II. Indications

  1. Osteoporosis Prevention in postmenopausal women (Estraderm or Estrasorb)
    1. As of 2015, Estrogen is not recommended by ACOG or AAFP for chronic condition prevention
  2. Hot Flashes (Evanmist, Estrogel, Elestrin, Divigel)

III. Advantages

IV. Efficacy: Osteoporosis Prevention (Estraderm or Estrasorb)

  1. Placebo
    1. Hip BMD: 2.04% loss
    2. Lumbar Spine BMD: 2.49% loss
  2. Dose: 0.025 mg estradiol patch
    1. Hip BMD: 0.26% gain
    2. Lumbar Spine BMD: 2.37% gain
  3. Dose: 0.05 mg estradiol patch
    1. Hip BMD: 2.85% gain
    2. Lumbar Spine BMD: 4.09% gain
  4. Dose: 0.06 mg estradiol patch
    1. Hip BMD: 3.05% gain
    2. Lumbar Spine BMD: 3.28% gain
  5. Dose: 0.1 mg estradiol patch
    1. Hip BMD: 2.03% gain
    2. Lumbar Spine BMD: 4.70% gain
  6. References
    1. Weiss (1999) Obstet Gynecol 94:330-6 [PubMed]

V. Preparations: Transdermal Combination Progesterone and Estrogen

  1. Activella (17B-Estradiol-Norethindrone Acetate)
    1. Contains 1 mg Estradiol with 0.5 mg Norethindrone
  2. Climara Pro (17B-Estradiol-Levonorgestrel)
    1. Patch contains 0.045 mg estradiol with 0.015 Levonorgestrel
    2. Patch applied weekly
  3. Combipatch (17B-Estradiol-Norethindrone Acetate)
    1. Patch contains 0.05 mg estradiol with 0.014 or 0.25 mg Norethindrone
    2. Patch applied twice weekly

VI. Preparations: Agents used for Osteoporosis (Transdermal Estradiol)

  1. Preparations must be taken with Progesterone if Uterus intact (Endometrial Hyperplasia risk)
    1. See Continuous Estrogen Replacement
    2. See Sequential Estrogen Replacement
  2. Estrasorb (Transdermal Estradiol)
    1. Two foil packs equivalent to 0.05 mg Estradiol
    2. Rub one packet on right top of thigh, back of calf
    3. Repeat with second packet on left leg
    4. Do not apply with Sunscreen (increases absorption)
  3. Estraderm (Transdermal Estradiol Patch)
    1. Dosing: 0.05 mg estradiol
    2. Change patch twice weekly using a different site
    3. Apply to non-irritated skin
      1. Lower Abdomen
      2. Buttock
      3. Do not apply to Breast

VII. Preparations: Agents used for Menopausal Hot Flashes (Transdermal Estradiol)

  1. Preparations must be taken with Progesterone if Uterus intact (Endometrial Hyperplasia risk)
    1. See Continuous Estrogen Replacement
    2. See Sequential Estrogen Replacement
  2. Evanmist
    1. Dosing: 1-3 sprays per day on inner Forearm to adjacent areas (not overlapping)
    2. Allow skin to dry for 30 minutes
  3. Estrogel (0.06% estradiol)
    1. Pump delivers 0.75 mg of estradiol (64 actuations per device)
    2. Apply gel from one wrist to the Shoulder, spreading thinly
  4. Elestrin (0.06% estradiol)
    1. Pump delivers 0.52 mg of estradiol (100 actuations per device)
    2. Apply to upper arm and Shoulder
    3. Allow to dry for 2 hours before immersing in water (e.g. swimming)
  5. Divigel (0.1% estradiol)
    1. Foil packet delivers either 0.25 mg, 0.5 mg or 1.0 mg estradiol per packet
    2. Apply packet contents to one upper thigh (5x7 inch area)
    3. Alternate to opposite side on subsequent application days
    4. Allow to dry for 1 hour before washing the area

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Cost: Medications

elestrin (on 10/19/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
ELESTRIN 0.06% GEL $3.42 per gram
divigel (on 2/3/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
DIVIGEL 0.25 MG GEL PACKET $3.73 each
DIVIGEL 0.5 MG GEL PACKET $3.67 each
DIVIGEL 1 MG GEL PACKET $3.72 per gram
minivelle (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
MINIVELLE 0.025 MG PATCH $17.77 each
MINIVELLE 0.0375 MG PATCH $17.97 each
MINIVELLE 0.05 MG PATCH $18.03 each
MINIVELLE 0.075 MG PATCH $18.03 each
MINIVELLE 0.1 MG PATCH $18.03 each

Ontology: Estraderm (C0720290)

Concepts Pharmacologic Substance (T121) , Hormone (T125) , Steroid (T110)
English Estraderm, estraderm

Ontology: Estrasorb (C1320235)

Concepts Steroid (T110) , Pharmacologic Substance (T121) , Hormone (T125)
SnomedCT 406454003
English estrasorb, Estrasorb (product), Estrasorb
Spanish Estrasorb (producto), Estrasorb

Ontology: transdermal estrogen (C1831768)

Definition (NCI) A transdermal formulation containing the synthetic form of estradiol, the most potent, endogenously produced estrogen. Upon topical administration, estradiol diffuses through the cell membrane and binds to and activates specific intracellular estrogen receptors located on estrogen-responsive tissues, including the reproductive tract, breast, pituitary, hypothalamus, liver, and bone. The activated ligand-receptor complex binds to estrogen response elements on DNA and promotes the transcription of genes involved in the functioning of the female reproductive system and secondary sex characteristics. In addition, estradiol inhibits the pituitary secretion of the gonadotropins luteinizing hormone (LH) and follicle stimulating hormone (FSH) through a negative feedback mechanism.
Definition (PDQ) A transdermal formulation containing the synthetic form of estradiol, the most potent, endogenously produced estrogen. Upon topical administration, estradiol diffuses through the cell membrane and binds to and activates specific intracellular estrogen receptors located on estrogen-responsive tissues, including the reproductive tract, breast, pituitary, hypothalamus, liver, and bone. The activated ligand-receptor complex binds to estrogen response elements on DNA and promotes the transcription of genes involved in the functioning of the female reproductive system and secondary sex characteristics. In addition, estradiol inhibits the pituitary secretion of the gonadotropins luteinizing hormone (LH) and follicle stimulating hormone (FSH) through a negative feedback mechanism. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=472200&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=472200&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C61440" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Steroid (T110) , Hormone (T125)
English transdermal estrogen, Transdermal Estrogen, Estrodiol Gel