Hormone replacement therapy is available in the following forms:
Tablets that are taken by mouth
There are many prescription preparations available that contain estrogen. Some have additional progesterone, which is either incorporated in the same tablet or taken separately.
Estrogen can be taken every day, in 28-day cycles. Typically, a progestin is added for the last 10 to 14 days in each cycle. This combination causes monthly bleeding, similar to a period, even in women who have not had one for years. Bleeding usually begins after the last progestin tablet is taken.
For women who are several years past menopause, estrogen and progesterone can be taken every day continuously. This usually avoids monthly bleeding, which is a common reason why women elect to discontinue HRT. With this option, the lining of the uterus remains healthy because the continuous progesterone keeps it from becoming thickened.
The estrogen implant is a small pellet containing pure estrogen. It is inserted under the skin of the abdomen or buttock. A woman receives a local anesthetic during insertion.
The implant allows estrogen to gradually be absorbed into the bloodstream. It is effective for four to eight months. Most women with implants also take progestin tablets the first 10 days of each month.
Transparent adhesive patches containing estrogen, or a combination of estrogen and progestin, can be applied on the skin below the waist, such as on the hip. The patches release the hormones directly into the skin. Patches are usually changed once or twice a week.
Estrogen creams can be used for local treatment of vaginal dryness and irritation. The cream is applied inside the vagina and travels into the bloodstream.
A gel is available that is applied to the skin once or twice daily. It contains estrogen that is readily absorbed by the body. Some women feel that they are more in control of their hormone therapy with a gel, and they find it convenient and easy to use. As with the cream, estrogen gel can relieve menopause symptoms but does not provide protection against osteoporosis.