If you’ve been prescribed HRT for Menopause – or you’re in the early stages of exploring your options – you may have noticed that patches and gels are two of the most commonly recommended forms.
Both deliver oestrogen through the skin and are well-established treatments. However, they work differently, they suit different women, and the right choice often comes down to your symptoms, your routine, and how your skin responds.
| Feature | HRT Patches (Transdermal Hormone Patches) | HRT Gels |
| Products Available | Estradot, Evorel, Evorel Conti, Evorel Sequi, FemSeven | Oestrogel (pump), Sandrena (sachets), Blissel Vaginal Gel |
| Active Ingredients | Estradiol (oestrogen-only); Estradiol + norethisterone acetate (Evorel Conti/Sequi) | Estradiol (Oestrogel, Sandrena); Estriol (Blissel) |
| HRT Type | Oestrogen-only or combined (oestrogen + progestogen in one patch) | Oestrogen-only (Oestrogel, Sandrena); Local vaginal oestrogen (Blissel) |
| How They Work | Hormone is released continuously through the skin via an adhesive patch | Hormone is absorbed through the skin after rubbing in the gel (Oestrogel/Sandrena); local oestrogen action in vaginal tissue (Blissel) |
| Application Method | Peel-and-stick patch pressed onto the skin | Gel rubbed into skin (systemic gels) or applied internally with an applicator (Blissel) |
| Application Frequency | Twice weekly (every 3-4 days) for most patches; once weekly for FemSeven | Daily for Oestrogel, Sandrena, and Blissel |
| Application Site | Lower abdomen or buttocks (below the waistline) | Arms and shoulders (Oestrogel); thigh (Sandrena); vaginal area (Blissel) |
| Who Can Use It | Postmenopausal women; Evorel Sequi also suited to perimenopausal women transitioning to HRT | Postmenopausal women (Oestrogel/Sandrena); women with localised vaginal symptoms (Blissel) |
| Separate Progestogen Needed? | Not always; Evorel Conti and Evorel Sequi include it; oestrogen-only patches require a separate progestogen if uterus intact | Yes: all gels are oestrogen-only; women with an intact uterus will need a separate progestogen prescribed |
| Side Effects | Skin irritation at the patch site, breast tenderness, headache, nausea, breakthrough bleeding or spotting | Skin reactions at application site, breast tenderness, headache, nausea (systemic gels); local irritation (Blissel) |
| Best Suited For | Women who prefer a discreet, low-maintenance option; those who want combined HRT in a single product; anyone prone to forgetting daily medication | Women who want flexible daily dosing; those who prefer no visible patch on the skin; anyone with vaginal dryness as the primary concern (Blissel) |
HRT patches are small, adhesive patches worn directly on the skin. They contain oestrogen (and, in some cases, a progestogen as well), which is absorbed steadily through the skin into the bloodstream. Because the hormones bypass the digestive system entirely, patches are considered a form of transdermal hormone replacement therapy.
Most patches are changed twice a week on the same two days each week, so once you establish a routine, they are fairly low-maintenance. You apply each patch to clean, dry skin below the waistline, usually the lower abdomen or buttocks, and wear it continuously until it is time for a new one.
There are several HRT patches available in the UK. Some, like Estradot, Evorel, and FemSeven, contain oestrogen only, which means women who still have a uterus will need a separate progestogen to protect the womb lining.
Others, like Evorel Conti and Evorel Sequi, are combined patches that deliver both hormones in a single patch, removing the need for a separate progestogen. Evorel Conti is designed for continuous use without a bleed, while Evorel Sequi is better suited to women who are still transitioning into menopause and benefit from a cyclical approach.
All HRT patches are prescription-only medicines.
HRT patches are used to relieve the symptoms caused by falling oestrogen levels during perimenopause and menopause. These include:
Some patches (Evorel 50, 75, and 100, and FemSeven) can also be prescribed to help prevent osteoporosis in postmenopausal women at increased risk of fractures, where other treatments are not suitable.
HRT patches are licensed, clinically proven treatments. They contain pharmaceutical-grade oestrogen at precise, regulated doses, and there is a substantial body of clinical evidence supporting their effectiveness for menopause symptom relief.
Most women notice an improvement in hot flushes and night sweats within a few weeks. Other symptoms, such as vaginal dryness, mood changes, and sleep problems, may take a little longer to improve, typically between one and three months.
Like all medicines, HRT patches can cause side effects, though not everyone experiences them. Many settle down within the first few months as your body adjusts.
Common side effects include:
Rotating the application site each time you change your patch helps to reduce localised skin reactions.
More serious side effects are less common. These include:
If you experience any of these, stop using the patch and seek medical help straight away.
HRT carries a small increased risk of blood clots and certain cancers (including breast cancer with long-term use), and your prescriber will discuss these risks with you in the context of your personal health history before starting treatment.
For most healthy women going through menopause, the benefits of HRT outweigh the risks, but this is an individual decision made with clinical support.
HRT gel is another form of transdermal HRT, meaning the hormones are absorbed through the skin rather than swallowed as a tablet.
HRT gel actually covers two quite different types of product:
Both types are well-established, prescription-only treatments, but they serve different purposes and should not be considered interchangeable.
Systemic gels (Oestrogel and Sandrena) are used to relieve the full range of menopause symptoms, including:
Because the oestrogen enters the bloodstream, it works throughout the body in the same way patches do.
Localised vaginal gel is used specifically for genitourinary symptoms of menopause (sometimes called GSM). These include:
It is a targeted treatment for women whose main concerns are localised to the vaginal area rather than wider menopause symptoms.
If you are looking for a non-hormonal option for vaginal dryness, Replens MD is available over the counter without a prescription. It works as a vaginal moisturiser rather than an HRT product and does not contain any hormones.
Systemic gels are licensed, clinically effective treatments for menopause symptoms. One practical advantage of gels like Oestrogel is that the dose can be adjusted relatively easily by changing the number of pump presses. This gives your prescriber more flexibility when fine-tuning your treatment compared to fixed-dose patches. Timelines are similar to patches, with noticeable improvement in hot flushes and night sweats within a few weeks, with other symptoms improving over one to three months.
Blissel and other localised vaginal oestrogen products are also well supported by clinical evidence, particularly for improving vaginal dryness, comfort during sex, and urinary symptoms.
As very little oestrogen is absorbed into the bloodstream from vaginal gels, they are sometimes suitable for women who cannot use systemic HRT, although this should always be confirmed with a prescriber.
Systemic gels share a similar side effect profile to HRT patches. Common side effects include:
As with patches, rotating the application site and allowing the gel to dry fully before dressing helps to minimise skin irritation.
The same serious risks associated with systemic HRT apply to gels, including a small increased risk of blood clots with longer-term use. Your prescriber will review these risks with you individually.
For Blissel vaginal gel, side effects are generally mild and localised. Some women experience:
Because systemic absorption is minimal, the broader risks associated with systemic HRT are much lower, though your prescriber will still assess suitability on an individual basis.
Patches and systemic gels deliver oestrogen transdermally, and in terms of clinical effectiveness, they are both very similar. The differences come down to practicalities: how you use them, how often, how much flexibility they offer, and how your skin and lifestyle respond.
Patches are changed twice a week for most products, or once a week for FemSeven. If you prefer a low-maintenance routine and don’t want to think about your HRT every day, patches have a clear advantage. Systemic gels require daily application, which suits some women but can feel like a greater commitment for others.
Patches come in fixed strengths, ranging from 25 to 100 micrograms per 24 hours, depending on the product. If your symptoms are not well controlled or you experience side effects at a particular dose, switching usually means moving to a different patch strength. Systemic gels offer more gradual dose adjustment.
With Oestrogel, for example, the dose can be increased or reduced by one pump press at a time, which can make it easier to find the level that works for you without jumping between fixed increments.
If you still have your uterus and need both oestrogen and a progestogen, patches offer a combined option in a single product. Evorel Conti and Evorel Sequi deliver both hormones through a single patch, simplifying the regimen considerably. There is no equivalent combined gel product, so women using a systemic gel who need progestogen cover will always require a separate prescription.
Patches use an adhesive backing that sits on the same area of skin for three to four days, which can cause redness, itching, or irritation at the patch site in some women. Gels do not use adhesive, so this type of reaction is less likely, though some women still find localised skin sensitivity at the application site. If you have known sensitivity to adhesives or have struggled with patches sticking or causing irritation in the past, gel may be worth considering.
Patches need to stay in place when you’re bathing, swimming, and exercising. Most women find they stay on reliably with correct application, but heat and excessive sweating can occasionally cause them to lift at the edges.
Gels are applied and absorbed quickly, so once dry, they do not need to remain on the skin surface. However, you do need to avoid washing the application area for at least an hour after applying a systemic gel, and care is needed to avoid transferring oestrogen to other people through skin-to-skin contact before the gel has fully dried.
If you’re worried about vaginal dryness, discomfort during sex, or urinary symptoms, patches and systemic gels don’t directly target vaginal tissue in the way a localised treatment does. Blissel vaginal gel acts directly on the vaginal area, restoring tissue locally without raising systemic oestrogen levels. It can be used alongside systemic HRT or, in some cases, on its own for women whose symptoms are limited to this area.
Neither option is universally better than the other. Both are clinically effective, widely prescribed, and considered safe and appropriate forms of HRT when used correctly under medical supervision.
The question is really which one is the better fit for you, and that depends on your symptoms, your lifestyle, and how your body responds to treatment.
HRT patches may suit you better if:
HRT gel may suit you better if:
Switching between forms is not uncommon. Some women start on patches and move to gel, or vice versa, as their symptoms evolve or if they experience tolerability issues. HRT is not a one-size-fits-all treatment, and your prescriber should regularly review your treatment to make sure it is still working well for you.
If you are unsure which option is right for you, the most important step is to speak with a qualified doctor who can assess your full symptom picture, medical history, and personal preferences.
If you are ready to explore HRT or want to review your current treatment, Click2Pharmacy’s online menopause and HRT clinic makes it straightforward to access the care you need without an in-person appointment.
We stock a full range of transdermal HRT options, including HRT patches, systemic HRT gels and vaginal gels.
Whether you are new to HRT, switching from another form, or looking to continue an existing prescription, our team is here to help.
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