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
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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 | |