What is the starting dose of estradiol (Estrogen) patch for menopause symptoms?

From the Guidelines

The starting dose of estradiol patch for menopause symptoms is typically 50 to 100 μg 24 hourly, applied transdermally via patches, to be changed twice a week or weekly according to the specific instructions provided for each brand. This dose is recommended based on the study by 1, which provides practical recommendations for hormonal replacement therapy in adolescents and young women with chemo- or radio-induced premature ovarian insufficiency. The estradiol patch works by providing a steady release of estrogen through the skin directly into the bloodstream, bypassing the liver and resulting in more stable hormone levels compared to oral formulations. This delivery method helps reduce hot flashes, night sweats, vaginal dryness, and other menopausal symptoms by replacing declining estrogen levels.

Some key points to consider when prescribing estradiol patches include:

• The dose should be adjusted according to each woman's tolerance and feeling of wellbeing 1.
• Combined 17βE and progestin patches can be used as a first choice, with sequential combined or continuous combined patches available, depending on the patient's request 1.
• Patients should discuss their complete medical history with their healthcare provider before starting therapy, as estrogen therapy has contraindications for certain conditions, including history of breast cancer, unexplained vaginal bleeding, or history of blood clots.
• The lowest dose possible to control symptoms should be used, and treatment should be individualized based on risks 1.

It's also important to note that the use of hormonal replacement therapy should be continued until the average age of spontaneous menopause (45-55 years), and the decision to stop or continue HRT must be weighed on individual risks, family history, personal feelings, and relevance of menopausal symptoms 1.

From the FDA Drug Label

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL Package Label – 0.025 mg NDC 70771-1563-8 Estradiol Transdermal System, USP (Twice-Weekly) Delivers 0.025 mg/day Includes 8 Systems Rx Only zydus pharmaceuticals PACKAGE LABEL.PRINCIPAL DISPLAY PANEL Package Label – 0.0375 mg NDC 70771-1564-8 Estradiol Transdermal System, USP (Twice-Weekly) Delivers 0.0375 mg/day Includes 8 Systems Rx Only zydus pharmaceuticals PACKAGE LABEL.PRINCIPAL DISPLAY PANEL Package Label – 0.075 mg NDC 70771-1566-8 Estradiol Transdermal System, USP (Twice-Weekly) Delivers 0.075 mg/day Includes 8 Systems Rx Only zydus pharmaceuticals

The starting dose of estradiol patch for menopause symptoms is 0.025 mg/day as it is the lowest available dose among the options provided 2.

From the Research

Estradiol Patch for Menopause Symptoms

• The starting dose of estradiol patch for menopause symptoms is not explicitly stated in the provided studies, but the doses used in the studies are as follows:
  • 0.05 mg/day 3
  • 25 micrograms E2 daily (7D-25) or 50 micrograms E2 daily (7D-50) 4
  • 14 μg to 50 μg estradiol daily dose 5
• These studies suggest that the efficacy of the estradiol patch in relieving menopausal symptoms is dose-dependent, with higher doses resulting in greater reductions in hot flushes and other symptoms 4
• The studies also report that the estradiol patch is generally well-tolerated, with minor systemic adverse events and occasional mild and transient skin reactions at the site of application 3, 4, 5

Dose-Response Efficacy

• A study by the Italian Menopause Research Group found that the 7D-50 patch, which releases 50 micrograms E2 daily, was more effective than the 7D-25 patch, which releases 25 micrograms E2 daily, in reducing hot flushes and other menopausal symptoms 4
• Another study found that the estradiol patch was effective in reducing the severity of menopausal symptoms, with a significant decrease in hot flushes and other symptoms after 12 weeks of treatment 3

Local Tolerability

• A network meta-analysis found that the metered-dose transdermal spray had better local tolerability than the estradiol patch, with fewer local skin reactions 5
• However, other studies reported that the estradiol patch was generally well-tolerated, with minor systemic adverse events and occasional mild and transient skin reactions at the site of application 3, 4