The key difference is how oestrogen enters your bloodstream, and this matters more than it might initially seem.

Oral tablets are swallowed and absorbed through the gut, passing through the liver before entering general circulation. This “first-pass” liver metabolism increases certain proteins, including clotting factors and triglycerides. As a result, oral oestrogen carries a small increase in the risk of blood clots (deep vein thrombosis or pulmonary embolism) — a risk that is absent with transdermal forms.

Transdermal oestrogen — patches, gels, or sprays — delivers oestrogen directly through the skin into the bloodstream, bypassing the liver entirely. Transdermal oestrogen does not increase clotting risk. This makes it the preferred option for most women, and particularly for women who are overweight, have cardiovascular risk factors, have a history of migraines with aura, or have any prior history of blood clots.

In India, oral oestrogen tablets are more widely stocked at standard pharmacies. Patches and gels are available but less commonly, and you may need to ask your pharmacist to order them. They are worth seeking out.

One important note: if you have an intact uterus (have not had a hysterectomy), you will need progesterone alongside the oestrogen, whichever form you use. Taking oestrogen without progesterone thickens the uterine lining and increases the risk of endometrial cancer. Progesterone tablets or a hormonal intrauterine device are the most commonly used options. Your gynaecologist will prescribe appropriately based on your situation.