How Should I Take Estrogen & Progesterone?

The female hormones estrogen and progesterone, when used as hormone replacement therapy to relieve menopausal symptoms, can be taken as a pill, skin patch, gel, vaginal cream or vaginal ring. The method you choose depends mainly on two factors: whether you've had your uterus removed and which menopausal symptoms you're trying to alleviate.

Hysterectomy

• According to the American Congress of Obstetricians and Gynecologists, If you've had your uterus removed (hysterectomy), your doctor will prescribe estrogen alone to relieve any hot flashes, sleeplessness, vaginal dryness and other symptoms you may be experiencing. You won't need progesterone, because its primary job in hormone replacement therapy is to keep the lining of the uterus from becoming too thick.

  If you still have your uterus, you'll most likely be prescribed a combination of estrogen and progesterone. While the estrogen helps eliminate the side effects of menopause, it also causes your uterine lining to grow, increasing your risk for endometrial cancer. Progesterone prevents this growth.

Systemic vs. Local

• Estrogen in pill, skin patch or gel form circulates throughout the body, giving you relief from hot flashes, mood swings and sleeplessness. They also provide protection against osteoporosis (bone loss). If osteoporosis is your biggest concern, consider just the estradiol skin patch, which is very low-dose and FDA-approved only for bone loss prevention.

  If your biggest issue is vaginal dryness and pain during sex, more targeted, local estrogen therapy will give you the greatest relief. You can choose from a daily-use vaginal cream or tablets or you can opt for slow-release vaginal rings, which only need to be inserted every three months. The estradiol acetate ring is the only localized estrogen therapy strong enough to relieve more far-reaching discomfort such as hot flashes.

  Progesterone comes in oral pill, intrauterine device and vaginal gel. With progesterone, you don't have to decide whether to take a form that works systemically or locally. Since its role is localized to preventing uterine cancer, each type is effective. But the North American Menopause Society (NAMS) cautions women to steer clear of progesterone skin creams, saying no studies prove these topical agents protect a woman from cancer.

Combination Therapy

• If you still have your uterus, you may feel most comfortable taking a pill or skin patch that includes both estrogen and progesterone. There are several different types available, and your doctor can recommend one that will work best for you given your mix of symptoms.

Dosage

• Your doctor will decide how often you should take your hormones based on what type of therapy you're on and whether you've just reached menopause. For instance, if you're taking estrogen alone, NAMS states you'll probably take the hormone daily for at least 25 days per month. If you need to take estrogen and progesterone and you're newly menopausal, you might begin with estrogen and then add progesterone a couple of weeks later.