Best location for Estradiol Patches?

[KayXo]

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.

Patches, gels, creams, pellets, injectables all deliver estradiol directly to the blood (similar to genetic women whose ovaries secrete the hormone directly into the blood), thus bypassing the first pass liver effect where coagulation factors are affected and increase clotting risks. One is not safer than the other. They are all equally safe, regardless of levels. This was confirmed by studies which reviewed the effect of high doses of patches and injectables in prostate cancer patients on coagulation. No effect was observed. It was deemed safe. Despite the fact that levels and doses were quite high.

Non-oral is the safest and that includes more than just patch.

[KayXo]

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".

I agree that with sublingual, more estradiol goes directly into the blood without having to first pass through the liver before reaching circulation BUT

1) with sublingual, there's always the risk of swallowing so that still some estradiol might end up going through the liver
2) sublingual gives a better ratio of estradiol:estrone than oral at first but after a few hours, estrone levels end up surpassing those of estradiol (estrone already starts to rise within 10 minutes of sublingual administration), perhaps due to enzymatic conversion in nearby tissues to mouth (as suspected by authors in a study) and due to the swallowing of estradiol which gets converted to estrone in the liver
3) the issue is not so much liver stress as even high doses of oral bio-identical estradiol (or even ethinyl, premarin as confirmed by Harry Benjamin) don't appear to affect liver function (AST, ALT, etc) but much more, clotting factors that are triggered by estrogen in the liver and increase clotting risk. Even then, if one compares hepatic effects of bio-identicals vs estrogens in birth control pills, one quickly realizes that clotting risks should only be very slightly increased by bio-identical estradiol.

Overall, sublingual is not so much beneficial for health reasons but more for the increased levels of estradiol it yields over time compared to oral. Though quite inconvenient compared to oral (you just swallow it) and more likely to cause PMS due to fluctuations although I've never known anyone complain of this (including me), despite taking pills even twice daily. But, I still like to advise anyone taking it sublingually to take it more frequently, just in case.  

I personally prefer sublingual over oral and non-oral over either because it's just a more natural way to get hormones and somehow, I think the body must probably respond better when you mimic nature. Pure speculation though.

[EllieM]

I personally prefer sublingual over oral and non-oral over either because it's just a more natural way to get hormones and somehow, I think the body must probably respond better when you mimic nature. Pure speculation though.

Me too. I'm hoping to switch to patches, but up here in the frozen hinterlands, they cost 3x as much, so in the interim I'm doing the sublingual thing TID. This all would have been so much easier if I had just been born female...

[amZo]

I was putting mine on my back shoulder or upper chest below the collar bone, sometimes on my upper outer arm. I used clear tape to keep them down.

[allisonsteph]

My doctor replied to my email. He said he does not recommend using tape to hold the patches in place. He did say that placing them on the shoulder would be fine.

[Pinkkatie]

My doctor replied to my email. He said he does not recommend using tape to hold the patches in place. He did say that placing them on the shoulder would be fine.

My doctor actually suggested that I use surgical tape to hold them in place especially in the shower.

[Jenna Marie]

teeg : Sounds like you might have the generic version of Climara. I did too at first - huge, thick, pancake-like thing that doesn't stick well. Vivelle is about the size of a dime (says their marketing), thin, clear, and stays stuck MUCH better. I only have to wear one at a time, but I could probably fit three in the space taken up by the old generic! Vivelle is more expensive, even with insurance, but so worth it to me.

Oh, and my doctor also recommended surgical tape over the top, as did many many women on the hysterectomy site I occasionally frequent (b/c they're taking the same meds I am in similar doses). The medicine is literally administered via the adhesive - meaning through the *bottom* of the patch - so nothing done to the top of the patch will affect absorption. And the manufacturers actually do know that it will fold/bend a bit; my guess is that if someone ever managed to get it so that the patch *never* flexed, they'd get a bit more estrogen than intended, b/c they're designed to deliver the intended dose while also taking into account that human skin is not a 100% still and flat medium.


(I haaaaate needles.  Never ever. Besides, I'm happy with Vivelle; no complaints at all. It's also packaged for cis women but intended to be changed twice a week, so no fuss from my insurance about using my patches in an unexpected way, either. They didn't like that I was going through double the amount of generic per month as they expected.) 

[FrancisAnn]

I love the small dot patches that last 3 1/2 days. They stick like glue & you never even notice they are on your body. For myself just below the panty line & I rotate sides. I just love them, so easy.