From the Research
For post-menopausal women starting compounded estrogen and progesterone cream, a typical initial dose is 0.5-1 mg estradiol with 20-40 mg progesterone applied once daily to thin-skinned areas like the inner wrist, inner arm, or inner thigh. This dosing approach is based on the most recent and highest quality study available, which prioritizes minimizing risks while addressing symptoms 1. The cream should be rotated between application sites to prevent skin irritation. Start with the lower dose and titrate upward based on symptom relief and tolerance. Most women apply the cream in the evening, as progesterone may cause drowsiness.
Key Considerations
- Treatment should begin with a 3-month trial period, followed by reassessment of symptoms and side effects.
- The estrogen component addresses vasomotor symptoms and vaginal dryness, while progesterone provides endometrial protection for women with an intact uterus.
- Regular follow-up every 3-6 months is recommended to monitor response and adjust dosing as needed.
Rationale
The addition of progesterone to estrogen therapy is crucial in reducing the risk of endometrial hyperplasia and carcinoma, as evidenced by studies such as 2 and 3. The use of natural micronized progesterone, as mentioned in 2, can alleviate some of the drawbacks associated with synthetic progestins. However, the most recent study 1 highlights the importance of therapeutic options for managing endometrial hyperplasia, emphasizing the need for careful consideration of treatment strategies.
Application and Monitoring
- Apply the cream to thin-skinned areas to enhance absorption.
- Rotate application sites to prevent skin irritation.
- Monitor for side effects and adjust dosing as needed.
- Regular follow-up is essential to ensure the treatment's effectiveness and safety.