Advantages and disadvantages of different dosage forms for BHRT
Buccal tablets:
  
Advantages:
Disadvantages:
• Rapid dissolving (much faster than troche)
• Fast onset of action
• Hormones released into blood exactly as
   formulated
• Avoids first pass effects of liver
• May have less blood clotting risk than with
   oral estrogens		 • May require multiple doses during the
   day
   
Capsules  
Advantages:
Disadvantages:
• Convenient
• Progesterone slow release or oil filled
   capsules produces a sedative or
   hypnotic effect.		 • First pass effects of liver.
• May increase the risk of blood clots with
   estrogens.
• May require multiple doses during
   the day.
   
Troches Sublingual (under the tongue)  
Advantages:
Disadvantages:
• Fast onset of action.
• Hormones released into the blood exactly as
   formulated.
• Avoid first pass effects of liver.
• May have less blood clotting risk than with
   oral estrogens.		 • Taste
• Dissolves too slow
• May require multiple doses during
   the day.
• Cannot use saliva testing.
   
Transdermal Creams or Gels  
Advantages:
Disadvantages:
• Hormones released into the blood exactly as
   formulated.
• Avoid first pass effects of liver.
• May have less blood clotting risk than oral
   estrogens.
• Continuous release from body fat.		 • Slower onset of action.
• Requires daily application.
• Extremely thin women may require more
   frequent dosing.
   
Vaginal Creams, Gels and Suppositories  
Advantages:
Disadvantages:
• Hormones released into the blood exactly
   as formulated.
• Avoid first pass effects of liver.
• May have less blood clotting risk than
   oral estrogens
• Can have a topical effect on vaginal tissues.		 • Not as convenient.
• Messy
• Concerns of inadvertent dosing partner when
   using estrogens.
   
Injectables  
Advantages:
Disadvantages:
• Avoids daily dosing
• Convenient
• Avoids first pass effects of liver		 • Requires an injection
• Extremely thin women may require more
   frequent dosing.
 
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