HRT: why is my medication in a cream?


Mary Heim, RPh, FAAFM

Mary Heim, RPh, FAAFM

A frequent question we field at the pharmacy is “Why can’t I take my HRT in a pill like all my other medications?”  Great question!


Side effects of oral estrogen not found in topical or vaginal estrogen:

*decrease in growth hormone

*elevated liver enzymes

*increase in C-reactive protein (a marker in inflammation)

*increase in gall stones

*increase in sex hormone binding globulin (SHBG), which can decrease active testosterone

*increase in estrone (E1)

*increase in triglycerides

*increase in blood pressure

*increase in carbohydrate cravings

*increase in blood clots

*weight gain


Bio-identical hormone replacement usually contains estradiol (E2) or a combination of estradiol and estriol (E3) labeled BiEst. Estrogen creams or patches are the preferred method of replacing this particular hormone. With transdermal application, E2 has been shown to not impact the liver synthesis of proteins the same way estrogen taken orally does. It also lowers triglycerides, which decreases your risk of heart disease. Finally, estradiol or E2 applied to the skin does not negatively effect blood clotting. Estrogen is best absorbed when applied to areas that contain fat cells.


A very large study (almost 700,000 women) published in the European Heart Journal (2008) demonstrated the risk of myocardial infarction (MI) in those patients using dermal or vaginal estrogen was less than placebo. The ESTHER study published in Circulation (2007) concluded that oral estrogen increased risk of blood clots and transdermal did not. These studies give physicians more confidence in prescribing transdermal or vaginal estrogen for symptomatic relief in menopausal women. With every medication, the patient and the physician evaluate the risk versus the benefit.

by Mary Heim, RPh, FAAFM, Women’s Health Specialist

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