What are the instructions for using a hormone replacement (HR) patch, such as Estraderm (estradiol) or Vivelle-Dot (estradiol)?

Hormone Replacement Patch Instructions

Hormone replacement patches should be applied to dry, intact skin of the back, abdomen, upper thighs, or upper arms, and should be changed according to the specific product instructions (typically twice weekly or weekly) to maintain optimal hormone levels and reduce symptoms. 1

General Application Instructions

• Apply transdermal estradiol patches to clean, dry, intact skin areas such as the back, abdomen, upper thighs, or upper arms 1
• Rotate application sites to prevent skin irritation 1
• Peak hormone levels occur approximately 6-8 hours after patch application 1
• For standard estradiol patches, they should be changed according to product-specific instructions:
  • Twice weekly patches: Change every 3-4 days 2
  • Weekly patches: Change once every 7 days 3

Dosing Guidelines

• For women with premature ovarian insufficiency (POI), patches typically release 50-100 μg of 17β-estradiol per 24 hours 2
• Dosing is often individualized based on symptom control and side effects 4
• Lower doses (25 μg/24 hours) may be effective for vasomotor symptom control and bone loss prevention with fewer side effects 4, 5
• Dose adjustments may be necessary after evaluating response at 3-6 months 1

Regimen Options

Sequential Combined Regimen (with withdrawal bleeding)

• Apply patches releasing 50 μg of 17β-estradiol daily for 2 weeks 2
• Follow with patches releasing 50 μg of 17β-estradiol and progestin (e.g., 10 μg of levonorgestrel) for 2 additional weeks 2
• Restart the 4-week cycle without interruption 2

Continuous Combined Regimen (to avoid withdrawal bleeding)

• Apply patches releasing 50 μg of 17β-estradiol and progestin (e.g., 7 μg of levonorgestrel) continuously without interruption 2
• This approach is preferred for improving long-term compliance as it minimizes bleeding disturbances 5

Alternative Combined Approach

• If combined estradiol/progestin patches are not available:
  • Apply transdermal estradiol patches continuously 2
  • Add oral or vaginal progestin for 12-14 days every 28 days (e.g., micronized progesterone 200 mg daily) 2

Special Considerations

• For women with intact uterus, progestin is required to protect the endometrium from hyperplasia 2, 4
• Micronized progesterone is the preferred progestin due to lower cardiovascular and venous thromboembolism risk 2
• Transdermal delivery avoids first-pass hepatic metabolism, providing more stable hormone levels compared to oral administration 1, 6
• Local skin irritation is the most common side effect of transdermal patches 6
• For adolescents with POI, lower starting doses are recommended with gradual increases over 2-3 years 2

Monitoring and Follow-up

• Evaluate treatment effect after 3-6 months of therapy 1
• Annual clinical reviews are recommended to assess compliance and side effects 1
• If breakthrough bleeding occurs, progestin therapy should be initiated or adjusted 2
• Monitor for common side effects including skin irritation, breast tenderness, and breakthrough bleeding 6, 7