Gynecology Book

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Sequential Estrogen Replacement

Aka: Sequential Estrogen Replacement, Cyclic Estrogen Replacement
  1. See Also
    1. Menopause
    2. Estrogen Replacement
    3. Continuous Estrogen Replacement
    4. Vaginal Estrogen
    5. Transdermal Estrogen
  2. Protocol
    1. Estrogen taken daily
    2. Progestin taken for 2 weeks of each month
      1. First 2 weeks of month may be better remembered
  3. Preparations: Estrogens Options (choose one to accompany a Progesterone)
    1. Conjugated Estrogen (Premarin) 0.625mg orally daily
    2. Estropipate (Ogen) 0.625 orally daily
    3. Esterified Estrogen (Estratab) 0.625 orally daily
    4. Estradiol (Estrace) 0.5 mg orally daily
    5. Transdermal Estrogen (must be an Estrogen only product if used sequentially)
      1. Example: Estradiol transdermal (Estraderm) 0.05 mg patch/week
  4. Preparations: Progestin Options (choose one to accompany an Estrogen)
    1. First line:
      1. Provera 5 mg orally daily for 2 weeks of each month
    2. Second line (refractory to Provera)
      1. Norethindrone orally daily for 2 weeks of each month
      2. Micronized Progesterone 200 ug orally daily for 2 weeks of each month
  5. Adverse Effects
    1. Cyclic withdrawal bleed in 80-90% within 6 months

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