FAQs about HRT Factsheet

Estrogen gels and sprays

Where do I put the gel?
Licensed directions are to rub the gel into the outside of your upper arm or inside of your upper thigh. Some women prefer to rub it in other places such as the shoulder blades or lower abdomen.

Do I have to rub the gel in until it’s gone?
It is best to rub it in rather than leaving it to dry. For most women it is easily absorbed into the skin within a few minutes, so lots of rubbing isn’t usually necessary ­ just the same amount as you would with a moisturising cream.
Once your skin is dry, you can wear clothes and exercise normally. It is usually advisable to wait around 30 minutes
before using other creams on the area, including sun cream.

Where do I put the spray?
Use the spray on the inner part of your forearm or the inner part of your thigh.

Can I shower after applying the gel or spray?
It is advisable to put the estrogen gel or spray on after having a shower ­ if this is not possible, try to leave as much time as you can between applying the gel or spray and taking a shower, bath or going swimming.

Will my partner be affected if we’re intimate?
Wash your hands after applying the gel or spray, and you should leave at least an hour before anyone else touches the
area where you applied it.

Can I split gel or spray morning and night, or does it have to be used all at once?
The most common dose for estrogen gels or sprays is between two and four pumps a day. Usually, if you need more than two pumps, it is preferable to divide the doses for use in the morning and in the evening. Some women need
higher quantities and your doctor will advise you about this if you need more.

Estrogen patches

Where do I put patches?

They should be stuck onto the skin below your waist. Most women stick them to the skin on their bottom or upper thigh. If they are not sticking on well, you should consider changing the make of patch, as each manufacturing uses
different adhesives. Some women wipe their skin with surgical spirit before applying the patches, as they find this helps
them to stick.

Can I shower when wearing patches?

The patches usually stick on well and stay in place in the shower, bath or when exercising. If your patches are not sticking to the skin well, you may need to try a different brand or size of patch, so tell the healthcare professional that prescribed them for you.

Estrogen and progestogen

Should I take progesterone at the same time as estrogen? Or one in the morning and one at night?

It is up to you; it is usually advised that women take micronised progesterone in the evening as it has a mild sedative effect and therefore aids sleep at night-time. It needs to be taken on an empty stomach, so it is worth bearing that in mind too. If your mornings are a rush and you don’t want to bother with rubbing on gels, creams or sticking patches, you can do this in the evenings too. Find a time that works for you, and easily becomes part of your daily routine, so you won’t forget.

Frequently Asked Questions about taking HRT

Testosterone

Where do I put testosterone cream or gel?
Rub the testosterone cream into the lower part of your tummy or your outer thigh. You may want to vary the place
you rub the cream or gel every few days to avoid possible growth of a few dark hairs.

Cyclical HRT

How do I take cyclical HRT?
Cyclical HRT, also known as sequential HRT, is often recommended for women who need estrogen and progestogen,
and who still have their periods (and do not have a Mirena coil in place).

There are 2 types of cyclical HRT:
– Monthly – this is usually recommended if you are still having periods, even if they are irregular. You take estrogen
every day, and take progestogen alongside it for the last 12­14 days of your menstrual cycle
– 3­monthly HRT – this is less commonly recommended; you are usually advised to add in the progestogen alongside
estrogen, for around 14 days, but to only do this every 3 months.

Changing type of HRT

Do I need to take a break if changing from one HRT to another?
There is usually no need to take a break if you are going to change from one type to another. If you are hoping for an
improvement, expect it to take several weeks to have a full effect. Some women experience bleeding when the dose
of estrogen increases.

Return of symptoms

If my symptoms come back, does it mean it’s not working?
Many women need their HRT treatment regime altered over time. There may be a noticeable improvement initially but
then not as much as you were hoping for, or there may be a return of some symptoms. You may need a higher dose;
you may need to try a different way of taking the hormone or need to try a different brand. You might benefit from
adding in testosterone, as well as estrogen (and progestogen). Whatever the reason, discuss it with your health
professional or see a menopause specialist if you are not satisfied.

Side effects

What side effects will I suffer and if I get any should I stop using it immediately?
The most common side effects include some breast discomfort and bleeding. Side effects are most likely to occur
when you first start taking HRT and then usually settle over time. If side effects have not settled after 3­4 months,
discuss it with your health professional.

Different brands of HRT use different estrogens and progestogens, so you may find that changing brands might help
with side effects. Switching the delivery method of HRT – for example from tablets to patches – can also help.
Some women find that HRT patches can irritate the skin, so talk to a health professional about switching brands or
changing to a gel or spray instead.

Timings

Should I take my HRT at exactly the same time every day?
It is useful to incorporate taking (or applying) your HRT into your daily routine, and this usually means it is at the same
time every day. If it happens an hour or two later (on a weekend for example) it isn’t usually an issue. The important
factor is taking the amount prescribed for you, for the frequency advised, on a consistent basis. The odd hour
variance, here or there, won’t matter.

If it’s a split dose, should there be exactly 12 hours in between?
12 hours is an approximate guideline, but it is not essential. Busy lives, or memory slip­ups often mean there won’t be
exactly 12 hours in between split doses. Just aim for as near to this as possible ­ if you are a few hours out either side
it doesn’t usually cause a problem.

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FAQs about HRT Factsheet
Dr Louise Newson

Written by
Dr Louise Newson

Dr Louise Newson is a GP and pioneering Menopause Specialist who is passionate about increasing awareness and knowledge of the perimenopause and menopause, and campaigns for better menopause care for all people.

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