Estradiol Patch to Gel Conversion
For a patient using Evorel 75 2 x 1/2 patches (equivalent to 37.5 mcg/day estradiol), start with Estrogel 0.5 mg daily applied to clean, dry skin, and if menopausal symptoms persist after 2-3 months, increase to 0.75 mg daily. 1
Conversion Rationale
- Half of an Evorel 75 patch delivers approximately 37.5 mcg/day of estradiol transdermally 1
- Standard transdermal patches releasing 50 mcg/24 hours are considered equivalent to 0.5-1 mg of transdermal gel daily 1
- The most conservative and appropriate starting dose is Estrogel 0.5 mg daily, as this closely matches the 37.5 mcg/day delivery from the half-patch regimen 1
Application Instructions
- Apply Estrogel to clean, dry skin on the lower abdomen, upper outer arm, or thighs 1
- Rotate application sites to minimize skin irritation 1
- Allow the gel to dry completely before dressing 2
Dose Titration Strategy
- Assess symptom control after 2-3 months on the initial 0.5 mg daily dose 1
- If vasomotor symptoms or other menopausal complaints persist, increase to 0.75 mg daily 1
- This stepwise approach ensures adequate symptom relief while minimizing exposure 1
Critical Endometrial Protection Requirement
If this patient has an intact uterus, progestin supplementation is mandatory to prevent endometrial hyperplasia and cancer 1, 2
Progestin options include:
- Micronized progesterone 200 mg orally or vaginally for 12-14 days every 28 days 1, 2
- Medroxyprogesterone acetate 10 mg daily for 12-14 days per month 1, 2
- Dydrogesterone 10 mg daily for 12-14 days per month 1
Common Pitfall to Avoid
- The vaginal route of estradiol administration achieves significantly higher serum and tissue estradiol levels than oral or transdermal routes 3
- If inadvertently applying gel vaginally, much lower doses would be required to avoid excessive systemic exposure 3
- Ensure the patient understands to apply Estrogel only to skin surfaces, never vaginally 1