Considering topical estrogen? Let’s explore your options and how to use them!

Quick Guide: How to Use Topical Estrogen, from Estrogen Patches to Creams

Perimenopause and menopause can bring up many questions, and one of them may be should you start estrogen and if so then how? If you’re considering estrogen replacement therapy, understanding how to use topical estrogen is important- so let’s dive into just that today!

In this quick guide, we’ll explore the various types of topical estrogen, from patches to creams, and provide essential information on when and where to apply them.  We’ll also cover why women typically start this type of bioidentical hormone replacement therapy (biohrt) and when.

When Women Usually Start Topical Estrogen

The consideration of topical estrogen often begins as menopause symptoms kick in, typically in a woman’s late 40s or early 50s. But there’s no one-size-fits-all approach here, or one dose fits all.

Some women might start earlier if they’re dealing with premature menopause, have had a hysterectomy, or in some cases even in late perimenopause. Others might hold off until their symptoms become more bothersome or not at all. It’s a personal decision, usually made when hot flashes, night sweats, or vaginal dryness enter the picture.

Types of Topical Estrogen

When it comes to topical estrogen, you’ve got options, but topical is what we are focusing on here. The oral estradiol option can be hard on the liver and not absorbed as well so I don’t use it in my practice.

So, let’s talk topical estradiol:

Estradiol patches are like hormone-infused stickers you place on your skin. They’re discreet and deliver a steady dose of a form of bioidentical estrogen called estradiol (other forms are estriol and estrone).  Popular brands include Climara, Vivelle Dot, Divigel, and generic forms of these name brands.

Compounded estrogen creams are custom-made combinations, typically of estradiol and estriol. They’re tailored to your specific needs, like a hormone cocktail just for you.  These are made at compounding pharmacies as traditional pharmacies only have topical estrogen in the estradiol patch noted above or the vaginal gel form.

For those dealing with vaginal dryness or painful sex, vaginal estradiol might be your go-to. It’s designed to tackle localized symptoms without affecting your whole system.

Determining which type is best type for you should be a discussion between you and your healthcare provider.  It’s best to work with a healthcare provider who is experienced with and has worked with hormone therapy to help you find the approach that is safest and best for you.

Estradiol Patch

First, let’s talk about the estradiol patch.  This is the easiest delivery method as it’s not something you have to apply every day, and there’s no mess from any cream.

These patches come in various strengths, so you and your provider can find the best dose for you. Depending on the brand you will need to apply the patch once to twice weekly. Some popular options include:

• Climara: Once-weekly, bigger than the twice weekly option
• Vivelle-Dot: Twice-weekly and tiny

Just remember placement matters – stick to clean, dry skin on your lower belly or on your gluteus area (butt).  I find the twice weekly dot type sticks better for me.  The larger weekly patch has come off frequently for me after a long, hot bath (and I take lots of these!).

Compounded Estrogen Cream

As noted above, if you’re looking for a more personalized approach, compounded estrogen cream might be the right approach for you. This approach allows your provider to adjust the estradiol and estriol combination and dose based on your symptoms.  An individualized approach can be key for many women in menopause as the internal production of hormones can vary, even after 1 year without a period.

Symptoms to monitor for after starting compounding estrogen, or any topical estrogen, include swelling, cramping, bleeding, breast pain, persistent menopausal symptoms like hot flashes, night sweats, or many of the skin, hair, and systemic changes that can go along with perimenopause and menopause.

Here’s the “rub” on how to apply topical estrogen cream: Apply it to the forearms, inner ankles, or tops of feet, twice per day.   Compounded estrogen cream is best absorbed where there is less fat so these areas tend to work best, though some women like to apply the cream to the inner thighs.

Just remember, while customization is cool, it’s crucial to stick to your prescribed dosage and follow-up regularly with your healthcare provider.

Vaginal Estradiol and When to Use This

Vaginal dryness can be a nightmare, so vaginal estradiol might be your new BFF. This localized treatment is perfect for those pesky down-there symptoms like dryness, itching, or pain during intimacy.

Vaginal estradiol comes in various forms:

• Creams: Apply directly where needed
• Tablets: Insert like a tiny, hormone-packed suppository
• Rings: Set it and forget it for weeks at a time

Typically, you’ll use this when systemic treatments aren’t cutting it or if you’re only dealing with vaginal symptoms. Remember, though, even localized estrogen isn’t risk-free, so chat with your doc about the pros and cons for your unique situation.

Where to Apply Topical Estrogen Patches and Creams

Let’s summarize how to apply all of these topical estrogens:

•  For patches, think smooth and hairless: lower belly, outer hip, or upper buttocks are prime real estate. Rotate spots to avoid skin irritation.
• Creams? They’re a bit more versatile. Apply to:
  • Inner ankles or tops of feet
  • Lower abdomen, it’s better to apply to an area that doesn’t have a lot of fat tissue though
  • Arms (inner part)
• Vaginal Creams- inner labia but not internally, save that for rings or tablets.

 

When to Talk to Your Doctor (Vaginal Bleeding, Cramping, Other Side Effects)

While topical estrogen can be a game-changer, it’s crucial to stay vigilant on if it’s right for you. If you experience unexpected vaginal bleeding, cramping, or any unusual side effects, don’t hesitate to contact your provider.

Remember, your health journey is unique, and staying informed is key. Keep the conversation going with your healthcare provider, and don’t be shy about asking questions. Your well-being is worth it, so take charge of your menopausal journey and confidently embrace this new chapter!

Bioidentical hormone replacement can be a game changer when it comes to mood, sleep, metabolism, and comfort level, but it’s not for everyone and an individualized approach is best.  If your provider won’t have the conversation about whether it’s right for you- maybe it’s time to find another provider.  You are your best advocate!

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