Estrogen Pill vs. Estrogen Cream or Patch – Which Works Best?

The Delivery System Makes All the Difference When it Comes to Hormones

One of the issues up on the radar screen in natural hormone replacement therapy is whether taking estrogen in the oral (pill form) or transdermal (skin cream or patches) works best. (It's already very clear that progesterone cream works better than progesterone pills.) A few studies

have been published showing that oral estrogen increases levels of C-reactive protein

(CRP), a marker of inflammation that is associated with heart disease.

The Voices of Experience
Jane Murray M.D., who specializes in natural hormone replacement therapy in

practice in Kansas City, decided to test this for herself after she noticed that

patients who used estradiol patches seemed to be doing better than those taking
pills. She

first tested an elderly patient who had been on a small dose of Premarin for
many years.

When her blood tests showed high CRP levels, Dr. Murray suggested she switch
to a patch.

After three months on the patch, the patient was tested again, and her CRP levels

normal. According to Dr. Murray, “That was my index case that woke me up to the fact that

this is a real and clinically relevant phenomenon. Since then I’ve had other patients with

the same result, so I now routinely recommend patches or cream over pills. I have noticed

that my overweight patients who are insulin resistant are more sensitive to the

CRP-elevating effects of oral estrogen. This may be why we’ve gotten such conflicting

reports over the years about estrogen’s effects on heart disease.”

Oral Estrogens Associated with Low Sex Drive
Dr. Murray continues, “I also found that patients on oral hormones tended to
have more

problems with low libido or sex drive. When I researched this I found that oral

stimulate the liver to make proteins, including SBHG [serum binding hormone globulin],

which binds to hormones and makes them inactive. When I tested hormone levels
in my

patients I found that when they were put on oral hormones their SBHG went way
up and their

free testosterone went way down, which accounts for the low libido. I found this
to be true

with oral hormone replacement hormones and with birth control pills. When I switched

women to the birth control patches their libido came back.”

Dr. Randolph Weighs In on Oral Estrogens
C.W. (Randy) Randolph, M.D. of Jacksonville Beach, Florida has had similar
results in
his busy natural hormone therapy practice, and adds that compared to transdermal
oral estrogens increase the risk of thromboembolic events [strokes and blood
clots]. He
points out that the liver proteins created by oral estrogens also raise blood
raise triglyceride levels, and suppress thyroid function. Because he is a pharmacist
well as a physician, Dr. Randolph makes his own transdermal hormone gels. He
recommends that women begin with a combination of 0.75 mg of estradiol and 1.5
mg of
estriol daily, and then adjust according to salivary hormone level tests and

Ylikorkala O, Evio S, Effects of hormone therapy and alendronate on C-reactive protein,

E-selectin, and sex hormone-binding globulin in osteoporotic women, Fertil Steril.


Kawano H, Yasue H, Effects of transdermal and oral estrogen supplementation on endothelial

function, inflammation and cellular redox state, Int J Clin Pharmacol Ther. 2003


Frohlich M, Muhlberger N, Markers of inflammation in women on different hormone

replacement therapies, Ann Med. 2003;35(5):353-61.

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