HRT patches: the complete UK guide

How they work

The patch holds oestradiol, the same oestrogen molecule your ovaries produced. It passes through the skin steadily and enters the bloodstream directly.

That last part matters. Oestrogen taken by mouth is absorbed through the gut and passes through the liver before reaching the rest of the body, which affects clotting factors. Oestrogen delivered through the skin bypasses that first pass.

UK guidance recommends the transdermal route for women at increased risk of venous thromboembolism, including women with a BMI over 30, because transdermal oestrogen is not associated with the clot risk seen with oral treatment. That is why a patch is often not a preference but a clinical judgement.

Combined and oestrogen-only patches

If you have a womb, you need progesterone as well as oestrogen, to protect the womb lining. There are two ways patches handle this:

• An oestrogen-only patch, with progesterone taken separately as a capsule
• A combined patch, containing both

If you have had a hysterectomy, you generally use oestrogen alone.

Which arrangement suits you depends on where you are in the transition, whether you still have periods, and how you respond. That is a prescriber's decision, not a shopping choice.

Where to put it

On clean, dry, unbroken skin below the waist. The usual sites are the lower abdomen, the buttock or the upper outer thigh.

Not on the breasts. Not on skin that is broken, irritated, or heavily creamed.

Rotate the site each time. Using the same patch of skin repeatedly is the most common cause of irritation. Give a site at least a week before returning to it.

Press it flat for about ten seconds after applying, particularly around the edges. That single step prevents most adhesion problems.

Keeping it on

Patches are designed to survive showers, baths and swimming. Most failures have simple causes:

• Moisturiser or oil at the site. Apply to clean, dry skin with nothing on it.
• Applying straight after a hot shower, when skin is damp and pores are open. Wait a few minutes.
• A site that creases or rubs, such as a waistband. Move it.
• Heat. Saunas, hot tubs and heat pads can loosen adhesive and can also increase absorption. Avoid direct heat over the patch.

If a patch does come off partway through, do not assume you have had a full dose. Replace it and keep your normal change day.

What to expect in the first weeks

Most women notice the first shift in symptoms within four to six weeks, and night-time symptoms often move first. Full benefit takes about three months.

Early on, some women experience breast tenderness, mild nausea, headaches or slight bleeding. These commonly settle within the first three months as your body adjusts.

Skin irritation at the site is the side effect specific to patches. Rotating properly resolves most of it.

What is not normal, and is worth reporting rather than waiting out: significant unexpected bleeding, severe headache, calf pain or swelling, or breathlessness.

Patches, gel or tablets

Patches give steady levels, need attention twice a week, and avoid the oral clot risk. The trade-off is visible adhesive and possible skin irritation.

Gel or spray delivers through the skin too, with the same clot advantage, but needs daily application and time to dry.

Tablets are simple and invisible, but carry the clot risk associated with the oral route.

Price is not the deciding factor at fira: the plan is one flat price whichever format you are prescribed.

Getting the dose right

Starting doses are usually conservative and adjusted upwards if symptoms persist. Needing an adjustment is normal, not a failure, and most women fine-tune once or twice in the first months.

If you are still symptomatic after a reasonable trial, that is information for your clinician, not a sign that HRT does not work for you.