A 54 year old lady who has smoked for 25 years is on estradiol and progesterone for menopause. Can she take oral estradiol, or is estradiol patch a better choice? Also, is there any contradiction for HT for smokers?


We, of course, encourage smoking cessation for all. However, being a smoker is NOT a contraindication for Hormone therapy for smokers like it is for women over age 35 who want hormonal contraception.

Hormone therapy in smokers can be given transdermally or orally. Transdermal is more recommended if the patient has a history of DVT or high Triglycerides, GI issues or high blood pressure. If she has a uterus, both estrogen AND progesterone/progestin are needed with hormone therapy.

There are many menopausal treatment options. Sometimes smokers metabolize estrogen faster and may not be able to use ultra low doses of estrogen if they have marked hot flashes.

All My Best,
Speaking of Women’s Health Nurse

April 2, 2019 at 9:23am