I am often asked “why creams?” or “why troches?” to treat menopause. The answer is not complex!
The skin is the biggest organ in the body and we have come to recognise that it is a very efficient medium though which various drugs can be absorbed straight into the blood stream. Conventional HRT is delivered by patch, renewed every three days, and also now you can get pain relief patches and various other medications absorbed by the skin.
The advantage of skin absorption over stomach absorption is that the product goes directly into the blood rather than passing through the liver first. The liver has enough to do, dealing with foods, your general biochemistry and responding to a multitude of requirements by other organs. Sending the liver a load of hormones it was never designed to digest is just silly, and could be downright dangerous!
So my preference is to start with creams. The absorption is gradual over 15-30 minutes and does not involve the liver. The cream has to be put on to an area of soft skin, in a different place each day of the week. I usually give my patients a small diagram that looks like a fat scarecrow to show the areas on the front of the body for each day. Applying the cream to the back of the arms or buttocks, or indeed anywhere on the back of the body, is less effective as the skin is generally too thick to absorb much cream.
When the patient has tried creams but we have not been able to achieve a good balance, I usually then transfer them to troches. These are small waxy lozenges for dissolving in the cheek for 10-15 minutes each day. Absorption from the mouth is quicker but there are two issues to be watched. The woman only has two cheeks so she needs to alternate which side she uses. The vaginal membranes are also squamous epithelium like the mouth, so she needs to utilise insertion into the vagina every 3-4 days as a way of spreading the load of absorption.
If there is not a variety of sites to absorb the hormones, the cells in contact will rapidly become saturated and will not absorb any more. Many times the failure to reach a proper balance of hormones can be because there has been either an inadequate area of skin exposed, or the same skin or same cheek has been used constantly and the cells have become overloaded and stopped absorbing.
It is possible to prescribe hormones in capsules or drops but I have found them less satisfactory. So good hunting with your hormone products! Make sure you have tried and found what is best for you and re-test regularly.
Blessings,
Maura