From the Guidelines
Hormone replacement therapy (HRT) should be used at the lowest effective dose for the shortest possible time to manage menopausal symptoms, as recommended by expert groups 1.
HRT Formulations
HRT is available in several formulations, including:
- Oral tablets (such as Premarin, Estrace, or Prempro)
- Transdermal patches (like Climara or Vivelle-Dot)
- Topical gels and creams (Estrogel, Divigel)
- Vaginal preparations (Vagifem tablets, Estring)
- Injectable options For estrogen therapy, typical doses range from 0.3-1.25mg for oral estradiol, 0.025-0.1mg/day for patches, and 0.5-1.5g daily for gels. Progesterone is often added for women with an intact uterus, commonly as oral micronized progesterone (100-200mg daily) or medroxyprogesterone acetate (2.5-5mg daily) 1.
Choosing an HRT Formulation
The choice between formulations depends on:
- Symptom profile
- Risk factors
- Patient preference Transdermal options bypass first-pass liver metabolism, potentially reducing clotting risks compared to oral formulations 1. Vaginal preparations provide localized relief for urogenital symptoms with minimal systemic absorption.
Treatment Approach
Treatment typically begins at the lowest effective dose and continues as needed for symptom management, with regular monitoring recommended to assess benefits and risks 1. The quality of evidence on the benefits and harms of HRT varies for different hormone regimens, and a cautious approach is recommended to avoid using HRT routinely for the specific purpose of preventing chronic disease in women 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
HRT Formulations
- Various formulations of Hormone Replacement Therapy (HRT) are available, including testosterone replacement therapy for hypogonadal men 2, 3, 4.
- The choice of formulation depends on factors such as cost, patient preference, and individual needs 3, 4.
- Testosterone replacement therapy can be administered through different routes, including buccal, nasal, subdermal, transdermal, and intramuscular (IM) 4.
- For women, HRT can be formulated with estrogen and progestogen, and the regimen can be cyclical or continuous, depending on the patient's needs and whether they have an intact uterus 5.
Types of HRT
- Topical gels and intramuscular injections are examples of testosterone formulations available for men 3.
- Selective estrogen receptor modulators and phytoestrogens are being developed as alternative options for managing menopause symptoms in women 5.
- Non-hormonal pharmacotherapies are also available for patients who cannot or do not want to use exogenous hormones 3.
Considerations for HRT
- The use of HRT should be individualized, taking into account the patient's unique characteristics, needs, and goals 3, 6.
- Patients should be counseled about the risks and benefits of HRT, and their preferences should be considered when selecting a formulation 5, 3.
- Close monitoring is required for patients receiving HRT to minimize risks and optimize benefits 4, 6.