having read that trans-dermal is safer in the long term.

We have some breast cancer in females in my family (albeit later in life) but I'm still slightly concerned.

There is loads of evidence and it's all online- just google the key words and you will find zillions of research papers. NICE menopause guidelines have some info on it too if you read the risks and look at the figures and summaries.

The summary of it is that transdermal oestrogen does not cause blood clots whereas tablets have a higher risk. There is no difference re. breast cancer but there is increasing evidence that micronised progesterone is safer re. breasts than synthetic progestogens- again, google the search words.

This is one such paper.

I put the words 'HRT transdermal safer' into google and lots came up!

Too many to link and I don't have the time, but here's one.

www.ncbi.nlm.nih.gov/pubmed/23848491

On that link you can see links to other similar articles on the far right of the page.

Thanks so much Polly - will have a good search!

Thanks Polly, that link is very helpful.

You might be able to read that last full article on researchgate. I would talk to my GP to try to get an impartial view how to minimise risks that matter to you.

The author's conflicts of interests statement:

"In his career, the author has been the principal investigator of clinical research studies granted by Eli Lilly, Farmitalia, Fournier, Organon, Sandoz, Solvay and Wyeth. He received unconditional travel grants for congress assistance from these companies as well as from Novo Nordisk, Piette, Servier, Solvay-Abbott and Schering. Lately, he ccasionally received consultancy honoraria and lecture fees from Besins Healthcare International and Merck/MSD. He (and his family) owns no stock (options) of any pharmaceutical company."

ps: that article isn't a peer reviewed original research article. It's probably a commissioned piece, something industry sponsored, anyway.

The thing is medrat every single piece of research on HRT transdermal v oral shows that it's safer! The NICE meno report states it too. If you are trying to say the author is in the hands of the drug companies, then that's rather cynical.

The reason it's safer is that it doesn't pass through the liver first ('first bypass') and affect levels of triglycerides.

GPs are not experts on HRT. If asked, they will quote the NICE guidelines which say the same thing- ie oral can cause blood clots. They are though under pressure to prescribe the cheapest drugs which are - guess what? - oral tablets not transdermal.

OP- this is the information from Nice- found online and the research papers used are also listed as links.

NICE guidelines

1.5 Long-term benefits and risks of hormone replacement therapy

Venous thromboembolism

1.5.1 Explain to women that:

the risk of venous thromboembolism (VTE) is increased by oral HRT compared with baseline population risk

the risk of VTE associated with HRT is greater for oral than transdermal preparations

the risk associated with transdermal HRT given at standard therapeutic doses is no greater than baseline population risk.

1.5.2 Consider transdermal rather than oral HRT for menopausal women who are at increased risk of VTE, including those with a BMI over 30 kg/m2.

1.5.3 Consider referring menopausal women at high risk of VTE (for example, those with a strong family history of VTE or a hereditary thrombophilia) to a haematologist for assessment before considering HRT.

Cardiovascular disease

1.5.4 Ensure that menopausal women and healthcare professionals involved in their care understand that HRT:

does not increase cardiovascular disease risk when started in women aged under 60 years

does not affect the risk of dying from cardiovascular disease.

1.5.5 Be aware that the presence of cardiovascular risk factors is not a contraindication to HRT as long as they are optimally managed.

1.5.6 Using tables 1 and 2, explain to women that:

the baseline risk of coronary heart disease and stroke for women around menopausal age varies from one woman to another according to the presence of cardiovascular risk factors

HRT with oestrogen alone is associated with no, or reduced, risk of coronary heart disease

HRT with oestrogen and progestogen is associated with little or no increase in the risk of coronary heart disease.

1.5.7 Explain to women that taking oral (but not transdermal) oestrogen is associated with a small increase in the risk of stroke. Also explain that the baseline population risk of stroke in women aged under 60 years is very low (see table 2).