What is the topical dosing for hormone replacement therapy (HRT) in women?

From the Guidelines

Topical hormone replacement therapy (HRT) for women typically involves estrogen or combined estrogen-progestin formulations applied directly to the skin, with dosages ranging from 50 to 100 μg 24 hourly for transdermal patches, and 0.5 to 1 mg daily for vaginal gel, as recommended by the most recent study 1.

Key Considerations

• The dose of 17βE should be adjusted according to each woman's tolerance and feeling of wellbeing, as stated in the study 1.
• For women with an intact uterus, a progestin must be added to prevent endometrial hyperplasia, which can be administered orally or via a vaginal progesterone cream.
• Treatment should start with the lowest effective dose and be adjusted based on symptom control.

Topical HRT Options

• Transdermal patches releasing 50 to 100 μg 24 hourly, changed twice a week or weekly, as recommended by the study 1.
• Vaginal gel, with doses ranging from 0.5 to 1 mg daily, as recommended by the study 1.
• Combined 17βE and progestin patches, available in different countries, as mentioned in the study 1.

Important Notes

• The routine use of hormone replacement therapy has been associated with a small increased risk of breast cancer and cardiovascular and thromboembolic morbidity, and its routine use is not currently recommended, as stated in the study 1.
• Hormone replacement therapy may be considered in women who experience severe menopausal symptoms, but should generally be used only for a limited period of time and at the lowest effective doses, as recommended by the study 1.

From the Research

Topical Dosing for Hormone Replacement Therapy (HRT) in Women

• The dosing for HRT in women can vary depending on the specific symptoms being treated and the individual's response to therapy 2, 3.
• For women with an intact uterus, estrogen must be combined with progestin to minimize the risk of endometrial hyperplasia and malignancy 4, 5.
• Common topical dosing regimens for HRT include:
  • 1 mg estradiol (valerate) or 25 micrograms estradiol delivered via a patch 2.
  • 0.5 mg gel or 0.3 mg conjugated equine estrogens 2.
  • 1 mg norethisterone acetate (NETA) or 1.5 mg medroxyprogesterone acetate (MPA) combined with estrogen 4.
• The minimum dose of progestogen required to protect the endometrium from hyperplasia is 1 mg NETA or 1.5 mg MPA 4, or 90 microg norgestimate (NGM) in a pulsed progestin regimen consisting of continuous 1 mg 17beta-estradiol (E2) 5.
• The choice of dosing regimen and specific medication should be individualized based on the woman's symptoms, medical history, and preferences, and should be reviewed annually with risk-benefit counseling 6.