Oral hormone replacement therapy refers to estrogen (and, when indicated, progesterone) taken as a daily pill. It is the oldest and most-studied route of HRT and remains a reasonable first-line option for many women.
When oral HRT is appropriate
- Healthy women within 10 years of menopause or under age 60.
- No personal history of VTE (deep vein thrombosis / pulmonary embolism).
- No uncontrolled hypertension or migraine with aura.
- Patient preference for once-daily dosing without skin adhesive.
When a patch is usually preferred
Transdermal estradiol bypasses first-pass hepatic metabolism and carries a lower VTE risk. Providers generally steer toward a patch when a patient has VTE risk factors, hypertriglyceridemia, gallbladder disease, or migraine with aura.
Progesterone pairing
Women with an intact uterus need progesterone to protect the endometrium. Micronized progesterone (Prometrium) is the current first-line pairing; medroxyprogesterone acetate (Provera) is the older synthetic option still seen in some regimens.