TROUBLESHOOTING: ESTROGEN PATCHES
One form of HRT (Hormone Replacement Therapy) that is both popular and available to women in Surgical Menopause to treat their menopausal symptoms are estrogen patches (examples are Climara, Vivelle Dot, Alora, Minivelle, and Estraderm along with generic estradiol patches). Estrogen patches are a transdermal form of delivering 17-beta Estradiol, meaning that the medication is absorbed and delivered through the skin’s membrane. Estrogen patches are designed to slowly and steadily release Estradiol into a woman’s body over several days, and are applied twice weekly or weekly depending on the brand of estrogen patches you are using.
Advantages of Estrogen Patches
The advantages of using Estrogen Patches over other forms of HRT are several.
Lower risk: The advantage of receiving your HRT via skin delivery is that unlike oral HRT which carries with it a higher risk of stroke, blood clots, and heart attack, estrogen patches bypass the liver and go directly into the bloodstream; thus putting women at a lower risk of these scenarios including those with a prior history of blood clot risk. A research study that was conducted in 2007 revealed that the estrogen patch does not present the risk of blood clots in postmenopausal women the same way oral estrogen does.
Convenience: Estrogen patches are convenient and low maintenance. Designed to last several days or a week depending on the brand, estrogen patches are simply stuck onto fatty areas of the skin, such as the abdomen or buttocks, below the panty line, and changed when the patch life expires. Many women enjoy the fact that they do not have to remember to take their HRT at regular intervals daily, as you would with oral HRT, creams, sprays or gels.
Fewer Fluctuations: A common issue women have with feeling well on HRT is that they experience hormone fluctuations in the periods between their HRT doses. However because estrogen patches are designed to be a slow release form of HRT, they provide a steady dose of hormones over several days meaning that fluctuations are minimized.
Patches are Bio-Identical: The estrogen that is used in all estrogen patches (17 – beta Estradiol) is Bio-Identical, and derived from plants (soy as well as wild yams depending on the brand). Bio-Identical hormones are structurally identical to the hormones the body naturally produces from ovaries. Because Bio-identical hormones mimic the hormones the body produced prior to surgery, there is often an easier transition and fewer side effects in using this form of HRT.
Variety: Not all estrogen patches are created equal; there is a variety of choices in brands and formulations, meaning there is a higher likelihood of finding a patch that will suit your particular needs. The manner by which the estrogen is released, the type of adhesive used to make the patch stick, the plant the 17- beta Estadiol is derived from (soy or wild yam based), along with the size and duration of the patch varies from brand to brand and can make a difference in terms of how beneficial they are for you. There is also a good deal of choice when it comes to doses, there are dose options ranging from low to high (for example 0.025mg/day, 0.0375mg/day,0.05mg/day, 0.06mg/day, 0.075mg/day, 0.1mg/day). Because there are many options when it comes to patches, if one does not agree with you, you can consult with your doctor about prescribing a different patch before you move onto another form of HRT.
Patches can be cut and tailored to your ideal dose: While there are a range of doses of estrogen patches, should you be someone whose ideal dose falls between the manufacturer's doses; estrogen patches can be safely cut with a pair of scissors so you can tailor your dose to your needs without any harm or loss of potency to the patch itself. Something important to note is that while matrix patches can be cut, reservoir patches can't. Please ask which kind of patch you are being prescribed by your MD before cutting it.
Can be worn Showering, Bathing and Swimming: The patch is designed to withstand the rigors of showering, bathing as well as swimming so long as it is not exposed to excessive heat or left soaking for long periods of time. While some women report trouble patch properly sticking, often a Tegaderm Square, which provides a waterproof barrier can be used to fix this problem
Pharmaceutical companies now offer a combined Estrogen & Progesterone patch: For women with a uterus but no ovaries it can be challenging to find a balanced HRT regiment that delivers the estrogen women need to feel well, but also the amount of progesterone needed to protect the uterus. There is now a patch that combines estrogen with Norethindrone (a synthetic progestin).
Troubleshooting Tips For Estrogen Patches
Patch Placement: Estrogen patches are best worn on fatty areas of skin on the lower abdomen and the buttocks below the panty line as well as on the hip. Some doctors have also suggested they can be worn on the shoulder blade, but we do not recommend this as this area has not been sufficiently studied.
Patch Site Rotation: Estrogen patch sites must be regularly rotated, and you should use a different, fresh patch of unbroken skin each time you apply your patch. It is important to keep in mind that you should not rotate between abdomen and buttocks or abdomen and thigh, as absorption is 20% higher on the buttocks and thigh than it is on the abdomen. It is best to rotate within a specific area, such as rotating from right to left side of the lower abdomen or right to left side of the buttocks or thigh. When sites are not regularly rotated it can result in “Tissue Exhaustion”, meaning that the skin will cease absorbing the patch in a particular area
Heat and Estrogen Patches Don’t Mix: Something important for estrogen patch users to be aware of is heat and estrogen patches do not mix well and thus patches should not be exposed directly to heat. The reason being that direct exposure to heat causes the patch to release more estrogen, more quickly. This effect is known as “Patch Dumping” and can result in the patch quite literally dumping its estrogen content into your body at an accelerated rate. This can throw your hormones off significantly and cause major hormone fluctuations that can leave you feeling poorly and unbalanced hormonally. Because of the patches response to heat you will need to avoid saunas, steam rooms, hot tubs, hot baths, hot/Bikram yoga altogether or you may wish to indulge in these heat-oriented activities on the days you are switching your patch, and put on a new patch afterwards.
Keeping the Patch On: Having your estrogen patch applied properly is important for delivering your correct dose of estrogen. When a patch is not properly adhering to the skin, then it cannot deliver the intended dose; which can result in hormonal fluctuations and menopausal symptoms returning.
All HRT brands use different adhesive, it is a part of their individual patents, but not all adhesives work equally well. Many women find that the generic patches do not stick as well, and within our support group several women have reported difficulties with the Climara patch (which is a weekly patch) for this same reason. Below we will go through the protocol we recommend for having your patch stay on for the duration it is intended to.
Wash your hands so they are free of any lotion, oil and powder.
Swab the area where you will be placing your patch with an alcohol swab or rubbing alcohol to remove any lotion, oil and powder
Allow area to fully dry for 5-10 minutes after swabbing the skin.
Position your patch in an area that won’t be irritated by clothing or crease from movement (ideal areas for patch placement are lower abdomen and on the buttocks below the panty line)
Press and spread the patch out firmly with the palm of your hand
Use a hair dryer to heat up the patch on your skin for 10-15 seconds to seal it to your skin, then repeat firmly pressing down on the patch with the palm of your hand.
(Optional) Cover patch with a Tegaderm square to ensure further protection of your estrogen patch
Removing Patch Residue: An issue patch users commonly run into is that when they remove their estrogen patches they are often left with adhesive and residue on their skin where the patch was. Some of the best methods we have found to easily resolve this is to rub Baby Oil or an alcohol swab over this area to remove the patch residue.
Patch Rash/Irritation: Some woman start on the patch, fall in love with it, only to find weeks or months later that they have developed a rash, irritation at their patch site. The irritation may be minor, a few tiny red marks, or it may be full on blisters and broken skin depending on the severity. Either way, this reaction is usually a good indicator, if it persists that this particular patch might not work out for you and you will probably have to switch to a different patch brand. As we have mentioned in this article there are quite a variety of patches and brands; patches all use different adhesives in their formulations, while one may cause you irritation another may work out for you perfectly well.
It is also important to note that having irritation or a rash at a patch site is not indicative that you are allergic to Estradiol, more likely your body is not responding well to the adhesive or it has a sensitivity to having a non-breathable barrier on your skin for a duration of time. If you are on the weekly patch, the first step may be to use a patch; which is changed twice weekly so to decrease the amount of time the patch is on the skin.
If you have tried several brands of patches and still are finding your reaction to be one of severe irritation, it is at this point we recommend consulting with your doctor and moving forward with another delivery method of HRT.
Absorption Problems: Some women settle on using an estrogen patch with high hopes due to all the advantages only to find their hormones are fluctuating wildly or their estrogen levels still remain extraordinarily low in relation to the dose of estrogen they are prescribed. In such cases, the root cause of this issue may be that your body does not absorb well or consistently through the skin membrane. This does not mean you will not absorb well utilizing a different delivery method, it simply means that estrogen patches are not the best fit for you for your HRT.