Does Estraderm MX (estradiol) contain progesterone?

Estraderm MX Does Not Contain Progesterone

Estraderm MX contains only estradiol (17β-estradiol) and does not contain progesterone. 1 It is a transdermal estrogen-only hormone replacement therapy delivered via a matrix patch system.

Composition of Estraderm MX

Estraderm MX is a matrix patch that delivers estradiol at doses of 0.05 mg/day (Estraderm MX 50) or 0.10 mg/day (Estraderm MX 100) 1. The patch contains:

• Active ingredient: Estradiol (17β-estradiol)
• Delivery system: Matrix patch technology
• Application: Applied twice weekly to the skin (typically buttocks)

Clinical Implications

The estrogen-only nature of Estraderm MX has important clinical implications:

For Women with Intact Uterus

• Progesterone supplementation required: Women with an intact uterus using Estraderm MX should receive concomitant progestogen therapy to prevent endometrial hyperplasia 1
• Risk without progesterone: Studies have shown a 4.8% incidence of endometrial hyperplasia in women with intact uteri using estrogen-only therapy 1

For Women Without a Uterus

• Estraderm MX can be used alone without progesterone supplementation
• No therapeutic advantage in prescribing progestins to hysterectomized women 2

Advantages of Transdermal Estradiol Delivery

Estraderm MX offers several advantages over oral estrogen formulations:

• Avoids first-pass hepatic metabolism 3
• Provides more physiological estradiol:estrone ratio 4
• Lower cardiovascular risk profile 4
• Lower risk of venous thromboembolism 4
• Can be cut into smaller pieces for lower dosing (remains stable for at least 1 month at temperatures ≤35°C) 5

Potential Side Effects

Common side effects of Estraderm MX include:

• Local skin irritation at application site (most common adverse effect) 3, 6
• Breast tenderness 1
• Leukorrhea (particularly with higher doses) 1

Important Considerations

1. For women with intact uterus: Must add a progestogen to prevent endometrial hyperplasia
2. For adolescents with premature ovarian insufficiency: Can be used as part of a gradual dose escalation protocol 4
3. For postmenopausal symptom management: Effectively reduces hot flushes, night sweats, and improves Kupperman Index scores 7

In conclusion, while Estraderm MX is an effective estrogen replacement therapy option, it contains only estradiol and no progesterone. Women with an intact uterus must receive additional progesterone therapy to prevent endometrial hyperplasia and potential endometrial cancer.