Last week we talked about prescribing estrogen and creating a custom tailored plan for you. There are a variety of ways to get estrogen into your body including creams, sprays, gels, patches, and pills. This week we are going to talk about how these medicines work and why we typically recommend topical sources of estrogen.
When you swallow a pill, the pill goes into your stomach and begins to break down where the medication is passed through the liver and then distributed throughout the rest of your body. When you use a topical form of estrogen, the medication is absorbed through the skin and into the bloodstream where it makes its way through the body before reaching the liver.
When you use a topical form of estrogen, the medicine reaches the liver in smaller, easier-to-process amounts whereas a pill happens all at once. Oftentimes some of the estrogen in pill form is broken down or discarded by the liver, and we have noticed that women who rely on estrogen pills usually need to take more of it in order to achieve the same results. Women who use topical estrogen generally require less of a dose because more of it is absorbed by the body before it passes through the liver.
Women who take an estrogen pill don’t have as much control over the amount of estrogen they are taking. Pills tend to come in 1mg increments whereas patches can be cut into pieces, and gels and creams can be easily adjusted to provide smaller doses. We want our patients to take the smallest amount of estrogen needed to do the job, and this can be more challenging with pills. Estrogen pills can be effective for some women, but we encourage trying topical sources first.