MANAGING MENOPAUSAL SYMPTOMS AND THE ROLE OF HORMONE REPLACEMENT THERAPY
The Skin as a Mechanism to Deliver Hormone Replacement Therapy (HRT) and as a Beneficiary Dr Charles Easmon, Editor
Women over 45 years presenting with menopausal symptoms are diagnosed with perimenopause or menopause based on their symptoms alone, without confirmatory laboratory tests1.
The skin is an excellent way for women to acquire their HRT on a daily basis. It is lower risk than oral HRT and has a higher chance of continued adherence
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HE SKIN is the largest organ of the body2. In adults, it has a surface area (depending on size) of at least 2 square metres and, if fully laid out, might fill the space of one tiger skin and a polar bear combined. It has layers including the outer epidermis, the dermis and the subcutaneous layer. It protects and nourishes and, of course, it needs to be protected and nourished. Archaeological digs of human and pre-human habitation seem to indicate that the use of balms, poultices and salves goes back far into history3. From the earliest days, it has been known that therapy can be given through the skin4. In more recent times great excitement and investment was put into a failed technological promise – vaccines via the skin. The company was called Powderject5 and the idea was that through a series of pins on a patch attached to a gun applicator, the vaccine would be delivered
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into the skin and hence prevent the need for a subcutaneous or intramuscular injection. Sadly, this gave rise to some controversy and the company got bought out. However, the skin as a delivery mechanism for substances other than vaccines is a well-studied and proven model of therapeutic drug delivery.
The Skin as a Safe Vehicle for HRT Adherence has been the buzzword in medicine over compliance for some years now. As a general practitioner, you need your patients to use your recommended therapies willingly for their own benefit rather than feeling compelled to do so. For a woman to apply a medication to her skin, as part of her daily routine is easy and studies show a higher uptake than the requirement for daily oral tablets. Skin based HRT can also use lower doses of oestrogen and a