From the Guidelines
A typical starting dose of topical BiEst/progesterone cream for a 46-year-old postmenopausal woman is 0.5-1 mg of BiEst (containing 80% estriol and 20% estradiol) combined with 20-40 mg of progesterone, applied once daily to thin-skinned areas such as the inner wrists, inner arms, or inner thighs. This dosage aims to relieve menopausal symptoms while minimizing risks associated with hormone therapy, as suggested by the most recent and highest quality study available 1. The BiEst formulation provides a more balanced estrogen approach than estradiol alone, with estriol offering milder effects. The progesterone component is essential for women with an intact uterus to protect against endometrial hyperplasia.
Key Considerations
- Treatment should start at the lower dose range and be adjusted based on symptom response and side effects.
- Regular follow-up with a healthcare provider every 3-6 months is important to monitor effectiveness and safety, with periodic hormone level testing as needed.
- Individual dosing may vary based on symptom severity, body weight, and hormone levels.
- The use of combined 17βE and progestin patches is recommended as a first choice, but in the context of topical BiEst/progesterone cream, the focus is on the specific formulation and dosage of BiEst and progesterone.
Evidence Base
The recommendation is based on the most recent study available 1, which provides guidance on hormonal replacement therapy in adolescents and young women with chemo- or radio-induced premature ovarian insufficiency. Although this study does not directly address postmenopausal women, its discussion on hormone therapy dosages and formulations informs the approach to topical BiEst/progesterone cream dosing. Earlier studies and guidelines, such as those from 2002 1 and 2013 1, provide context but are superseded by the more recent evidence.
Safety and Efficacy
The chosen dosage and formulation aim to balance the relief of menopausal symptoms with the minimization of risks associated with hormone therapy. Regular monitoring and adjustments as needed are crucial to ensure the therapy remains effective and safe for the patient. The progesterone component is particularly important for protecting against endometrial hyperplasia in women with an intact uterus, highlighting the need for careful consideration of the patient's individual health status and medical history.
From the Research
Topical Biest/Progesterone Cream Dosage
- The provided studies do not specifically mention the normal dose of topical biest/progesterone cream for a 46-year-old postmenopausal woman.
- However, the studies discuss the importance of hormone replacement therapy (HRT) in managing menopausal symptoms, including the use of estrogen and progesterone 2, 3, 4, 5, 6.
- The studies emphasize the need for individualized treatment, considering factors such as age, time since menopause, and comorbidity status 5, 6.
- While the studies do not provide specific dosage information for topical biest/progesterone cream, they highlight the importance of weighing the benefits and risks of HRT and considering patient-specific factors when prescribing treatment 2, 5, 6.
Hormone Replacement Therapy (HRT)
- HRT is an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause 5.
- The Women's Health Initiative (WHI) hormone therapy trials clarified the benefits and risks of HRT, including how the results differed by age 5.
- The studies suggest that HRT may have a more favorable effect on coronary heart disease and all-cause mortality in younger women, close to menopause, than in women more than a decade past menopause 5, 6.