II. Indications
- Hot Flashes (Evanmist, Estrogel, Elestrin, Divigel)
-
Osteoporosis Prevention in postmenopausal women
- As of 2015, Estrogen is not recommended by ACOG or AAFP for chronic condition prevention
- Consider as an additional indication, when symptomatic management is desired
III. Advantages
- Studies suggest no increased Thromboembolism risk
IV. Efficacy: Osteoporosis Prevention (Estraderm or Estrasorb)
-
Placebo
- Hip BMD: 2.04% loss
- Lumbar Spine BMD: 2.49% loss
- Dose: 0.025 mg Estradiol patch
- Hip BMD: 0.26% gain
- Lumbar Spine BMD: 2.37% gain
- Dose: 0.05 mg Estradiol patch
- Hip BMD: 2.85% gain
- Lumbar Spine BMD: 4.09% gain
- Dose: 0.06 mg Estradiol patch
- Hip BMD: 3.05% gain
- Lumbar Spine BMD: 3.28% gain
- Dose: 0.1 mg Estradiol patch
- Hip BMD: 2.03% gain
- Lumbar Spine BMD: 4.70% gain
- References
V. Medications: Transdermal Combination Progesterone and Estrogen
- Indicated in Vasomotor Symptoms of Menopause with intact Uterus
- Climara Pro (17B-Estradiol-Levonorgestrel)
- Patch contains 0.045 mg Estradiol with 0.015 Levonorgestrel
- Patch applied weekly
- Combipatch or ActivellaPatch (17B-Estradiol-Norethindrone Acetate)
- Patch contains 0.05 mg Estradiol with 0.014 or 0.25 mg Norethindrone
- Patch applied twice weekly
VI. Medications: Transdermal Estradiol Patches, Gels and Sprays
- Indicated in Vasomotor Symptoms of Menopause status post Hysterectomy
- All preparations are bioidentical (Estradiol) and contain no Progesterone
- Preparations must be taken with Progesterone if Uterus intact (Endometrial Hyperplasia risk)
-
Estradiol transdermal patch (Climara, Minivelle, Vivelle-Dot)
- Apply 0.05 mg patch per week (or 0.025, 0.075 or 0.1 mg)
- Estasorb and Estraderm were older Estradiol 0.05 mg patches that have been discontinued
- Evamist Transdermal Spray
- Dosing: 1-3 sprays per day on inner Forearm to adjacent areas (not overlapping)
- Allow skin to dry for 30 minutes
- Estrogel (0.06% Estradiol)
- Elestrin Gel (0.06% Estradiol)
- Divigel (0.1% Estradiol)
- Foil packet delivers either 0.25 mg, 0.5 mg or 1.0 mg Estradiol per packet
- Apply packet contents to one upper thigh (5x7 inch area)
- Alternate to opposite side on subsequent application days
- Allow to dry for 1 hour before washing the area
Images: Related links to external sites (from Bing)
Related Studies
| evamist (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| EVAMIST 1.53 MG/SPRAY | $15.28 per ml | |
| elestrin (on 3/15/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ELESTRIN 0.06% GEL | $3.25 per gram | |
| divigel (on 9/3/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DIVIGEL 0.25 MG GEL PACKET | $5.41 each | |
| DIVIGEL 0.5 MG GEL PACKET | $5.37 each | |
| DIVIGEL 0.75 MG GEL PACKET | $5.41 each | |
| DIVIGEL 1 MG GEL PACKET | $5.40 per gram | |
| DIVIGEL 1.25 MG GEL PACKET | $4.31 per gram | |
| minivelle (on 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MINIVELLE 0.0375 MG PATCH | Generic | $6.51 each |
| MINIVELLE 0.05 MG PATCH | Generic | $6.54 each |
| MINIVELLE 0.075 MG PATCH | Generic | $6.43 each |
| MINIVELLE 0.1 MG PATCH | Generic | $6.87 each |
| climara pro (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| CLIMARA PRO PATCH | $56.42 each | |
| combipatch (on 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| COMBIPATCH 0.05-0.14 MG PTCH | $28.53 each | |
| COMBIPATCH 0.05-0.25 MG PTCH | $28.49 each | |
Ontology: Estraderm (C0720290)
| Concepts | Pharmacologic Substance (T121) , Hormone (T125) , Steroid (T110) |
| English | Estraderm, estraderm |
Ontology: Estrasorb (C1320235)
| Concepts | Steroid (T110) , Pharmacologic Substance (T121) , Hormone (T125) |
| SnomedCT | 406454003 |
| English | estrasorb, Estrasorb (product), Estrasorb |
| Spanish | Estrasorb (producto), Estrasorb |
Ontology: transdermal estrogen (C1831768)
| Definition (NCI) | A transdermal formulation containing the synthetic form of estradiol, the most potent, endogenously produced estrogen. Upon topical administration, estradiol diffuses through the cell membrane and binds to and activates specific intracellular estrogen receptors located on estrogen-responsive tissues, including the reproductive tract, breast, pituitary, hypothalamus, liver, and bone. The activated ligand-receptor complex binds to estrogen response elements on DNA and promotes the transcription of genes involved in the functioning of the female reproductive system and secondary sex characteristics. In addition, estradiol inhibits the pituitary secretion of the gonadotropins luteinizing hormone (LH) and follicle stimulating hormone (FSH) through a negative feedback mechanism. |
| Definition (PDQ) | A transdermal formulation containing the synthetic form of estradiol, the most potent, endogenously produced estrogen. Upon topical administration, estradiol diffuses through the cell membrane and binds to and activates specific intracellular estrogen receptors located on estrogen-responsive tissues, including the reproductive tract, breast, pituitary, hypothalamus, liver, and bone. The activated ligand-receptor complex binds to estrogen response elements on DNA and promotes the transcription of genes involved in the functioning of the female reproductive system and secondary sex characteristics. In addition, estradiol inhibits the pituitary secretion of the gonadotropins luteinizing hormone (LH) and follicle stimulating hormone (FSH) through a negative feedback mechanism. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=472200&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=472200&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C61440" NCI Thesaurus) |
| Concepts | Pharmacologic Substance (T121) , Steroid (T110) , Hormone (T125) |
| English | transdermal estrogen, Transdermal Estrogen, Estrodiol Gel |
