Estradiol Dosing for 30-Day Supply
For a standard 30-day supply of oral estradiol for hormone replacement therapy, order 30-60 mg total (1-2 mg daily), or for transdermal patches, order patches delivering 1.5-3.0 mg total estradiol over 30 days (50-100 mcg/day). 1
Oral Estradiol Dosing
Standard oral dosing for hormone replacement therapy is 1-2 mg daily, requiring 30-60 mg total for a 30-day supply. 2, 1
- The FDA-approved initial dosage range is 1-2 mg daily of oral estradiol, adjusted to control symptoms, with the minimal effective dose determined by titration 1
- For postmenopausal women, oral estradiol 1-2 mg daily combined with progestin (such as dydrogesterone 5 mg or dienogest 2 mg) is recommended when transdermal administration is contraindicated or refused 2
- Low-dose oral estradiol (1 mg daily) has been shown effective for treating vasomotor symptoms and preventing bone loss with fewer side effects 3
Calculation for 30-Day Supply:
- 1 mg daily dose = 30 mg total for 30 days
- 2 mg daily dose = 60 mg total for 30 days
Transdermal Estradiol Dosing (Preferred Route)
Transdermal patches delivering 50-100 mcg/24 hours are the first-choice formulation, requiring patches that deliver 1.5-3.0 mg total estradiol over 30 days. 2, 4, 5
- Adult doses for transdermal estradiol range from 50-100 mcg daily (changed twice weekly or weekly depending on the brand) 2
- The recommended maintenance dose is 100-200 mcg/day for adults, though lower starting doses of 25-50 mcg/day can be titrated upward 4
- Transdermal administration is strongly preferred as first-line therapy due to superior safety profile, avoiding hepatic first-pass metabolism and reducing thrombotic risk (OR 0.9 vs 4.2 for oral estrogen) 5
Calculation for 30-Day Supply:
- 50 mcg/day × 30 days = 1.5 mg total estradiol
- 100 mcg/day × 30 days = 3.0 mg total estradiol
Vaginal Estradiol Dosing
Vaginal gel formulations require 15-30 mg total for a 30-day supply (0.5-1 mg daily). 2
- Vaginal estradiol gel doses range from 0.5-1 mg daily for hormone replacement therapy 2
- Vaginal administration achieves significantly higher serum and endometrial estradiol levels than oral administration at equivalent doses, so lower doses should be used 6
Calculation for 30-Day Supply:
- 0.5 mg daily dose = 15 mg total for 30 days
- 1 mg daily dose = 30 mg total for 30 days
Critical Prescribing Considerations
Always add progestin for endometrial protection in women with an intact uterus. 2, 1
- Sequential regimens require micronized progesterone 200 mg daily (or MPA 10 mg, or dydrogesterone 10 mg) for 12-14 days every 28 days 2
- Continuous regimens require minimum daily doses: norethisterone 1 mg, MPA 2.5 mg, or dydrogesterone 5 mg 2
- Micronized progesterone is first choice due to lower cardiovascular and thrombotic risk 2
Start with the lowest effective dose and use cyclic administration (3 weeks on, 1 week off) for oral formulations. 1
Transdermal formulations should be administered continuously without interruptions. 2