Menopausal Hormone Therapy (MHT) Patch
Patient Information & Counselling Guide
What is MHT?
Menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT), replaces hormones that naturally decline during perimenopause and menopause, particularly oestrogen.
An oestrogen patch delivers oestrogen through the skin and into the bloodstream. Transdermal MHT (patches or gels) avoids the first-pass effect through the liver and is generally associated with a lower risk of blood clots than oral oestrogen.
If you have a uterus (womb), you will usually also need progesterone/progestogen to protect the lining of the uterus from becoming too thick. This may be given as a separate medication or as part of a combined MHT product.
Table of Contents
What symptoms can MHT help?
MHT is particularly effective for:
- Hot flushes and night sweats
- Sleep disturbance related to menopause
- Vaginal dryness and discomfort
- Pain or discomfort during sex related to vaginal dryness
- Mood changes associated with menopause
- Reduced concentration or “brain fog”
- Some menopause-related joint and muscle symptoms
MHT also helps prevent bone loss and osteoporosis while you are taking it.
Improvement can begin within a few weeks, but some symptoms may take 2-3 months to improve fully.
How do I use my MHT patch?
- Apply the patch to clean, dry, intact skin.
- Suitable areas may include the lower abdomen, hip or buttock, depending on the product instructions.
- Do not apply the patch to the breasts.
- Avoid broken, irritated or inflamed skin.
- Avoid applying moisturiser, oil or body lotion to the area immediately before applying the patch.
- Press the patch firmly onto the skin for approximately 10 seconds.
- Rotate the application site to reduce skin irritation.
- Follow your prescription regarding how often the patch should be changed.
You may shower and exercise while wearing most patches.
If your patch falls off
If the patch becomes loose or falls off, follow the instructions for your specific product. If possible, replace it with a new patch and continue with your usual change schedule. If you are unsure what to do, contact your doctor or pharmacist.
What side effects can occur?
Side effects are usually mild and may improve as your body adjusts to treatment.
Possible effects include:
- Breast tenderness
- Headache
- Nausea
- Bloating
- Fluid retention
- Mood changes
- Breakthrough bleeding or spotting
- Skin irritation at the patch site
If side effects are persistent or troublesome, do not stop treatment without discussing it with your doctor. The dose, type of MHT or progesterone component can sometimes be adjusted.
Bleeding while using MHT
Irregular spotting or bleeding is relatively common during the first few months after starting or changing MHT.
However, heavy, persistent, recurrent or unexpected bleeding should be assessed by a doctor, particularly if it continues after the initial adjustment period or occurs after a prolonged period without periods.
Understanding the risks
MHT is considered an effective treatment for troublesome menopausal symptoms, but it is not suitable for everyone.
The benefits and risks depend on factors such as your age, symptoms, medical history, family history, type of MHT, dose and duration of treatment.
Blood clots
The risk of blood clots is lower with transdermal oestrogen (patches/gels) than with oral oestrogen.
Tell your doctor if you have previously had a blood clot, pulmonary embolism, thrombophilia or a strong family history of blood clots.
Breast cancer
The relationship between MHT and breast cancer depends on the type of MHT used, duration of treatment and individual risk factors.
Combined oestrogen + progestogen MHT is associated with a small increase in breast cancer risk with longer-term use. Oestrogen-only MHT has a different risk profile.
Your individual breast cancer risk should be considered when deciding whether MHT is appropriate.
Continue with routine breast screening appropriate for your age and personal risk.
Uterine (endometrial) protection
If you have a uterus, oestrogen should generally not be taken on its own long-term, because unopposed oestrogen can cause thickening of the uterine lining and increase the risk of endometrial cancer.
Progesterone/progestogen is prescribed to protect the uterus.
When should MHT be avoided or discussed carefully?
Tell your doctor before starting MHT if you have or have previously had:
- Breast cancer or another hormone-sensitive cancer
- Unexplained vaginal bleeding
- A previous blood clot or pulmonary embolism
- A known clotting disorder
- Stroke or significant cardiovascular disease
- Significant liver disease
- Severe migraine or other important medical conditions
MHT should be individualised rather than started solely on the basis of a blood test.
Seek urgent medical attention if you develop:
- Sudden chest pain or difficulty breathing
- Coughing up blood
- A painful, swollen or red leg
- Sudden weakness, numbness, facial drooping or difficulty speaking
- Severe sudden headache or new neurological symptoms
- Very heavy or concerning vaginal bleeding
Follow-up
The aim of MHT is to use the lowest effective dose that provides satisfactory symptom relief, while regularly reviewing whether treatment remains appropriate.
Your treatment may need adjustment during the first few months.
Please contact your doctor if:
- Your symptoms are not improving
- Side effects are troublesome
- You develop persistent or heavy bleeding
- You are concerned about breast symptoms
- You are unsure how to use your patch
- Your medical circumstances change
FAQ
What is an MHT patch?
An MHT patch is a way of using menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT). It delivers oestrogen through the skin and into the bloodstream, replacing hormones that naturally decline during perimenopause and menopause. Because it avoids the first-pass effect through the liver, transdermal MHT is generally associated with a lower risk of blood clots than oral oestrogen.
Do I need progesterone with an oestrogen patch?
If you have a uterus (womb), you will usually also need progesterone/progestogen to protect the lining of the uterus. Oestrogen should generally not be taken on its own long-term, because unopposed oestrogen can cause thickening of the uterine lining and increase the risk of endometrial cancer. Progestogen may be given as a separate medication or as part of a combined MHT product.
How long does an MHT patch take to work?
Improvement can begin within a few weeks, but some symptoms may take 2-3 months to improve fully. Your treatment may also need adjustment during the first few months.
Where should I put my MHT patch?
Apply the patch to clean, dry, intact skin. Suitable areas may include the lower abdomen, hip or buttock, depending on the product instructions. Do not apply it to the breasts or to broken, irritated or inflamed skin, and rotate the application site to reduce skin irritation.
Can I shower or exercise with an MHT patch?
You may shower and exercise while wearing most patches. If the patch becomes loose or falls off, follow the instructions for your specific product. If possible, replace it with a new patch and continue with your usual change schedule.
What are the side effects of an MHT patch?
Side effects are usually mild and may improve as your body adjusts to treatment. They can include breast tenderness, headache, nausea, bloating, fluid retention, mood changes, breakthrough bleeding or spotting, and skin irritation at the patch site. If side effects are persistent or troublesome, do not stop treatment without discussing it with a doctor, as the dose, type of MHT or progesterone component can sometimes be adjusted.
Is bleeding normal when starting MHT?
Irregular spotting or bleeding is relatively common during the first few months after starting or changing MHT. However, heavy, persistent, recurrent or unexpected bleeding should be assessed by a doctor, particularly if it continues after the initial adjustment period.
Remember: MHT is individualised. The information above is general and does not replace a medical consultation or your prescribed treatment instructions.
