From the Guidelines
Estradiol patches are a recommended treatment option for managing menopausal symptoms, particularly for women experiencing moderate to severe hot flashes, night sweats, and vaginal dryness. According to the most recent and highest quality study available, 1, estrogen transdermal formulations, such as patches, may be preferred over other formulations due to lower rates of venous thromboembolism (VTE) and stroke.
Key Considerations
- Commonly prescribed estradiol patches include Estraderm, Vivelle-Dot, Climara, and Alora, with typical starting doses ranging from 0.025 to 0.05 mg/day.
- The patches are applied to clean, dry skin on the lower abdomen or buttocks and changed according to the specific product instructions, typically once or twice weekly.
- For women with an intact uterus, estradiol patches should be combined with progesterone (such as oral micronized progesterone 100-200 mg daily or cyclically) to protect the uterine lining.
- Treatment duration should be individualized, but generally using the lowest effective dose for the shortest time needed to control symptoms is recommended.
Benefits and Risks
- The benefits of estradiol patches include relief from menopausal symptoms such as hot flashes, night sweats, and vaginal dryness.
- The risks include breast tenderness, headaches, and skin irritation at the application site, as well as a potential increased risk of stroke, DVT, and gallbladder disease, as noted in 1 and 1.
- However, the absolute risk is low, and the patches may have a lower risk of blood clots and stroke compared to oral estrogen therapy, as suggested by 1.
Clinical Decision Making
- Clinicians should understand the evidence but individualize decision making to the specific patient or situation, taking into account the woman's clinical situation, preferences, and values to maximize benefits over harms, as recommended by 1 and 1.
- The USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women, but this recommendation does not apply to women considering hormone therapy for the management of menopausal symptoms, as stated in 1 and 1.
From the Research
Role of Estradiol (Estrogen) Patches in Menopause Management
- Estradiol patches are a form of hormone replacement therapy (HRT) used to manage menopause symptoms 2.
- They are an effective treatment for symptoms of acute climacteric syndrome and for preventing long-term estrogen deficiency 2.
- Estradiol patches can be used in combination with progestogen to reduce the risk of endometrial hyperplasia in women with an intact uterus 3, 4, 5, 6.
Benefits and Risks
- Estradiol patches can provide effective protection against the development of endometrial hyperplasia and/or carcinoma when combined with progestogen 3, 4, 5, 6.
- Unopposed estrogen therapy is associated with an increased risk of endometrial hyperplasia, irregular bleeding, and non-adherence to therapy 3, 4, 5, 6.
- The addition of progestogen to estrogen therapy can help reduce the risk of endometrial hyperplasia and improve adherence to therapy 3, 4, 5, 6.
Treatment Regimens
- Continuous combined estrogen-progestogen therapy and sequential estrogen-progestogen therapy are effective regimens for reducing the risk of endometrial hyperplasia 3, 4, 5, 6.
- Low-dose estrogen continuously combined with a minimum of 1 mg norethisterone acetate or 1.5 mg medroxyprogesterone acetate is not significantly different from placebo in terms of endometrial hyperplasia risk 3, 4.
- Monthly sequential therapy (progestogen given every month) is more effective than long cycle sequential therapy (progestogen given every 3 months) in reducing the risk of endometrial hyperplasia 5, 6.