HRT Types — Estrogen, Progesterone, and Delivery Methods

A detailed comparison of HRT formulations, routes, and how to choose with your doctor.

Key takeaways

Oral estrogen (tablets) offers convenient dosing but carries slightly higher blood clot risk
Transdermal estradiol (patch, gel, spray) bypasses the liver — lower clot risk and preferred for most women
Women with a uterus MUST take progestogen — to prevent endometrial cancer. This can be sequential or continuous
Micronized progesterone (Prometrium) has better sleep and mood profile than synthetic progestins
Vaginal estrogen (cream, tablet, ring) treats GSM with minimal systemic absorption — very safe

There are many types of hormone therapy — understanding the options helps you make an informed choice.

Oral (tablets) — convenient, well-studied, but slightly higher blood clot risk. Standard dose: 1-2 mg estradiol or 0.625 mg conjugated equine estrogen
Transdermal (patch, gel, spray) — absorbed through skin, bypasses first-pass liver metabolism. Lower clot risk. Preferred for women with migraine, BMI >30, or clot risk factors
Vaginal (cream, tablet, ring) — minimal systemic absorption. Used for GSM only, not for hot flashes

Micronized progesterone (Prometrium/Urogestan) — bioidentical. Better sleep, less mood disturbance. Take at night
Synthetic progestins (MPA, norethisterone, dydrogesterone) — effective but may have more metabolic and mood side effects
Mirena IUD (levonorgestrel) — delivers progestogen locally to the uterus. Good for women who cannot tolerate systemic progestogens

Sequential — daily estrogen + progestogen 12-14 days/month. For women still having periods
Continuous combined — daily estrogen + daily progestogen. For postmenopausal women. Leads to no bleeding
Tibolone — synthetic steroid with estrogenic, progestogenic, and androgenic activity. Used in some countries

NICE NG23; The Menopause Society; Endocrine Society

This content is strictly informational and does not substitute professional medical advice. Consult your doctor for any clinical decisions.

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