Patches or gel: which HRT suits you
- Both patches and gel deliver oestrogen through the skin and avoid the oral clot risk.
- Patches suit twice-weekly routine and combined-hormone convenience; gel suits daily fine dose control.
- fira prescribes patches and capsules; we do not currently prescribe gel.
- On a fira plan, the price is the same whichever format you're prescribed.
The short comparison
| Patch | Gel | |
|---|---|---|
| How often | Once or twice a week | Every day |
| Visible | Yes, a small adhesive square | No |
| Drying time | None | Two to five minutes |
| Skin reactions | More common, manageable by rotating sites | Less common |
| Dose adjustment | In set patch strengths | Finer, by number of pumps |
| Transfer to others | No risk | Real risk until dry |
| Affected by heat | Adhesion and absorption can be affected | Less so |
| Combined with progesterone in one product | Available as a combined patch | No, progesterone taken separately |
Why the route matters more than the choice
The important clinical decision is usually transdermal versus oral, not patch versus gel.
Oestrogen swallowed as a tablet is absorbed through the gut and passes through the liver, which affects clotting factors. Oestrogen through the skin does not. UK guidance recommends the transdermal route for women at increased risk of venous thromboembolism, including women with a BMI over 30.
So if you have been offered a patch or gel rather than tablets, that is likely a considered decision rather than an arbitrary one.
When a patch is the better fit
- You would rather deal with it twice a week than every morning
- You want the option of a combined patch containing both hormones
- There are small children or a partner who would be in contact with an application site
- Your mornings are busy enough without waiting for something to dry
When gel is the better fit
- You have reacted to patch adhesive
- You do not want anything visible on your skin
- You want finer control over dose, adjusted a pump at a time
- You live somewhere hot, or you swim daily, and patches have lifted
Progesterone, either way
If you have a womb, you need progesterone alongside oestrogen to protect the womb lining, whichever format you use. With gel that means a separate capsule. With patches you can have either a combined patch or a separate capsule.
If you have had a hysterectomy, oestrogen alone is usual.
What fira prescribes
We prescribe patches and capsules. We do not currently prescribe gel.
That is a formulary decision, not a clinical claim that gel is worse. If your assessment suggests gel is genuinely the better route for you, your clinician will tell you, and you should act on that rather than on what is convenient for us to supply.
Cost
On a fira plan the price is the same whichever format you are prescribed: one flat monthly price covering treatment, delivery and dose changes. Your dose can change; your price does not.
On an NHS prescription, formats are charged the same per item, and a prepayment certificate covers HRT items for a year.
How the decision actually gets made
A clinician weighs your clot risk, blood pressure, BMI, migraine history, skin, whether you still have a womb, whether you are still having periods, and what you will realistically keep doing. Then they propose a format and explain why.
That is what our free assessment collects.
Orbyt Group Ltd (company number 12623899). Fira is a brand of Orbyt Group Ltd, registered in England and Wales. This article is general information and is not personal medical advice. Always read the patient information leaflet supplied with your medicine.