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Transdermal Estrogen

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Transdermal Estrogen, Estraderm, Estrasorb, Transdermal Estradiol, Evamist, Estrogel, Elestrin, Divigel, Vivelle Dot, Minivelle, Climara Pro, Combipatch

  • See Also
  1. Menopause
  2. Estrogen Replacement
  3. Continuous Estrogen Replacement
  4. Sequential Estrogen Replacement
  5. Vaginal Estrogen
  • Indications
  1. Hot Flashes (Evanmist, Estrogel, Elestrin, Divigel)
  2. Osteoporosis Prevention in postmenopausal women
    1. As of 2015, Estrogen is not recommended by ACOG or AAFP for chronic condition prevention
    2. Consider as an additional indication, when symptomatic management is desired
  • Advantages
  1. Studies suggest no increased Thromboembolism risk
    1. Scarabin (2003) Lancet 362:428-32 [PubMed]
  1. Placebo
    1. Hip BMD: 2.04% loss
    2. Lumbar Spine BMD: 2.49% loss
  2. Dose: 0.025 mg Estradiol patch
    1. Hip BMD: 0.26% gain
    2. Lumbar Spine BMD: 2.37% gain
  3. Dose: 0.05 mg Estradiol patch
    1. Hip BMD: 2.85% gain
    2. Lumbar Spine BMD: 4.09% gain
  4. Dose: 0.06 mg Estradiol patch
    1. Hip BMD: 3.05% gain
    2. Lumbar Spine BMD: 3.28% gain
  5. Dose: 0.1 mg Estradiol patch
    1. Hip BMD: 2.03% gain
    2. Lumbar Spine BMD: 4.70% gain
  6. References
    1. Weiss (1999) Obstet Gynecol 94:330-6 [PubMed]
  1. Indicated in Vasomotor Symptoms of Menopause with intact Uterus
  2. Climara Pro (17B-Estradiol-Levonorgestrel)
    1. Patch contains 0.045 mg Estradiol with 0.015 Levonorgestrel
    2. Patch applied weekly
  3. Combipatch or ActivellaPatch (17B-Estradiol-Norethindrone Acetate)
    1. Patch contains 0.05 mg Estradiol with 0.014 or 0.25 mg Norethindrone
    2. Patch applied twice weekly
  • Medications
  • Transdermal Estradiol Patches, Gels and Sprays
  1. Indicated in Vasomotor Symptoms of Menopause status post Hysterectomy
  2. All preparations are bioidentical (Estradiol) and contain no Progesterone
  3. Preparations must be taken with Progesterone if Uterus intact (Endometrial Hyperplasia risk)
    1. See Continuous Estrogen Replacement
    2. See Sequential Estrogen Replacement
  4. Estradiol transdermal patch (Climara, Minivelle, Vivelle-Dot)
    1. Apply 0.05 mg patch per week (or 0.025, 0.075 or 0.1 mg)
    2. Estasorb and Estraderm were older Estradiol 0.05 mg patches that have been discontinued
  5. Evamist Transdermal Spray
    1. Dosing: 1-3 sprays per day on inner Forearm to adjacent areas (not overlapping)
    2. Allow skin to dry for 30 minutes
  6. Estrogel (0.06% Estradiol)
    1. Pump delivers 0.75 mg of Estradiol (64 actuations per device)
    2. Apply gel from one wrist to the Shoulder, spreading thinly
  7. Elestrin Gel (0.06% Estradiol)
    1. Pump delivers 0.52 mg of Estradiol (100 actuations per device)
    2. Apply to upper arm and Shoulder
    3. Allow to dry for 2 hours before immersing in water (e.g. swimming)
  8. Divigel (0.1% Estradiol)
    1. Foil packet delivers either 0.25 mg, 0.5 mg or 1.0 mg Estradiol per packet
    2. Apply packet contents to one upper thigh (5x7 inch area)
    3. Alternate to opposite side on subsequent application days
    4. Allow to dry for 1 hour before washing the area
  • References
  1. Chang (2023) Am Fam Physician 108(1): 28-39 [PubMed]
  2. Filer (1994) Am Fam Physician 49(7):1639-42 [PubMed]
  3. Hill (2016) Am Fam Physician 94(11): 884-9 [PubMed]