A stick-on solution to menopause symptoms

Whether you’re sliding towards perimenopause or already dealing with symptoms, chances are, you’ve heard about hormone replacement therapy (HRT). Supplementing your body’s estrogen is one of the most effective ways of managing menopause symptoms like hot flashes, night sweats, and vaginal dryness. But how exactly you get those hormones might be a little more under-the-radar. Yes there is a pill, but patches are gaining popularity as a way to get estrogen into your system. 

Like the word “patch” implies, you just stick it on and let it do its thing — no pills, no needles, no messy creams. And patches aren’t just convenient. Depending on the person, they can also be one of the safest ways to supplement your hormones. Here, we break down everything you need to know.

During the menopausal transition, which encompasses perimenopause (the time leading up to menopause, in which you’re still getting a period), menopause (the moment you’ve gone 12 months without a period), and post-menopause (everything after menopause), the body slows down and then stops making certain hormones — namely, estrogen and progesterone. For some people, that drop can lead to a host of unpleasant symptoms, like hot flashes and night sweats, mood changes, and sleep disturbances.

That’s where hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), comes in: It’s a treatment that supplements these lower levels of hormones. And for many women, HRT improves symptoms, offering relief and restoring comfort.

For the majority of women with a uterus, HRT usually includes both estrogen and progesterone. The estrogen is there to relieve symptoms. “It typically provides the most therapeutic benefit for symptom management,” says Molly Beck, DNP, a women’s health nurse practitioner at the University of Utah who’s certified by The Menopause Society. Progesterone, meanwhile, is there because estrogen on its own can make the uterine lining get too thick. “If the uterine lining thickens over time and there's nothing there to either stop it from thickening or to shed it, then eventually those cells will change over time to increase your risk of cancer,” Beck explains. The progesterone keeps the lining at the right thickness, which is why most people on HRT take both estrogen and progesterone. One notable exception: If you’ve had a hysterectomy and, as a result, don’t have a uterus, then there’s no need for the progesterone in your HRT.

Estrogen patches are literally adhesive patches that stick to your skin and release estrogen, which eventually reaches your bloodstream. It’s a process called “passive diffusion,” in which the drug moves from an area of higher concentration (the patch itself) to a lower concentration (the skin under the patch). “The drug needs to permeate the epidermis — the outermost skin layer — then continues down through the dermis until it hits the capillaries, where it is absorbed into the bloodstream,” Beck says.

And that’s when the hormone jumps into action. Instead of having wildly fluctuating estrogen levels, which is what can trigger the hot flashes, mood changes, and other symptoms, the estrogen patch helps even things out. “All an estrogen patch does is take the edge off the drop,” says Dr. Sally MacPhedran, M.D., the director of the Midlife Women's Center at University Hospitals Cleveland Medical Center and a professor of reproductive biology at Case Western Reserve University School of Medicine. It doesn’t bring your estrogen levels back up to what they were when you were younger, but it makes levels less erratic. “We're just giving you a steady state [of estrogen] so that when your ovaries are inconsistently making estrogen during perimenopause, you're not being bombarded by high levels and then having withdrawal with no estrogen at times,” says Beck.

While you can find combo patches, which combine estrogen with progestin, a synthetic version of progesterone, going that route is not usually recommended. An arm of the Women’s Health Initiative study found that some women’s risk of breast cancer went up slightly with MHT — and experts believe that higher risk may have been caused by progestin, says Beck. As a result, most doctors recommend going with a progesterone capsule, as that is bio-identical to the progesterone made by your body. “Estradiol patches and a progesterone capsule are, based on the research that we have at this point, the safest way to use menopause hormone therapy if you have a uterus,” Beck says.

Estrogen patches are becoming an increasingly popular form of HRT for a few reasons, the biggest being that it’s the safest option for most people. “The transdermal form of estrogen is by far the safest method of estrogen administration,” says Beck. Here’s why: When you take estrogen orally via a pill, it gets processed through your liver. That can impact your clotting factors, ultimately increasing your risk for blood clots. It can also increase the production of certain proteins by your liver that raise your risk for other issues related to HRT. “But if you use estrogen in a transdermal form, we don't see any impact on the clotting mechanisms,” Beck says. 

Another advantage is that an estrogen patch delivers a more constant dose of hormones compared to a pill. “It has more of a steady-state absorption through the skin versus when you metabolize an oral administration,” says Beck. The pill’s effects peter out over time, which is why you need to take it every 24 hours. As a result, you might feel great during the early daytime, but experience night sweats later while you’re trying to sleep. “We call it a peak-and-trough effect,” Beck says. Patches don’t have that. As long as it’s on your skin, it’s delivering estrogen.

And finally, there are other transdermal forms of estrogen out there, like gels, creams, and sprays, but these things can get messy (a cream can get onto your pet or kid). A patch, on the other hand, is a clean, one-and-done application.

It's normal to be a little nervous about putting hormones into your body — but know that the average dose of estrogen in a patch is a fraction of the amount of estrogen you’d find in a birth control pill. “It's a very low dose,” says MacPhedran.

Moreover, the estrogen in the patch is a bioidentical version of estradiol, meaning it has the same makeup as the hormone produced by your ovaries. As a result, side effects only occur if you are sensitive to your own hormones. “If you were somebody who noticed when you were cycling that your breasts were tender or you got headaches, then you might have that similar side effect with a patch, because it is a little bit of that same hormone,” says MacPhedran. For that reason, tender breasts, headaches, bloating, and vaginal bleeding or spotting (especially when you first start) tend to be the most common side effects. But “by and large, patients generally feel better on estrogen, and there are very few side effects for most women,” says Beck.

The more serious risks associated with HRT include the potential increased risk of breast cancer with long-term use of estrogen-progestin therapy (not with estrogen alone), as well as a possible increase in your risk of a stroke and other clotting issues. That’s why it’s important to remember that HRT isn’t right for every person out there — and you should talk to your healthcare provider first to make sure you’re a good candidate for it.

There are two types of patches: those with just estrogen and combo patches that pair estrogen with progestin. The latter are particularly useful for patients who have a hard time remembering to take a separate progesterone pill when using an estrogen patch, says Beck. “In this scenario, estrogen taken alone puts them at high risk for endometrial cancer — much higher than the slight increased risk for breast cancer with prolonged progestin use,” she explains. So if you’re at low risk for breast cancer, the combo patch could be a good option. Otherwise, you’ll likely take the estrogen-only patch and pair it with the progesterone pill.

Patches, both estrogen-only and the combo form, also come in once-weekly or twice-weekly versions. Beck, for her part, prefers the twice-weekly patches. While the once-weekly patch is more convenient, it’s also a thicker patch since it has to contain more of the drug. Because of that, “patients will often talk about how the edge is starting to peel up, or it’s losing connection with their skin and falling off early,” says Beck. 

The twice-weekly option, which is thinner, tends to stick on better, even through swimming and exercise. The drawback is that you might have to remember an odd application schedule, like Monday mornings and Thursday evenings, but it’s nothing a recurring alarm can’t solve.

There is also a question of insurance coverage. “Some only cover the once-a-week version,” says MacPhedran.

Estrogen patches are relatively easy to use, but it helps to keep some things in mind when you’re applying and wearing one.

Where to apply estrogen patches

Estrogen patches go on any area of skin that’s clean, dry, and hairless. “The way I describe it is: If you are wearing a pair of men's boxer shorts, the patch would go anywhere underneath the boxer shorts — so from belly button to mid-thighs,” says MacPhedran. “Front, back, buttocks, doesn't matter.” They’re pretty discreet, clocking it at roughly the size of a postage stamp (although some are as small as your thumbnail).

You could also put the patch on your upper arm or shoulder blade, especially if having the patch on your lower body bothers you when pulling your pants up. You shouldn’t put it directly on your breast — the composition of breast tissue differs from other areas of the body, leading to a different absorption rate, Beck says — or anywhere that’s going to limit the adhesive connection with skin, like your lower arm or leg (due to body hair).

How to apply estrogen patches

Estrogen patches are as foolproof as HRT gets. First, find a new spot: MacPhedran recommends alternating sides to let skin breathe between applications. After that, “get the skin nice and clean and dry,” she says. “Use rubbing alcohol, let it air-dry really well, and then put the patch on.”

What to do if your estrogen patch falls off

First, know that it’s unlikely for your patch to fall off; they’re designed to outlast showers, swimming, hot tubs, exercise, and other kinds of activities. But if it does fall off, try your best to stick it back on immediately, “because some patients will actually get symptomatic from going without estrogen even for a day or two,” says Beck. If it falls off and you can’t stick it back on — or you can’t find it — then apply a new one.

Can it irritate skin?

It’s possible to experience irritation, especially if you have naturally sensitive skin. If your skin is red after wearing a patch, then you can apply over-the-counter hydrocortisone cream to calm the area once you remove it, says MacPhedran.

If dermatitis is a repeat problem, talk to your provider about other options. “Sometimes it's just related to one of the ingredients in the adhesive — and if we switch manufacturers, then we can find one that works better for you,” says Beck.

Estrogen patches are a transdermal medication that can help treat symptoms of menopause like hot flashes, night sweats, mood changes, and sleep issues. They stick to your skin and release estrogen (and sometimes also a form of progesterone) into your bloodstream. They are considered the safest among hormone replacement therapy options, since they don’t raise your risk of blood clots (oral estrogen can). Plus, they can provide a steady stream of hormones for consistent symptom relief. Not sure if estrogen patches are right for you? You can talk to a menopause-trained clinician through WeightWatchers Clinic for Menopause about your options and get prescriptions for HRT if you’re a good candidate.