Continuous Estrogen Replacement

1. See Also
   1. Menopause
   2. Estrogen Replacement
   3. Sequential Estrogen Replacement
   4. Vaginal Estrogen
   5. Transdermal Estrogen
2. Indications
   1. Estrogen Replacement in Late post-Menopause
3. Preparations: Estrogen with Progesterone Combination
   1. Two pill regimen
      1. Estrogen taken daily
      2. Progestin taken daily
   2. Combination Pill
      1. Activella (Estradiol + Norethindrone)
      2. FemHRT (Ethinyl Estradiol + Norethindrone)
      3. Premphase (Conjugated Estrogens + Medroxyprogesterone)
      4. Prempro (Conjugated Estrogens + Medroxyprogesterone)
   3. Low-dose Combination
      1. Angeliq (Estradiol + Drospirenone)
   4. Patch
      1. Climara Pro (Estradiol + Levonorgestrel)
      2. Combipatch (Estradiol + Norethindrone)
4. Preparations: Estrogen Options
   1. See Sequential Estrogen Replacement
   2. Premarin (Conjugated Equine Estrogen)
      1. Dose: 0.625 mg daily
      2. Ranges 0.3 to 1.25 mg per day
   3. Estrace (17B-Estradiol)
      1. Dose 1 mg daily
      2. Ranges 0.5 to 2 mg per day
5. Preparations: Progestin Options
   1. Provera 2.5 mg qd OR
   2. Norethindrone 0.35 mg qd OR
   3. Micronized Progesterone 100 mg qd
6. Advantages: Compared with Sequential Estrogen Replacement
   1. Decreased uterine bleeding
7. Adverse effects
   1. Decreased Libido: Consider Estratest instead Premarin
      1. Estrogen 1.25
      2. Methyltestosterone 2.5
   2. Recurrent Vaginal Bleeding
      1. Rule-out Endometrial Cancer with Endometrial Biopsy
      2. Change Estrogen Replacement regimen
         1. Estradiol 1 mg qd and
         2. Norethindrone Acetate (NETA) 0.1 to 0.5 mg qd
            1. NETA 0.1 mg: No bleeding in 79% at 1 year
            2. NETA 0.25 mg: No bleeding in 84% at 1 year
            3. NETA 0.5 mg: No bleeding in 90% at 1 year
      3. References
         1. Archer (1999) Obstet Gynecol 94:323-9