Understanding the Different Types of HRT: Creams, Pills, Patches, Pellets, Injections, Fastbursts, and Troches.
Hormone Replacement Therapy (HRT) can be a game-changer for women dealing with the frustrating and often debilitating symptoms of perimenopause and menopause, hot flashes, mood swings, fatigue, weight gain, low libido, brain fog, and more. But one of the most common questions we hear is:
“What type of hormone therapy is best for me?”
From daily creams to long-lasting pellets, the form of hormone delivery can make a big difference in how you feel and how consistent your hormone levels stay. Below is an in-depth look at the most commonly used types of HRT, allowing you to better understand your options.
Creams and Gels (Topical)
What They Are:
Hormones, typically estrogen or testosterone, are delivered through a transdermal cream or gel and applied to the skin.
How They Work:
Absorbed directly through the skin into the bloodstream, bypassing the digestive system and liver.
Pros:
Bypasses liver metabolism
Flexible and customizable dosing
Easy to adjust over time
Great for sensitive GI systems
Cons:
Daily application required
Risk of transfer to others through skin contact
Absorption can vary
Best For:
Women who want non-oral therapy, need individualized dosing, or have a higher risk of clotting.
Pills (Oral Estrogen and/or Progesterone)
What They Are:
Tablets taken by mouth once daily, such as estradiol or micronized progesterone.
How They Work:
Absorbed through the digestive tract and processed by the liver before entering circulation.
Pros:
Easy and familiar format
Often covered by insurance
Micronized progesterone can support sleep
Cons:
First-pass liver metabolism increases clot risk
Can affect cholesterol and gallbladder function
Best For:
Patients without cardiovascular risk or liver concerns who prefer oral medication.
Patches (Transdermal Estrogen)
What They Are:
Adhesive patches worn on the skin (usually abdomen or buttocks), changed every few days.
How They Work:
Deliver estrogen steadily through the skin into the bloodstream.
Pros:
Steady hormone delivery
Lower clotting risk than oral estrogen
Easy to use and low maintenance
Cons:
May cause skin irritation
Can come off with sweat or water exposure
Best For:
Women with clotting risks, cardiovascular concerns, or those who want a hassle-free delivery method.
Pellets (Subcutaneous Implants)
What They Are:
Tiny implants are placed under the skin (usually in the hip area) during an in-office procedure every 3–6 months.
How They Work:
Pellets slowly dissolve and release hormones over time, providing consistent blood levels.
Pros:
Long-lasting and low maintenance
Consistent hormone levels
Mimics natural release patterns
Cons:
Requires a minor procedure
The dose cannot be adjusted after insertion
Not typically covered by insurance
Best For:
Women seeking convenience and consistent hormone delivery without daily or weekly routines.
Troches (Buccal or Sublingual)
What They Are:
Lozenges that dissolve under the tongue or between the cheek and gum.
How They Work:
Absorbed directly into the bloodstream via the oral mucosa, bypassing liver metabolism.
Pros:
Quick absorption
Custom-compounded doses
Avoids GI and liver processing
Cons:
Requires proper placement
Can irritate gums or affect dental enamel
Must avoid swallowing for best results
Best For:
Women are looking for a non-invasive, fast-acting option with flexible dosing.
Fast Bursts (On-Demand Hormone Support)
What They Are:
Rapid-acting troches, sublinguals, or nasal sprays designed for quick, short-term symptom relief—often for libido or energy.
How They Work:
Hormones are absorbed quickly through mucous membranes, delivering a fast-acting boost.
Pros:
Immediate effects
Used as needed, not daily
Great for intimacy, energy dips, or mood
Cons:
Not a baseline replacement method
Hormonal spikes if overused
Requires professional dosing guidance
Best For:
Women who are already on daily HRT occasionally need symptom-specific, quick-acting support.
Injections (IM or SubQ Hormones)
What They Are:
Hormones like testosterone or estradiol are injected into the muscle or subcutaneous tissue, typically once weekly or biweekly.
How They Work:
Enter the bloodstream directly for reliable absorption and fast symptom relief.
Pros:
Predictable and fast absorption
Self-administered at home or in-clinic
Flexible dosing schedules
Cons:
Requires a needle and injection technique
Risk of fluctuating levels between doses
Possible site discomfort
Best For:
Women using testosterone or needing reliable hormone delivery who are comfortable with self-injections or regular clinic visits.
A Note on Progesterone
If you still have a uterus and are using estrogen therapy, you must also take progesterone to protect your endometrial lining from estrogen-induced overgrowth. Progesterone is available in pill, cream, or vaginal form—with oral micronized progesterone being the most evidence-backed for endometrial protection.
So, What’s Right for You?
There’s no one-size-fits-all when it comes to hormone therapy. The best choice depends on your:
Symptoms and goals
Medical history (e.g., clotting risk, migraines, liver issues)
Preferences for daily vs. long-acting methods
Absorption ability and lifestyle factors
Working with a knowledgeable HRT provider allows you to fine-tune your regimen to get symptom relief while protecting your long-term health.
Final Thoughts
Your hormones are deeply connected to how you feel—mentally, emotionally, and physically. Understanding your options is the first step in taking control of your health journey.
At Balance & Restore Wellness, we create personalized HRT plans that align with your body, your lifestyle, and your goals. Whether you’re new to hormone therapy or exploring better options, we’re here to guide you every step of the way.
🗓️ Book your FREE 15-minute consultation today to get started.
🔗 www.balancerestorewellness.com
