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Patch vs Pills for Estrogen Replacement

by Dr. Sharon Orrange on September 12, 2017 at 4:08 pm

Many women struggle with lack of interest in sex after menopause. Lower estrogen with menopause may result in vaginal dryness, painful intercourse and—because estrogen helps regulate the parts of the brain that control mood and desire—libido takes a hit as well. Many women come to primary care doctors for help when sexual desire is lacking and they want to get back to the days when they felt desire and satisfaction.

Pharmacologic therapies to improve libido in women are limited at best and while combination estrogen and progesterone therapy after menopause may help, it does matter how you take it.

This month in the Journal of the American Medical Association, results of a large study were released that showed the use of estrogen patches—but not pills—significantly improved libido.

Here’s what we know:

  • Prior studies have shown that estrogens alone or combined estrogen and progesterone result in only a small improvement (related to pain during intercourse) when used within 5 years of menopause. Those studies didn’t classify how women were using the estrogen or progesterone though.
  • Why an estrogen patch? This study separated out results from estrogen patches compared to pills. All women were also on progesterone, because women with a uterus need the progesterone to protect the lining of the uterus (endometrium). The estrogen patch may be more beneficial because the patch results in a ratio of estradiol to estrone (two types of estrogen hormone) that comes close to matching the ratio before menopause.
  • Wait what? Yes—blood concentrations of free estradiol with a transdermal estradiol patch (used on your skin) is twice that seen with pills.
  • Who was included in the study? 670 women, within 3 years after their last period, were treated for 4 years with either transdermal estradiol (patch) or oral estrogen pill. This study did not include women who had undergone hysterectomy or surgical menopause.
  • What were the two groups prescribed? The women taking estrogen pills (0.45 mg estrogen + 200 mg progesterone for 12 days each month) were compared to the group using the estradiol patch (50 mcg + progesterone 200 mg). Sexual function was assessed by scores comparing desire, arousal, lubrication, pain, satisfaction, and orgasm.
  • What did we learn? The group using estradiol patches had a 7.2% improvement in their scores while those taking estradiol pills did not have a significant increase. These changes in sexual desire were not immediate, and most were noticeable after 18 months of treatment. This effect was more significant for those who had low sexual function to start with.
  • What are the estradiol patch options? Estradiol patches similar to those used in this study, in the 50 mcg dosage, are used either once or twice weekly. Estradiol, Climara, and Vivelle-Dot are all available as 50 mcg patches. See my previous blog on patch vs pill for cost discussion.
  • Take home message: Treatment with estrogen patches showed modest benefit for sexual function, especially in those who had low sexual function to begin with—and patches were more effective than estrogen pills.

What has worked for you?

Dr O.

Effects of Oral vs Transdermal Estrogen Therapy on Sexual Function in Early Menopause. JAMA Internal Medicine published online August 28th 2017.

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