Hormone replacement therapy - pills, patches or gels?

Common types of HRT delivery
Most people in the UK take HRT by mouth in tablet form, which is convenient and flexible. It is easy to change if problems occur. A large proportion of the absorbed oestrogen is inactivated when it passes through the liver so the dose has to be higher than if the oestrogen is absorbed straight through the skin in the form of a patch. The tablets can be oestrogen alone or combined oestrogen and progestogen.

Patches are also convenient to use and are popular. The new matrix patches give less skin irritation than the older type, which have a higher alcohol content.

Implants are popular with gynaecologists and are often prescribed at the time of hysterectomy and ovarian removal. They give gradually decreasing levels of oestrogen over a few months and need periodically replacing. They can be combined with testosterone implants for women who suffer from reduced libido after the menopause. They are not without problems, as there's a tendency to need the implants replaced earlier each time. The tissues seem to become less responsive to the hormones.

A recent addition to the HRT treatment options is the nasal spray. You squirt one dose a day up your nose and the oestrogen is absorbed to give you symptom relief for 24 hours. There are said to be fewer side effects with this way of taking it, but some women have reported problems with a sore and blocked nose.