Do not Rotate Topical BHRT Sites by Joseph J Collins, RN, ND
Now here is an interesting practice: Women and men who prescribed topical hormone creams or gels are told to rotate the site that they rub the cream into. They are told that they should rub it on the right arm one day, the left arm the next, then right leg, then left leg, etc. It reminds me of that gambling game in which you put a pebble under one of many cups and switch them around while the person watching the switches tried to guess where it is. The rotation of site is a remnant of the problem women and men had with hormone patches – they started to get rashes and reactions to the glues in the patch. So, rotation of hormone patches due to problems with adhesive agent somehow has resulted in rotation of hormone creams and gels. Those who support rotation of application say that they do so because the hormones will build up if given in one area and saturate the tissue.
In fact, the science tells us that topical application creates a temporary reservoir that allows for continuous release of hormones. The reservoir is refilled every morning. The hormones diffuse out into the body providing gradual continuous release. See page 78 in Discover Your Menopause Type.
The “build up” theory ignores one important point – we are not made of wood.
Applying hormones to living tissue that has a regular blood supply is not “like applying furniture polish that builds up” (yes, that is how it was explained). This need to rotate sites everyday becomes even harder to accept when we see that that bioidentical estradiol is successfully delivered in a weekly patch. Even more, bioidentical estradiol is delivered in a vaginal ring that stays in place for 90 days. In both of those cases, the tissue adjacent to the hormone patch or ring act as a conduit and temporary reservoir for hormones that allows for continuous release of hormones. But beyond the fact that rotation of sites is unnecessary, there is a reason why it should not be done – because it encourages the application of hormones above the umbilicus (belly button) – which has its potential risks – as discussed below.
Women who have been asked to apply hormones once a day below their umbilicus achieve stable hormones levels more quickly, evidenced by resolution of symptoms.