Oestrogel vs Patches for Perimenopause HRT: Which Transdermal Oestrogen Is Right for You?
Comparing Oestrogel and oestrogen patches for perimenopause HRT. Understand the differences in dose flexibility, skin reactions, and daily routine.
Two Ways to Deliver Transdermal Oestrogen
For most women starting hormone replacement therapy in perimenopause, body-identical transdermal oestrogen is now the preferred option over oral tablets. Transdermal delivery means oestrogen is absorbed through the skin, bypassing the liver and avoiding the small increase in blood clot risk associated with oral oestrogen. Within the transdermal category, women often encounter two main formats: gels such as Oestrogel, and adhesive patches. Both deliver the same type of oestrogen, 17-beta oestradiol, but they differ in how that delivery works in practice. Understanding the practical differences helps women and their prescribers find the best fit for individual lifestyle and skin.
How Oestrogel Works
Oestrogel is a clear, pump-action gel containing 0.06 percent oestradiol. The standard starting dose is one to two pump doses applied once daily to the inner arm, thigh, or lower abdomen. The gel dries quickly and leaves no visible residue. Because it is pump-dispensed, the dose is flexible: it can be adjusted up or down by half a pump in some formulations, making it easier to fine-tune during the dose-finding phase. This flexibility is particularly valuable in perimenopause, when symptoms fluctuate significantly and women may need to adjust during hormonal swings. The gel must be applied to a consistent skin area and should not be washed off for at least an hour.
How Patches Work
Oestrogen patches are adhesive squares or circles applied to the skin, usually on the lower abdomen, buttocks, or outer thigh. They come in fixed doses ranging from 25 micrograms to 100 micrograms per day and are changed every three or seven days depending on the brand. Twice-weekly patches such as Estradot and Evorel are among the most commonly prescribed. The convenience of changing the patch just twice weekly appeals to women who prefer not to think about their HRT daily. Patches maintain a more stable oestradiol level between changes compared with daily gel, though some women experience a slight dip just before a patch change.
Dose Flexibility vs Consistency
Oestrogel has the advantage when dose flexibility is the priority. Because perimenopause involves fluctuating rather than absent oestrogen, some women find they need more support on difficult days and slightly less on others. The pump-action format makes it straightforward to adjust by a dose or half-dose with a prescriber's guidance. Patches offer better consistency between applications, which suits women who have settled on a stable dose and want the reliability of a set-and-forget routine. For women who have moved beyond the perimenopausal fluctuation phase and into surgical or established menopause, patch consistency can be a genuine advantage.
Skin Reactions and Practical Considerations
Skin reactions are more common with patches than with gel. Some women develop redness, itching, or a persistent mark where the patch sits, particularly in hot or humid conditions or when the patch edge lifts. Rotating patch sites and using hypoallergenic patch brands can help. Oestrogel rarely causes skin irritation, though some women find the application process takes getting used to, particularly the need to avoid contact with others for several minutes until the gel is fully dry. Women should not apply moisturiser or sunscreen to the application site immediately before or after gel use. Both formats can be affected by intense sweating or swimming, though modern patches are designed to stay on through normal activity.
Cost, Availability, and Prescribing
In the UK, both Oestrogel and patches are available on NHS prescription, with a standard prescription charge applying per item. Some women find one easier to obtain than the other depending on local supply. Oestrogel is often preferred by prescribers who want flexibility for women in early perimenopause. Patches may be preferred for women who have had issues with gel compliance or who want minimal daily routine disruption. Both should be prescribed alongside a progestogen for women who have a uterus, either as a separate preparation or in a combined patch. The choice of progestogen delivery is a separate conversation with your prescriber.
Which Should You Choose?
If you are in active perimenopause with fluctuating symptoms and want to fine-tune your dose as your hormones shift, Oestrogel offers more flexibility. If you prefer a routine you only need to think about twice a week and have no concerns about skin sensitivity, patches may suit you better. Many women try one format and switch to the other based on lived experience rather than clinical difference. Both are effective, safe when properly prescribed, and well-supported by evidence. The most important step is working with a prescriber who understands perimenopause well and can guide dose adjustments over time. PeriPlan can help you track symptom changes after any HRT adjustment so you have clear data to bring back to your next appointment.
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