Key Takeaways
HRT creams and pills are absorbed differently in the body
Dr. Green explained that oral HRT passes through the liver first, whereas creams are directly absorbed through the skin. Because transdermal methods bypass metabolization by the liver, they carry a more favorable safety profile with regard to blood clots. However, Dr. Green noted that the overall risk difference between the two is small, since the underlying risks are already low for appropriately screened patients.
Progesterone cream only protects the uterine lining when it's compounded and dosed correctly
Dr. Green explained that Winona maintains strict quality control over its compounding pharmacies specifically to ensure consistent dosing and potency of the progesterone cream for adequate uterine protection. He cautioned that not all compounded or over-the-counter progesterone products meet that standard, which can leave the uterus unprotected.
Bioidentical progesterone appears safer than the synthetic progestins linked to breast cancer risk
Dr. Green clarified that older research linking HRT to increased breast cancer risk used a synthetic progestin, not the bioidentical micronized progesterone widely prescribed today. Early data suggests that bioidentical micronized progesterone may not carry the same risk. However, research is still emerging.
For persistent vaginal dryness that does not fully improve with systemic HRT, Dr. Green noted that vaginal estrogen cream can be used alongside a patch, pill, or body cream. Because the cream works locally on the tissues where it is applied, there is minimal systemic absorption, making it safe to use on its own or as a complement to systemic hormone therapy.
Hormone lab tests don't guide how HRT is dosed
Dr. Green explained that hormone levels fluctuate throughout the day, so a single blood test doesn't fully reflect what's happening in the body hormonally. Winona adjusts treatment based on symptoms, not lab values, the same approach recommended by the American College of Obstetricians and Gynecologists (ACOG) and Menopause Society.
