From the Guidelines
A once-a-week hormone replacement estrogen patch is recommended for post-pubertal adolescent/young adult childhood cancer survivors with premature ovarian insufficiency (POI), with a dosage of 50 to 100 μg 24 hourly, to be changed twice a week or weekly, as per the specific instructions provided for each brand 1.
Key Considerations
- The patch should be applied to clean, dry skin on the lower abdomen, buttocks, or hip, rotating application sites to prevent skin irritation.
- If an intact uterus is present, progesterone (either cyclically or continuously) should be added to protect against endometrial cancer.
- The dose of estrogen should be adjusted according to each woman's tolerance and feeling of wellbeing.
- Combined 17βE and progestin patches are recommended as a first choice, with medroxyprogesterone (MP) being the first choice among progestins due to its lower risk of cardiovascular disease and venous thromboembolism 1.
Potential Risks and Benefits
- Potential risks include blood clots, stroke, and breast cancer, particularly in patients with relevant risk factors.
- Benefits include improved symptoms of menopause, prevention of osteoporosis, and potential improvement in libido and sexual function.
Monitoring and Follow-up
- Regular follow-up is essential to monitor the patient's response to treatment and adjust the dose as needed.
- Annual imaging and breast self-examination are recommended for patients on hormone replacement therapy, especially those with a high risk of breast cancer 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Hormone Replacement Estrogen Patch
- A once a week hormone replacement estrogen patch is a form of menopausal hormone therapy (MHT) that can be used to alleviate symptoms of menopause 2.
- The use of unopposed estrogen therapy, however, may increase the risk of endometrial hyperplasia and carcinoma in women with an intact uterus 2, 3.
- The addition of progestogen to estrogen therapy can help prevent the development of endometrial hyperplasia and improve adherence to therapy 2, 4, 5.
Endometrial Safety
- Transdermal continuous combined hormone replacement therapy with estrogen and progestogen has been shown to provide adequate long-term endometrial protection in postmenopausal women 4.
- A systematic review of 84 RCTs found that most progestogens used in combined MHT regimens were effective in preventing endometrial hyperplasia and malignancy, but study quality varied 5.
- The use of progesterone versus progestins in MHT may have a similar or possibly better risk profile for endometrial outcomes, venous thromboembolism, and cardiovascular outcomes 6.
Types of Estrogen and Progestogen
- Estradiol (E2) and progesterone (P4) are commonly used in MHT, and studies have compared their effects to those of other estrogens and progestins 6.
- E2-based MHT may have a similar or possibly better risk profile for venous thromboembolism and cardiovascular outcomes compared to conjugated equine estrogens (CEE)-based MHT 6.
- P4-based MHT may have a similar or possibly better risk profile for breast cancer and cardiovascular outcomes compared to progestin-based MHT 6.