What is the purpose of an estrogen (E2) patch, also known as transdermal estrogen therapy?

From the Guidelines

Estrogen patches are a recommended form of hormone replacement therapy for menopausal symptoms, particularly for women who cannot tolerate oral estrogen, due to their lower risk of venous thromboembolism and stroke, as noted in the study by Denlinger et al. 1.

Key Points to Consider

• Estrogen patches deliver estrogen through the skin directly into the bloodstream, bypassing the liver and resulting in more stable hormone levels and potentially fewer cardiovascular risks.
• Common brands include Climara, Estraderm, Vivelle-Dot, and Alora, with dosages typically ranging from 0.025 to 0.1 mg/day.
• The patch is usually applied to clean, dry skin on the lower abdomen or buttocks once or twice weekly, depending on the specific product.
• When starting therapy, it's best to begin with the lowest effective dose and adjust as needed, as recommended by the study 1.
• Women with an intact uterus should also take progesterone alongside estrogen to prevent endometrial hyperplasia.

Important Considerations

• Estrogen patches are contraindicated in women with a history of breast cancer, unexplained vaginal bleeding, blood clots, stroke, or liver disease, as noted in the study by Denlinger et al. 1.
• Side effects may include skin irritation at the application site, breast tenderness, headaches, and nausea.
• The use of estrogen patches should be individualized, taking into account the patient's medical history, symptoms, and preferences, as recommended by the study 1.

Additional Recommendations

• Locally applied vaginal estrogen is generally thought to be safe because there is minimal systemic absorption, as noted in the study 1.
• Patients with cardiovascular disease are typically advised to use a transdermal systemic agent to minimize activation of thrombotic factors and effects on lipids, as recommended by the study 1.
• The indications, benefits, and risks of continuing or discontinuing use of hormone replacement therapy should be reviewed periodically, as recommended by the study 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 – 0.05 mg NDC 70771-1565-8 Estradiol Transdermal System, USP (Twice-Weekly) Delivers 0.05 mg/day Includes 8 Systems Rx Only zydus pharmaceuticals PACKAGE LABEL.PRINCIPAL DISPLAY PANEL Package Label – 0.1 mg NDC 70771-1567-8 Estradiol Transdermal System, USP (Twice-Weekly) Delivers 0.1 mg/day Includes 8 Systems Rx Only zydus pharmaceuticals

The Estradiol Transdermal System is available in three different doses:

• 0.025 mg/day 2
• 0.05 mg/day 2
• 0.1 mg/day 2 It is a twice-weekly transdermal patch.

From the Research

Estrogen Patch

• Estrogen-containing hormone therapy, which can be administered through an estrogen patch, is an effective treatment for vasomotor symptoms, such as hot flashes and night sweats, associated with menopause 3, 4, 5.
• The use of estrogen patches can help reduce the frequency and severity of hot flashes, as well as improve sleep quality and reduce vaginal dryness 4, 5.
• However, estrogen therapy may also be associated with side effects, such as vaginal discharge, genital irritation, uterine bleeding, and breast symptoms, particularly in elderly women 4.
• The decision to use an estrogen patch should be made after careful consideration of the individual's risks and preferences, and in consultation with a healthcare provider 3, 5.
• Other treatment options for menopausal symptoms, such as nonhormonal medications, cognitive behavior therapy, and clinical hypnosis, may also be effective and should be discussed with a healthcare provider 3, 6, 5.