Estrogen Patches NZ: How they work and how to use
Updated: Jul 6
Are you looking for a safe and effective way to reduce your perimenopause symptoms, maintain the health of your vulva, vagina and urinary tract, skin, and improve your sex life? Look no further than estrogen patches. This guide will teach you everything you need to know about estrogen patches and how to use them to your advantage.
What are estrogen patches?
Estrogen patches NZ are small, adhesive patches that allow hormones to be absorbed directly into the blood stream via the skin. They are a form of menopausal hormone therapy containing estradiol, a hormone that is naturally found in the female body and helps maintain reproductive and cellular health.
Estradiol patches can be used to treat symptoms of menopause such as hot flashes, night sweats, mood and vaginal and urinary health.
What are the benefits of using estrogen patches?
There are a number of benefits of using estrogen.
1. Reduce menopausal symptoms such as hot flashes, sweats and mood swings.
Read more about 34 symptoms of perimenopause.
2. Increase bone density and reduce risk of osteoporosis
3. Alleviate vaginal dryness and discomfort
4. Improve sex drive and sexual function
5. Reduce the risk of heart attack and stroke
6. Reduce the risk of diabetes and liver disease
7. Improve cognition and memory
8. Reduce the risk of breast and uterine cancer.
9. Reduce urinary tract infections
Everything You Want To Know About Estrogen Patches
1. Estrogen Patches: Safety and efficacy
Estrogen patches are a safer form of estrogen than oral estrogen. Estradiol is the main female form of estrogen. When it is delivered through the skin, it does not increase the risk of blood clots. This is because it can be delivered at a much lower dose through the skin as it does not have to first pass through your stomach and liver.
It is important to use your patches in the dose prescribed to you and discuss with your doctor or health care provider if you want to increase or decrease your dose or if you are having side effects.
If you have not had a hysterectomy (surgery to remove the uterus/womb), you must take another type of hormone called Utrogestan (natural progesterone) or a progestogen in addition to using estrogen patches.
Natural progesterone or progestogen helps to balance the effects of estrogen and protects the lining of the uterus from being overstimulated to grow. Progesterone or progestogens are given cyclically or continuously.
Women who have had a hysterectomy do not need to use progesterone or progestogen to balance the effect of estrogen in the uterus/womb.
According to current best practice, safest time to start using estrogen patches (or any form of HRT) is within 10 years of your final period.
2. Estrogen Patches: Dosage
Estrogen patches come in 4 doses.
25 microgram patch
50 microgram patch
75 microgram patch
100 microgram patch
Most women start on 25-50 microg patches and increase upwards to find the dose that resolves their symptoms.
More is not always better.
The patches are changed twice per week or approximately every 3.5 days.
3. Estrogen Patches: Cost
Estrogen patches have been funded through Pharmac in New Zealand since 2016. You will still pay a doctors visit fee/prescription fee and a pharmacy fee of between $5-15 dollars per prescription. However since the 2023 NZ government budget announcement, you can expect estrogen patches to be subsidised.
Read more about HRT funding in New Zealand.
4. Estrogen Patches: Availability
Estrogen patches are available in New Zealand and Australia. At the time of writing in 2023, we are still having ongoing shortages of estrogen patches due in part to:
the disruptions to the global supply chain from the covid pandemic and
due to better recognition of the safety of modern HRT including estrogen patches and therefore an increase uptake in use.
Most women who want it, do have access to estrogen patches although their current dose patch may not be available. You may have to double up with patches or cut a patch in half or thirds to get the correct dose.
5. Estrogen Patches: Instructions for use
Estrogen patches need to be applied to clean, dry and hair-free skin. They are usually placed on the lower stomach or upper buttock.
Remove the backing from the patch and press firmly onto the skin for 10 seconds.
Apply each new patch to a different area of your lower abdomen/buttocks.
You can take a bath, shower, or swim as you normally do while using estrogen patches.
When you removed the patches fold them in half adhesive sides together and place in the bin.
6. Estrogen Patches: Monitoring
While using estrogen patches you should see your doctor at least once a year for a check-up. Until you get your dose right you may need to be seen more frequently.
You can monitor your symptoms using an app such as Balance Menopause App.
While using estrogen patches you should:
check your own breasts and monitor for changes
participate in 2 yearly mammogram screening
have a 3 yearly cervical smear
have an annual blood pressure check and cholesterol level blood test.
You do not need to monitor estrogen levels.
7. Estrogen Patches: Contraindications or who should not use estrogen patches?
If you have the following conditions, estrogen patches may not be the best treatment for your peri/menopause symptoms:
cancer of the breast or uterus (womb)
blood clots in the veins or lungs.
a condition that increases the tendency for you to get blood clots
abnormal vaginal bleeding that has not been investigated
severe liver problem
porphyria
You should talk with your medical provider to get individualised advice for you and your health risks.
8. Estrogen Patches: Pregnancy risk
Estrogen patches are not considered a form of contraceptive or birth control so if you are still having periods and do not want to get pregnant, you will need to use contraception. Many women use a Mirena as the progestogen component of HRT and this also doubles as contraception. You can also use condoms alongside estrogen patches.
9. Estrogen Patches: Side effects
Estrogen patches are not for everyone.
Common side-effects of using estrogen patches include:
skin irritation at the patch site
headache
breast tenderness or enlargement
nausea and vomiting.
You could also get irregular bleeding if you have a uterus and your estrogen dose is not balanced with progesterone/progestogen as estrogen promotes growth of the uterus lining (endometrium). Any unexpected or unexplained vaginal bleeding should be discussed with your doctor.
As with all medications, if you experience any serious side effects or symptoms, seek medical attention right away. These include:
sudden severe headache,
chest pain,
leg or arm swelling,
increase in blood pressure,
vision changes or
jaundice
10. Estrogen Patches: Long Term Risks
Estrogen only HRT is associated with a lower risk of breast cancer. There is a small increase in breast cancer risk when combined with a progestogen.
Heart Disease
In follow up analyses of the Women's health initiative study, there was no evidence of harm from heart disease for women who started menopause hormone therapy (MHT) close to the menopause. In fact, there was a trend towards a reduced risk for these women.
Breast cancer
In the Women's Health Initiative, women over 60 years who used only oral estrogens had reduced risk of breast cancer both while using estrogen and when they had discontinued at 20 year follow-up. Among women over 60 who started HRT using oral estrogens and synthetic progestogen had 4 additional cases per 1000 of breast cancer and this additional risk persisted at 20 years follow-up.
Current studies do not differentiate between breast cancer risk using estrogen patches vs oral estrogens. Hopefully further studies will provide more safety data.
Blood Clots
Use of oral estrogens increases the risk of blood clots such as clots in the legs, lungs and strokes.
Estrogen patches are a safer way to deliver estrogen as it comes in smaller more constant doses and does not overload the liver and interfere with clotting factors.
According to guidance from the Australasian Menopause Society:
"transdermal menopause hormone therapy has little or no effect on coagulation factors or risk of venous thrombo-embolism."
11. Estrogen Patches: How long do I use estrogen patches?
You can continue to use estrogen patches as long it is helpful for you. Shared-decision making means having an ongoing and open discussion with your health provider about benefits and risks of HRT/estrogen patches.
Many women use patches as they get through the perimenopause transition and reduce and stop using estrogen patches once they are through menopause.
If your symptoms have resolved or your develop a new medical condition or you become at high risk for serious medical conditions you may choose to discontinue using estrogen patches.
12. Estrogen Patches: Discontinuation
If you chose to stop using HRT, including estrogen patches, this should be done gradually. Sudden hormonal changes can exacerbate menopause symptoms and also increase disease risk.
13. Estrogen patches: Removing and disposal
To remove your estrogen patch, slowly peel it off from your skin. Where there is adhesive left on the skin, once it has dried you can remove it my gently rubbing the sticky residue with oil or lotion.
Fold your used patch into itself so it cannot inadvertently get stuck to anyone/anything else and dispose of it into the rubbish bin.
14. Estrogen patches: Tracking your Symptoms
One of the best ways to keep track of your perimenopause or menopause symptoms is through the Balance Menopause app which is specifically designed for tracking menopausal symptoms.
I hope this answers many of your questions about estrogen patches.
As a menopause doctor, Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you through the perimenopause and menopausal stages of life, supporting all aspects of your health and wellbeing.
Dr Deb Brunt is a menopause specialist in New Zealand and also provides menopause health coaching internationally to support the best health habits. She has a passion for supporting women adapt to their changing female physiology for optimum health so they are able to live their best lives.
Schedule a free discovery call with her to learn more.
Dr Deb Brunt | Ōtepoti Integrative Health | Book Appointment
References
Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of Cardiovascular Disease by Age and Years since Menopause. JAMA. 2017; 297(13):1465-1477.
North American Menopause Society. Hormone Therapy Position Statement. 2022.