HRT Medication Delivery Methods

When you and your provider decide that Hormone Replacement Therapy (HRT) is appropriate, the next question is how to take it—pill, patch, gel, spray, ring, or something else. The delivery method can affect how well your symptoms improve, your side-effect profile, and how easy it is to stay on treatment.

This page walks through the main HRT delivery methods women use for menopause symptoms based on the latest research, how each one works, and what to consider when choosing the option that best fits your body and lifestyle.

Systemic vs Local (Vaginal) HRT

Most HRT medications fall into two main categories: systemic and local. Understanding the difference can help you and your clinician match the method to your symptoms.

Systemic HRT

Systemic HRT is absorbed into your bloodstream and circulates throughout your whole body. It is typically used to treat hot flashes, night sweats, sleep problems, mood changes, and to help protect bone density. It is available as:

• Oral tablets
• Skin patches
• Gels or sprays applied to the skin
• Certain higher-dose vaginal rings

Systemic therapy provides hormone levels high enough to ease vasomotor symptoms (like hot flashes) and other whole-body effects of menopause.

Local (Vaginal) HRT

Local or “topical” vaginal HRT is aimed directly at the vagina and nearby urinary tissues. Only tiny amounts reach the rest of the body, so it mainly treats:

• Vaginal dryness, irritation, and itching
• Pain with sex
• Some urinary symptoms, such as urgency or recurrent infections

Local HRT is available as vaginal creams, tablets or pessaries, and low-dose vaginal rings. It is often used on its own for genitourinary symptoms, or alongside systemic HRT if vaginal discomfort continues.

Oral HRT: Pills and Tablets

Oral HRT is one of the most familiar forms. You swallow a tablet once daily (sometimes twice), which may contain estrogen alone or estrogen combined with progestogen if you still have a uterus.

Advantages:

• Simple and familiar: just take a pill at the same time each day.
• Often widely available and relatively inexpensive.
• Many dose and combination options to tailor to symptoms.

Considerations:

• The hormone passes through your liver first, which may slightly increase the risk of blood clots and stroke in some women.
• May not be ideal if you have a history of clotting disorders or certain cardiovascular risk factors.
• You must remember a daily tablet, which some people find harder than weekly options.

Oral tablets remain a common and flexible HRT option in national guidelines. NHS – Types of HRT² Mayo Clinic³

Transdermal Patches

Patches are small, adhesive squares worn on the skin (usually the lower abdomen or buttocks) that release estrogen—or estrogen plus progestogen—steadily into your bloodstream.

Advantages:

• Hormone is absorbed through the skin, bypassing the liver.
• May carry a lower risk of blood clots and stroke than oral estrogen for some women.
• Convenient “set it and forget it” schedule—typically changed once or twice a week.

Considerations:

• Some women experience mild skin irritation at the patch site.
• Patches can occasionally loosen or peel in hot weather, with heavy sweating, or after swimming.
• You must remember to change the patch on the correct day.

Expert groups often favor transdermal estrogen for women with elevated clot risk or those who prefer to avoid oral therapy. The Menopause Society¹

Estrogen Gels and Sprays

Estrogen gels and sprays are applied directly to clean, dry skin (often the arms, shoulders, legs, or abdomen) once daily. The hormone is absorbed through the skin into your bloodstream, similar to a patch but without the adhesive.

Advantages:

• Transdermal delivery bypasses the liver and may be safer for some women with clotting or migraine concerns.
• Dosing can be adjusted more easily in small steps.
• Invisible once absorbed, with no patch edges or adhesive.

Considerations:

• You must wait for the product to dry before dressing or having skin-to-skin contact.
• Requires a daily routine—missing doses can affect symptom control.
• Absorption can vary slightly depending on application technique and skin condition.

Many women prefer gels or sprays as a flexible, non-patch way to use transdermal estrogen. NHS – Types of HRT²

Vaginal Rings

Vaginal rings are soft, flexible devices placed in the vagina, where they release estrogen over weeks or months. There are:

• Low-dose local rings – mainly for vaginal dryness and discomfort.
• Higher-dose systemic rings – provide enough estrogen to help with hot flashes as well.

Advantages:

• Steady estrogen delivery with very little daily effort.
• Low-dose rings give primarily local effect with minimal systemic absorption.
• Can be a good option for women who dislike creams or daily tablets.

Considerations:

• Requires insertion (by you or your clinician) and removal on schedule.
• Some women feel aware of the ring at first, though this usually fades.
• Systemic rings still require progesterone if you have a uterus.

Low-dose vaginal rings are recognized as a convenient and effective option for long-term local symptom relief.

Vaginal Creams, Tablets, and Pessaries

These low-dose estrogen products are inserted directly into the vagina using an applicator several times a week. They are designed to treat local symptoms rather than hot flashes.

Advantages:

• Excellent for dryness, irritation, and pain with sex.
• Very low systemic absorption; generally considered safe for long-term use in most women.
• Can be used together with systemic HRT if vaginal discomfort persists.

Considerations:

• Require regular application—often nightly at first, then a few times per week.
• Some women find them slightly messy or notice minor leakage.
• They usually do not help with hot flashes or night sweats.

Major menopause guidelines support vaginal estrogen as a safe and effective long-term treatment for genitourinary syndrome of menopause.

Progesterone-Releasing Intrauterine Devices (IUDs)

A hormonal IUD placed in the uterus can release a small, steady dose of progestogen. In the context of HRT, it is usually combined with estrogen from a patch, gel, spray, or tablet.

Why it’s used:

• If you have a uterus, you need progesterone to protect the uterine lining from overgrowth caused by estrogen.
• An IUD delivers this progesterone primarily to the uterus, with lower systemic levels.
• It can also reduce or stop bleeding over time.

Considerations:

• Must be inserted and removed by a clinician.
• Some women experience cramping or spotting after insertion.
• Not appropriate for everyone, especially with certain uterine conditions.

Many guidelines recognize progesterone-releasing IUDs as an effective way to provide the progestogen component of HRT while using transdermal or oral estrogen. ACOG – Hormone Therapy for Menopause⁴

Implants and Pellets

Some clinics offer hormone pellets or implants placed under the skin (often in the hip area). These slowly release hormones over several months.

Advantages:

• “Set it and forget it” option that doesn't’t require daily or weekly dosing.
• Can provide relatively steady hormone levels during the implant’s lifespan.

Considerations and cautions:

• Dose cannot be easily adjusted once the pellet is inserted.
• If the dose is too strong or causes side effects, it cannot be quickly removed.
• Many pellets are compounded and not FDA-approved, so quality and exact dosing may be less predictable.

Because of these concerns, major medical societies generally recommend FDA-approved patches, gels, tablets, and vaginal products as first-line options.

Choosing the Right Delivery Method

There is no single “best” way to take HRT. The safest and most effective option depends on several factors:

• Your main symptoms – hot flashes and night sweats often need systemic HRT, while vaginal pain or dryness may respond to local estrogen alone.
• Your medical history – a history of blood clots, migraine, liver disease, or certain cancers may steer you toward (or away from) specific methods.
• Whether you have a uterus – if you do, you will need progesterone/ progestogen or a progesterone-releasing IUD along with estrogen.
• Your preferences and lifestyle – daily vs weekly dosing, comfort with vaginal products, tolerance of patches or gels.

Organizations such as The Menopause Society, NAMS, and ACOG recommend personalizing HRT type, dose, and route, using the lowest effective dose for symptom relief and reassessing regularly with your clinician. The Menopause Society¹ ACOG⁴

Important Disclaimer

The information provided here is for educational purposes only and should not be considered medical advice. Hormone therapy must be individualized and supervised by a licensed healthcare professional.

Do not start, change, or stop any hormone treatment without consulting your healthcare provider. For guidance specific to your health and hormone needs, please schedule an evaluation with a qualified practitioner.

1. The Menopause Society – Hormone Therapy for Menopause: Benefits, Risks & Options
2. NHS – Types of Hormone Replacement Therapy (HRT)
3. Mayo Clinic – Menopause Hormone Therapy: Benefits and Risks
4. American College of Obstetricians and Gynecologists – Hormone Therapy for Menopause