From the Guidelines
Estradiol patches are contraindicated in patients with a history of hormonally mediated cancers, abnormal vaginal bleeding, active or recent history of thromboembolic events, pregnancy, and active liver disease. The use of estradiol patches is also cautioned in survivors with coronary heart disease or hypertension, current smokers, and those with an increased genetic cancer risk 1. These contraindications and precautions are due to the potential risks associated with estrogen therapy, including an increased risk of stroke, pulmonary embolism, and invasive breast cancer, as seen in the Women's Health Initiative (WHI) study 1.
When considering the use of estradiol patches, it is essential to weigh the benefits against the potential risks, particularly in patients with a history of cancer or other comorbidities. The lowest dose possible to control symptoms should be used, and treatment should be individualized based on risks 1. Alternative formulations, such as transdermal estrogen, may be preferred due to lower rates of venous thromboembolism (VTE) and stroke 1.
Key points to consider when prescribing estradiol patches include:
- History of hormonally mediated cancers, such as breast or endometrial cancer
- Abnormal vaginal bleeding
- Active or recent history of thromboembolic events
- Pregnancy or breastfeeding
- Active liver disease
- Coronary heart disease or hypertension
- Current smoking status
- Increased genetic cancer risk
- Use of the lowest effective dose and individualized treatment planning 1.
From the Research
Estradiol Patch Contraindications
- The estradiol patch is contraindicated in women with a history of thrombosis or thrombophilia, as estrogen replacement therapy may increase the risk of thrombosis 2, 3.
- Women with estrogen-dependent breast cancer should use the estradiol patch with caution, as it may increase the risk of cancer recurrence 4.
- Absolute contraindications to estrogen replacement therapy include a history of breast cancer, thrombosis, or thrombophilia, as well as active liver disease or liver tumors 5.
- Relative contraindications include a history of stroke, myocardial infarction, or coronary heart disease, as estrogen replacement therapy may increase the risk of these conditions 6, 2.
- The estradiol patch should be used with caution in women with a history of cardiovascular disease, as it may increase the risk of cardiovascular events 6, 2.