From the Guidelines
The use of a once-a-week estrogen patch is not recommended for the primary prevention of chronic conditions in postmenopausal women due to the associated harms, including an increased risk of stroke, gallbladder disease, and urinary incontinence, as well as a small increase in the risk for deep vein thrombosis (DVT) 1. When considering hormone replacement therapy for menopausal symptoms, a once-a-week estrogen patch may be an option, but it should be used with caution and under the guidance of a healthcare provider. The patch is available in various dosages, ranging from 0.025 mg to 0.1 mg per day, and is typically applied to clean, dry skin on the lower abdomen, buttocks, or hip, and replaced every 7 days. Some key points to consider when using a once-a-week estrogen patch include:
- The patch offers advantages over oral estrogen, including bypassing the liver and providing steady hormone levels, which may reduce the risk of clotting 1.
- Side effects may include skin irritation at the application site, breast tenderness, headaches, and nausea.
- For those using estrogen for menopausal symptoms who still have a uterus, a progestogen is typically also prescribed to protect the uterine lining.
- Regular follow-up with a healthcare provider is essential to monitor effectiveness and adjust dosing as needed. It is essential to weigh the benefits and harms of hormone replacement therapy and discuss individual risks and benefits with a healthcare provider before starting treatment 1.
From the Research
Estrogen Patch Application
- The once-a-week estrogen patch has been studied for its efficacy in relieving climacteric symptoms in postmenopausal women 2, 3.
- A study comparing the clinical efficacy and plasma estrogen levels of once and twice a week transdermal estradiol delivery systems found that both patches had similar clinical efficacy and were well tolerated 3.
- The daily number of hot flushes significantly decreased in all groups, with a decrease of 78% with the 25 micrograms E2 patch, 93% with the 50 micrograms E2 patch, and 97% with the twice-weekly parent patch 2.
Efficacy and Safety
- The efficacy of low-dose estrogen therapy for menopausal women has been reviewed, with studies showing a decrease in hot flashes of 60%-70% with half-strength estrogens, compared to 80%-90% with standard dosing 4.
- Transdermal estradiol has been shown to increase bone mineral density and decrease the risk of cardiovascular disease compared to oral estrogen therapy 5.
- The smallest available estradiol transdermal patch, Minivelle, has been approved for the prevention of postmenopausal osteoporosis and provides the lowest effective dose of estrogen 5.
Hormonal Effects
- Estradiol variability and progesterone levels have been found to be associated with perimenopausal depressive symptomatology, with greater estradiol variability and absence of progesterone levels consistent with ovulation associated with higher levels of depressive symptoms 6.
- The underlying hormonal dysregulation of the menopause transition, involving changes in both estradiol and progesterone, may drive perimenopausal mood instability 6.