Estrace (Estradiol) Dosing Recommendations
The standard adult dose for transdermal estradiol patches is 50-100 μg/24 hours, while oral estradiol (Estrace) is typically dosed at 1-2 mg daily for most indications, with dosage adjusted based on symptom control and treatment goals. 1, 2
Adult Dosing Guidelines by Route of Administration
Oral Estradiol (Estrace)
- Initial dose: 1-2 mg daily 2
- Maintenance dose: Titrate to lowest effective dose that controls symptoms 2
- Administration: Cyclic (e.g., 3 weeks on, 1 week off) or continuous depending on indication 2
- Maximum dose:
Transdermal Estradiol (Patches)
- Initial dose: 50 μg/24 hours 1
- Maintenance dose: 50-100 μg/24 hours 1
- Maximum dose: 100-200 μg/24 hours 3, 1
- Application: Changed either twice weekly or weekly depending on specific product 1
Transdermal Estradiol (Gel)
- Standard dose: 0.5-1 mg daily applied to skin 1
Indication-Specific Dosing
For Menopausal Symptoms
- Start with lowest effective dose (oral: 1 mg daily; transdermal: 50 μg/24 hours) 1, 2
- Evaluate symptom control after 4-6 weeks 1
- If symptoms persist, increase dose incrementally (transdermal: to 75 μg/24 hours, then 100 μg/24 hours) 1
- For oral administration, adult dose range is 1-2 mg daily 2
For Hypogonadism or Primary Ovarian Failure
For Premature Ovarian Insufficiency (POI)
- Adult dose: Oral estradiol 2-4 mg daily or transdermal estradiol 100-200 μg/24 hours 3
- Adolescents with POI: Follow gradual dose escalation protocol (see table below) 3
Special Considerations
Progestin Addition
- Women with intact uterus must receive progestin along with estrogen 2
- Add progestin after at least 2 years of estrogen therapy in adolescents or when breakthrough bleeding occurs 3
- Standard progestin options:
Adolescent Dosing for Pubertal Induction
Gradual dose escalation over 2-3 years is recommended 3:
| Time after start | Transdermal Estradiol | Oral Estradiol |
|---|---|---|
| 0-6 months | 1/8 patch weekly or 1/4 patch for 3-4 days/week | 0.5 mg every other day |
| 6-12 months | 1/4 patch weekly | 0.5 mg every other day |
| 12-18 months | 1/2 patch for 3-4 days, 1/4 patch remaining days | 0.5 mg daily |
| 18-24 months | 1/2 patch weekly | 0.5 mg and 1 mg alternating days |
| >24 months | Full patch weekly | 1 mg daily |
Monitoring and Dose Adjustments
- Reevaluate treatment necessity every 3-6 months 2
- Aim for the lowest effective dose for the shortest duration consistent with treatment goals 2
- For women with a uterus, perform adequate diagnostic measures (e.g., endometrial sampling) for unexplained persistent or recurring vaginal bleeding 2
- Consider serum estradiol monitoring, as approximately 25% of women using the highest licensed transdermal dose may have subtherapeutic levels (<200 pmol/L) 4
Contraindications
- Breast cancer history 1
- Estrogen-dependent neoplasia 1
- Undiagnosed vaginal bleeding 1
- Active thromboembolic disorders 1
Route Selection Considerations
- Transdermal administration is preferred for women with cardiovascular risk factors due to lower risk of venous thromboembolism 1
- Oral administration undergoes first-pass liver metabolism, which may increase certain risks 1
- Vaginal administration results in significantly higher serum and endometrial estradiol levels compared to oral administration at the same dose, requiring much lower doses if this route is used 5