HRT Gel vs Cream: Which Transdermal Estrogen Is Right for You?

Why transdermal estrogen is often preferred

Transdermal estrogen, meaning estrogen delivered through the skin rather than by mouth, has become a widely recommended option for hormone replacement therapy during perimenopause and menopause. Compared with oral estrogen, transdermal forms bypass first-pass metabolism in the liver, which means they do not increase clotting risk in the same way and are generally considered safer for most women, including those with certain cardiovascular risk factors. Both gel and cream are popular transdermal options. They achieve similar therapeutic goals but differ in their formulation, application method, dose flexibility, and texture, and understanding those differences helps women have a more informed conversation with their prescribers.

How HRT gel works

Estrogen gel is typically a clear or lightly coloured alcohol-based gel that is applied to the skin of the arm, inner thigh, or abdomen once daily. The estrogen is absorbed through the skin into the bloodstream steadily over 24 hours. Common branded gels such as Oestrogel, EstroGel, and Sandrena are available in pump dispensers or sachets, allowing consistent dosing. Gels dry quickly, within one to two minutes in most cases, and the alcohol base evaporates to leave little residue. The alcohol also serves as an absorption enhancer. Dose is typically measured in pumps or grams, and adjustments can be made in small increments, which is useful for titrating the dose to symptom control.

How HRT cream works

Estrogen cream uses a fatty or emollient base rather than an alcohol base to deliver estrogen through the skin. It is often thicker in texture and may feel more moisturising on application. Some HRT creams are compounded preparations made to individual prescriptions, particularly in the context of bioidentical hormone therapy, whereas others are standardised pharmaceutical products. Because the fatty base releases estrogen more slowly and less predictably than an alcohol-based gel, absorption can vary more between individuals and even between applications. Compounded creams in particular have less robust clinical data on consistent blood levels compared with gel formulations, which is an important consideration when evaluating efficacy and safety.

Comparing absorption and blood levels

One of the most clinically relevant differences between gel and cream is the consistency of estrogen absorption and the resulting blood levels. Regulated gel formulations have been tested in clinical trials and produce predictable estradiol concentrations when applied as directed. Compounded creams, particularly those applied vaginally or to the inner wrist where skin is thinner, can produce highly variable blood levels, sometimes higher than intended and sometimes lower. For women who need consistent estrogen levels to manage symptoms effectively, a standardised gel formulation offers more reliability. Both gel and cream require a minimum waiting period after application before showering, swimming, or applying sunscreen to avoid washing off the dose before absorption is complete.

Practical considerations for daily use

Gel is generally easier to apply and dries quickly, which suits women with busy morning routines. It can be applied to a large area of skin, which reduces local skin concentration and potential irritation. Cream tends to require more rubbing in and may leave a residue depending on the formulation. Both require care around transfer: estrogen from either form can be transferred to a partner or child through skin contact before the product has dried or absorbed, particularly from the application site. Wearing clothing over the area after application reduces transfer risk. Women who apply gel or cream to the inner arm should avoid application sites near the wrist or hand where contact with others is most likely.

Which might suit you better

Women who value precise dosing and reliable absorption tend to find gel more straightforward to work with. The pump dispenser format makes dose adjustments simple and the texture is generally well tolerated. Women who prefer a richer feel, or who have very dry skin and find the alcohol base irritating, may prefer a cream formulation, provided they use a standardised product rather than a compounded one. Some women simply prefer one texture over the other for comfort and compliance, and a treatment that suits your routine is more likely to be used consistently. It is worth trying both under medical guidance if one does not feel right.

Having the conversation with your doctor