Recommended Dosage of Estradiol Patch
The recommended dosage of estradiol transdermal patch is 50 to 100 μg/24 hours for postmenopausal women, with patches typically changed twice weekly or weekly depending on the specific product. 1, 2
Dosage Guidelines by Indication
For Treatment of Menopausal Symptoms
- Initial dosage range is typically 50-100 μg/24 hours for moderate to severe vasomotor symptoms and vulvovaginal atrophy 1
- The lowest effective dose should be used to control symptoms 2
- Patches are typically changed twice weekly or weekly depending on the specific product instructions 1
- Efficacy has been demonstrated with patches delivering as low as 25 μg/24 hours, though 50 μg and 100 μg doses show more rapid symptom relief 3
For Prevention of Osteoporosis
- Similar dosing of 50-100 μg/24 hours is recommended 2
- Treatment should be considered only for women at significant risk of osteoporosis 2
- Effective therapy maintains plasma estradiol levels of at least 35-55 pg/ml 4
Administration Protocol
For Women with an Intact Uterus
- A progestin must be added to reduce the risk of endometrial cancer 2
- Options include:
- Sequential combined patches: Estradiol alone for 2 weeks, followed by estradiol+progestin for 2 weeks 1
- Continuous combined patches: Estradiol and progestin administered continuously 1
- Transdermal estradiol with oral/vaginal progestin: Estradiol patch continuously with oral/vaginal progestin for 12-14 days every 28 days 1
For Women Without a Uterus
- Estradiol patch alone without progestin is sufficient 2
- Continuous administration without interruption 1
Specific Progestin Recommendations When Used
- Micronized progesterone (MP): 200 mg daily for 12-14 days every 28 days (first choice) 1
- Medroxyprogesterone acetate (MPA): 10 mg daily for 12-14 days per month 1
- Dydrogesterone: 10 mg daily for 12-14 days per month 1
Important Considerations and Precautions
Duration of Treatment
- Use the lowest effective dose for the shortest duration consistent with treatment goals 2
- Reevaluate periodically (every 3-6 months) to determine if treatment is still necessary 2
- For women with premature ovarian insufficiency, treatment should continue until the average age of natural menopause (45-55 years) 1
Monitoring
- Adequate diagnostic measures, such as endometrial sampling, should be undertaken for undiagnosed persistent or recurring abnormal vaginal bleeding 2
- Dose should be adjusted according to each woman's tolerance and symptoms 1
Cardiovascular Considerations
- Transdermal estradiol is preferred over oral formulations due to lower cardiovascular risk, especially in cancer survivors 1
- Transdermal administration avoids first-pass hepatic metabolism, resulting in a more favorable risk profile 1
Common Pitfalls to Avoid
- Using oral estrogens when transdermal is available: Transdermal delivery provides more stable hormone levels and avoids first-pass metabolism 4, 5
- Failure to add progestin in women with intact uterus: This significantly increases risk of endometrial hyperplasia and cancer 6
- Inadequate dose titration: Doses should be adjusted based on symptom control rather than using a fixed dose for all patients 1
- Overlooking the need for periodic reevaluation: Treatment should be reassessed every 3-6 months 2