What is the recommended administration and dosing for an Estradiol (estrogen) patch?

From the Guidelines

Estradiol patches should be administered transdermally via patches releasing 50 to 100 μg 24 hourly, to be changed twice a week or weekly according to the specific instructions provided for each brand, as recommended for post-pubertal adolescent/young adult childhood cancer survivors with premature ovarian insufficiency 1. The administration and dosing of Estradiol patches can vary depending on the individual's needs and medical history.

• The patches are typically applied to clean, dry, hairless skin on the lower abdomen or upper buttocks.
• The dose of 17βE should be adjusted according to each woman's tolerance and feeling of wellbeing 1.
• Combined 17βE and progestin patches are recommended as a first choice, with both sequential combined and continuous combined patches available, inducing or avoiding withdrawal bleeding as per patient's request 1.
• If combined 17βE and progestin patches are not available, transdermal 17βE can be administered continuously and oral (or vaginal) progestin can be added cyclically for 12–14 every 28 days 1.
• The choice of progestin should be guided by the patient's individual needs and medical history, with medroxyprogesterone acetate (MPA) being the only progestin for which available evidence demonstrates full effectiveness in inducing secretory endometrium together with a full replacement dose of estrogen when used regularly 1.
• However, natural micronized progesterone (MP) has been shown to have a favorable profile in terms of minimizing hormonal-related cardiovascular risks and having a neutral or beneficial effect on blood pressure 1.
• The decision to stop or continue HRT must be weighed on individual risks, family history, personal feelings, and relevance of menopausal symptoms, with lower post-menopausal doses of HRT having been associated with an advantageous risks-benefit ratio 1.

From the FDA Drug Label

When estrogen is prescribed for a postmenopausal woman with a uterus, a progestin should also be initiated to reduce the risk of endometrial cancer. For treatment of moderate to severe vasomotor symptoms, vulval and vaginal atrophy associated with the menopause, the lowest dose and regimen that will control symptoms should be chosen and medication should be discontinued as promptly as possible. The usual initial dosage range is 1 to 2 mg daily of estradiol adjusted as necessary to control presenting symptoms. Administration should be cyclic (e.g., 3 weeks on and 1 week off).

The recommended administration and dosing for an Estradiol patch is to start at the lowest dose for the indication, with a usual initial dosage range of 1 to 2 mg daily of estradiol, adjusted as necessary to control presenting symptoms. The administration should be cyclic (e.g., 3 weeks on and 1 week off) 2.

• The minimal effective dose for maintenance therapy should be determined by titration.
• Patients should be reevaluated periodically as clinically appropriate (e.g., 3-month to 6-month intervals) to determine if treatment is still necessary.

From the Research

Administration and Dosing of Estradiol Patch

The recommended administration and dosing for an Estradiol (estrogen) patch can be summarized as follows:

• The patch is typically applied twice weekly, with a 3-week application period followed by a 1-week period without the patch 3.
• The patch releases 50 micrograms of estradiol per day, which is effective in relieving climacteric symptoms in postmenopausal women 3, 4.
• Alternative dosing regimens include a once weekly application of a 7-day estradiol transdermal patch, with daily release rates of 25,50, or 75 micrograms of estradiol 5.
• The patch can also be applied continuously for 12 weeks, without progestin opposition, with release rates of 25 or 37.5 micrograms of estradiol per day 6.

Efficacy and Tolerability

The efficacy and tolerability of the estradiol patch can be summarized as follows:

• The patch is effective in relieving climacteric symptoms, including hot flushes and night sweats, in postmenopausal women 3, 6, 7.
• The patch is well tolerated, with low rates of adverse experiences and skin irritation 3, 6, 7.
• The patch induces increases in mean estradiol, estrone, and estrone sulfate plasma levels, as expected 4, 7.

Key Findings

Key findings from the studies include:

• The estradiol patch is therapeutically equivalent to a conventional liquid reservoir patch in relieving climacteric symptoms 3.
• The patch is better tolerated by the skin than a liquid reservoir patch, with significant differences in local skin reactions 3.
• The once weekly application of a 7-day estradiol transdermal patch is effective and well tolerated, with good pharmacokinetic performance and low rates of adverse experiences 5.