Good grief, sublingual works, shhh.
Sublingual is the same mode of absorbtion as supposatories,
you'll tell me that doesn't work either!
Estrogen that is absorbed through the stomach gets
matabolised differently than the one that's absorbed directly
into the bloodstream. This processing creates more by products,
including those linked to DVT. But, unless taking non bio identical
estrogens and dosages, this risk is rather low. The liver itself
is usually not the issue unless it is already severely impaired.
The reason they don't promote one mode over another often
has more to do with FDA approval than anything else.
Another mode of absorbtion will need a whole new protocol
and tests. Since estrogen is basically a cheap generic, there's not much money
in getting it certified for something else than what already works.
Anyone who's taken estrogen sublingually properly will immediatly feel
an immediate strong effect that you feel as it is a stimulant and
a vaso dilatator.
If you swallow the pill, you don't get that since it will be absorbed slower.
The reason pills are pushed over sublingual is first because that's how
they were tested and FDA approval for another means is expensive;
secondly, the reason they were tested that way was because
there is much better compliance for pill taking than taking
a pill and waiting 10 minutes that it will dissolve. Compliance
is a big deal, since you don't get all the benefit of the medication
if you don't take it.
The reason sublingual works is because micronised estrogen in a binder was a convenient
way of packaging estrogen and micronised particles can be absorbed by highly vascular tissues
like under the tongue and the anus.
Micronised progesterone is the same, except its not very robust so they've got to suspend it in oil to give some a chance to be absorbed before being broken down by the stomach acids (that's why
the content of the capsules are rather high).
(since its in oil, sublingual doesn't quite work since you'll have trouble not swallowing it). But, the capsules do work as suppositories, which is not always advertised on the capsules. Again, FDA would require testing for this new method, why bother for something so cheap with such a low margin of profit.
