Is Your Estrogen HRT Going To Waste?

Taking HRT should not be a matter of just using it and hoping for the best. There are a lot of things that can affect absorption rates, so blind trust is not what’s needed here. Instead…

Things to know about

Firstly, know: transdermal estradiol (e.g. gel or patches) is almost always absorbed better than oral estradiol (i.e. pills); intramuscular estradiol (i.e. injection) is also better than pills, if (and only if) administered correctly.

This video covers gel and patches, and discusses a recent study that included 1,058 women (perimenopausal and postmenopausal) using estrogen patches or gels, finding significant variability in blood estradiol levels, regardless of dose or delivery method. Even women on high-dose patches or gels could have low (sub-therapeutic) blood levels, and vice versa.

Some numbers for serum estradiol levels before we continue:

• 60–150 pg/mL: ideal range for bone loss prevention.
• <54 pg/mL: considered sub-therapeutic by the study.
• <20–30 pg/mL: levels consistent with untreated menopause.

If you haven’t already, you might want to get your serum estradiol levels checked. A good protocol is to get a test every 3 months when starting, until levels appear stable and it’s established you’re now at the right dose. Then switch to 6-monthly, and then (if everything’s stable) annually.

Now, factors found to affect absorption:

• Formulation/brand differences affect absorption rate.
• Biological factors: age, ethnicity, skin fat (adiposity), hydration, and blood flow, all affect absorption. Of the modifiable factors there: best absorption is seen in cases of lower adiposity, better hydration, and better blood flow.
• Patch issues: skin reactions and/or poor adhesion reduce effectiveness.
• Application site: inner arms (thin skin) may absorb better than thighs/belly.*
• Timing: showering within an hour of applying gel can reduce absorption by up to 22%**.
• Metabolism: some women metabolize estrogen quickly and eliminate it fast (lower blood levels). Others may retain it longer, showing higher levels.

*however, if you do use your inner arms as an administration site, remember to avoid the crook of the elbow on the side you will get blood drawn from for blood tests, otherwise you’ll get an artificially elevated reading.

**Showering (or similar) immediately before applying the gel can also be a problem if you use a product with surfactants (like most soaps and shower gels), including sodium lauryl sulfate. So, it can be good to wait for a while after using such products.

For less on all of this (we normally say “for more on all of this”, but as it happens, this writer added some extra information above that wasn’t in the video), enjoy:

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Want to learn more?

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HRT Side Effects & Troubleshooting

Take care!