Best location for Estradiol Patches?

[allisonsteph]

I was prescribed Estradiol patches today (one patch per week). I'm curious as to where the best location to wear them is. I'd like to hear if there's one place better than another in people's experience.

[Jamie D]

I wore them on my butt and off of the panty lines.  It is best to rotate locations, as the can become itchy.

[MiaSakura]

My Dr Said just above the panties/pantie line to avoid rubbing and what not.  Which has been weird to reach. But worked well enough so far.

[Jenna Marie]

The patch should come with instructions; some brands recommend against certain spots. (All of them should NEVER be worn on the breasts, as apparently it can increase breast cancer risk.) Personally, I use the spot others have mentioned - lower belly, below belly button but above panty line. At the panty line it'll risk being rubbed off, lower than that and it still tends to chafe against my pants, and too much higher and I'm getting too close to "above the waist" which mine warns against. Definitely do follow the instructions, as absorption can be different depending on location, and if you put it somewhere they say not to you may be getting considerably more or less estrogen than intended.

And you really do want to rotate locations. I don't have problems with itching and rashiness since I switched from generic Climara (those were *huge* and got dirty easily), but it still takes a while for the clinging clothes fuzz etc. to wear off of the old adhesive spot and I don't want to overuse one patch of skin.

[KayXo]

Menopause. 2000 Sep-Oct;7(5):364-9.
The effect of site of application on the transcutaneous absorption of 17-beta estradiol from a transdermal delivery system (Climara).

Abstract
OBJECTIVE:
The effect of site of application on 17-beta estradiol bioavailability was assessed in an open-label, randomized, crossover study of a once-weekly transdermal estradiol patch (Climara).
DESIGN:
After placement of a transdermal patch of estradiol on either the buttocks or abdomen, serial plasma samples were obtained over 7 days and for the immediate 24 h after patch removal. Plasma estradiol concentrations were used to estimate pharmacokinetic parameters for the rate and extent of absorption between the two sites.
RESULTS:
Plasma estradiol concentrations were sustained at premenopausal levels over the week in most subjects. After application on the buttock, mean peak plasma concentration (Cmax) was 125.1% and mean relative bioavailability (AUC(0-168)) was 117.2% of that from the abdomen site.
CONCLUSIONS:
In summary, the buttocks seem to be an acceptable site for the application for this once-weekly 17-beta estradiol transdermal delivery system. Because the extent of absorption was significantly more for buttock than for abdomen application, this application site may provide an advantage in women who experience menopausal symptoms at the end of the week.

J Clin Pharmacol. 1996 Nov;36(11):998-1005.
Pharmacokinetics of a 7-day 17 beta-estradiol transdermal delivery system: effect of application site and repeated applications on serum concentrations of estradiol and estrone.


FemPatch (Parke-Davis Pharmaceutical Research, Division of Warner-Lambert Company, Ann Arbor, MI), a new 7-day 17 beta-estradiol transdermal delivery system (TDS), has been developed for treatment of menopausal vasomotor symptoms. This two-period crossover study was conducted to determine the effects of TDS application site (buttocks versus abdomen) and early TDS replacement on estradiol and estrone concentrations, and to quantify intersubject and intrasubject pharmacokinetic variability. Eighteen healthy, postmenopausal female volunteers received a single 7-day TDS application to the abdomen and repeated TDS applications to the buttocks (regular replacement on days 7 and 14, intentional early replacement on day 17, and removal on day 21). Serial serum samples were assayed for estradiol and estrone by validated radioimmunoassay methods. The 7-day TDS delivers estradiol at a constant, near zero-order rate for the duration of application, independent of application site. Mean serum estradiol concentrations were higher after application to the buttocks than after application to the abdomen (19 and 15 pg/mL above baseline, respectively), making the buttocks the preferred site for TDS application.

[allisonsteph]

Thank you all for the input so far. I applied my first one to my lower abdomen before posting my question. After wearing it for 24 hours I can't imagine that it will stay in place for another six days. I will try the next one on my buttocks.

[Kim 526]

I wear mine on the lower abdomen with a clear window bandage over it, because I'm sick of losing patches after a shower or two.

[Jenna Marie]

I will say I had a ton of problems with the generic Climara patch. I switched to Vivelle Dot and have had no issues since; it's intended to stay on only 3.5 days, but I've actually accidentally forgotten to change one and had it still stuck tightly after 5-7 days. (they're tiny, too, unlike the gigantic generics.)

[Pinkkatie]

I've been putting them on my abdomen. They stick just fine, but are not 100% flush with the skin 24 hours a day. I've been wondering if that might be a problem.

[Jenna Marie]

Pinkkatie : The manufacturers build some tolerance into them. As long as most of it's in contact with skin most of the time, it's fine.

[teeg]

(they're tiny, too, unlike the gigantic generics.)

This was exactly my problem with patches when I tried them a couple months ago... I forget the name of the brand, but they were circular patches literally 2" accross... I'll ask my endocrinologist about Vivelle Dot. Do you have to wear more than one patch? My endocrinologist had me on multiple patches to equal the amount of estrogen needed in HRT. Needless to say with 2" sized patches that was a little impracticle.

They stick just fine, but are not 100% flush with the skin 24 hours a day.

This happened to me a lot. I tried them on my lower tummy, above the panty line and almost to my belly button, my upper arms, towards the back of the upper arms and front. I didn't try my buttocks, but it seemed if I applied it while standing, when I sat down they'd fold and lose contact - or if I applied while sitting, they'd fold while standing.

[Pinkkatie]

Pinkkatie : The manufacturers build some tolerance into them. As long as most of it's in contact with skin most of the time, it's fine.

That's good to know! I don't want to use them incorrectly and not get the results due to that reason.

This happened to me a lot. I tried them on my lower tummy, above the panty line and almost to my belly button, my upper arms, towards the back of the upper arms and front. I didn't try my buttocks, but it seemed if I applied it while standing, when I sat down they'd fold and lose contact - or if I applied while sitting, they'd fold while standing.

I moved them to my buttocks and using surgical tape to keep them in place that seems to be helping me with the folding up problem.

[justpat]

  HI, I am on the Climara patch its about 2" x 1,25 I have tried them several places like the rest of you. your behind is suppose to be the best place so I have tried to keep them in that area. I found they do well on my "love handles" just above the belt line place them long ways parallel to the belt. First I shave the area then before placing I clean the area with alcohol,never had a problem with them peeling and they don't crinkle to bad.The other place is more on my hip, stand up take your hand and feel your pelvic bone in front.Just behind it is an area that does not flex to much, kind of a hollow spot ,of course I am a NB (no butt) so yours may be a little different. Place the patch long ways up and down after cleaning the area. I hardly get any crinkles there.  Good luck  Pat

[KayXo]

Patches are soooooooo a pain in the BUTT!  Can't you all ask for injectables instead (or even gel)...so much easier! I hated being on patches, I wore several at the same time, at least they were small though (Estradot).

[teeg]

Patches are soooooooo a pain in the BUTT!  Can't you all ask for injectables instead (or even gel)...so much easier! I hated being on patches, I wore several at the same time, at least they were small though (Estradot).

I'd try to tough out my needle phobia if I knew for sure that injectables were a good choice. I was recommended oral (sublingual) estradiol as it's a constant steady dose. I'm unsure if that was recommended to me by my endocrinologist in terms of measuring my levels or if that plays a part in development. I also heard that levels fluctuate greatly with injectables, but I'm not sure the importance of that as estrogen naturally flucuates per month in all females anyway... Also I heard that the sensitivity of estrogen receptors might descrease after such a steady dose, but not sure of the validity of that.

I actually brought up the subject of gel after I stopped the patches, and I think my endocrinologist got gel confused with some sort of topical lotion. 

[KayXo]

I'd try to tough out my needle phobia if I knew for sure that injectables were a good choice.

Why wouldn't they be? They don't increase clotting risks and give higher estradiol levels relative to estrone. One poke in the butt once a week and that's it! Very convenient too.

I was recommended oral (sublingual) estradiol as it's a constant steady dose.

Oral is more or less steady. Sublingual is DEFINITELY not. Levels peak in the first hour, then quickly fall in the hours that follow. Sublingual needs to be taken several times daily to keep levels steadier as opposed to oral, where twice daily or even once daily suffices.

I also heard that levels fluctuate greatly with injectables

They do tend to peak the first couple of days but levels do not fluctuate to the extent that one experiences highs and lows psychologically (PMS symptoms), IF injections are done frequently enough. As far as I know, no transsexual woman has ever complained about this unless injections are too spaced out.

Also I heard that the sensitivity of estrogen receptors might descrease after such a steady dose, but not sure of the validity of that.

I tend to agree that desensitization could occur if levels are too constant. LhRh (GnrH) analogues (agonists) actually exploit this very principle by constantly stimulating cells, increasing output of GnRH and/or LhRh at first but eventually cells become desensitized and stop producing these hormones. So, injectables could be advantageous in that respect vs other forms that tend to yield steadier levels. However, I wouldn't go as far as cycling because that is another extreme that is likely to make us feel crappy. We certainly don't need that after everything else we have to go through.

[teeg]

Why wouldn't they be? They don't increase clotting risks and give higher estradiol levels relative to estrone. One poke in the butt once a week and that's it! Very convenient too.

They might very well be. I've not really spoken about them much with my endo, but definitely will later today. 

Oral is more or less steady. Sublingual is DEFINITELY not. Levels peak in the first hour, then quickly fall in the hours that follow. Sublingual needs to be taken several times daily to keep levels steadier as opposed to oral, where twice daily or even once daily suffices.

This sort of makes sense. I take my dose sublingually twice daily, but don't feel like they're doing much, not sure why.

They do tend to peak the first couple of days but levels do not fluctuate to the extent that one experiences highs and lows psychologically (PMS symptoms), IF injections are done frequently enough. As far as I know, no transsexual woman has ever complained about this unless injections are too spaced out.

The thing that scares me about this mainly is if they'd fluctuate down to the point where there's not much estrogen going around at all, perhaps towards the end of the month when I'm due for another shot.

[allisonsteph]

Patches are soooooooo a pain in the BUTT!  Can't you all ask for injectables instead (or even gel)

The patches were prescribed to me based upon my age and medical history. I am 45 years old and smoked cigarettes for 33 years. I stopped smoking the day I was prescribed my HRT. My doctor feels that given these factors, patches are the safest delivery method.

I've tried my most recent patch on my butt and that is not sticking at all, keeps getting stuck to my panties. I have emailed my doctor and asked if using tape over the patch is ok. Not fully understanding how transdermal patches work, I don't want to interfere with the delivery of this vital medication.

[KayXo]

The thing that scares me about this mainly is if they'd fluctuate down to the point where there's not much estrogen going around at all, perhaps towards the end of the month when I'm due for another shot.

Well, to avoid this, you need to inject more frequently (i.e. sooner). Depending on form of estrogen, injections are usually done every week (sometimes even less) to every 2 weeks. I think, in your case, Estradurin (polyestradiol phosphate) lasts much longer and estradiol is released VERY slowly so that this will lead to very steady doses (not good for desensitization) and lower levels over time because a little is released at a time. This might mean that higher doses for this particular estrogen are necessary compared to other forms like estradiol valerate where greater amounts are released faster thus giving higher levels and shorter duration of high levels.   

[EllieM]

Oral is more or less steady. Sublingual is DEFINITELY not. Levels peak in the first hour, then quickly fall in the hours that follow. Sublingual needs to be taken several times daily to keep levels steadier as opposed to oral, where twice daily or even once daily suffices.

It's not quite as simple as that. While a comparative study (http://www.ncbi.nlm.nih.gov/pubmed/9052581) agrees with you (more or less) about the rate of absorption, there are also the effects of a better estradiol:estrone ratio in the blood, as well as a reduction in hepatic stress. The reason for this is that the first pass through the liver doesn't happen and more of the estrogen circulates through the entire body before the liver gets it. Since the venous blood from the digestive system passes first through the liver before being recirculated, orally taken meds are pre-processed by the liver before the rest of the body gets it, so there is more stress on the liver and more of the estradiol gets "stepped on".
Bottom lining it for y'all:
The endo was happy with my last blood work. I'm happy with the way I feel and what is going on in my body.
Do some reading, then talk to your doc. That would be the one who went to med school and knows a bit more about how this stuff works.