Transdermal Estrogen

1. See Also
   1. Menopause
   2. Estrogen Replacement
   3. Continuous Estrogen Replacement
   4. Sequential Estrogen Replacement
   5. Vaginal Estrogen
2. Indications
   1. Osteoporosis Prevention in postmenopausal women (Estraderm or Estrasorb)
   2. Hot Flashes (Evanmist, Estrogel, Elestrin, Divigel)
3. Advantages
   1. Studies suggest no increased thromboembolism risk
      1. Scarabin (2003) Lancet 362:428-32
4. 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
5. 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
6. Preparations: Agents used for Osteoporosis (Transdermal Estradiol)
   1. 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)
   2. Estraderm (Transdermal Estradiol Patch) 0.05 mg
      1. Must be taken with Provera if Uterus intact
         1. See Continuous Estrogen Replacement
         2. See Sequential Estrogen Replacement
      2. Apply to non-irritated skin
         1. Lower Abdomen
         2. Buttock
         3. Do not apply to Breast
      3. Change patch twice weekly using a different site
7. Preparations: Agents used for Hot Flashes (Transdermal Estradiol)
   1. Evanmist
      1. Dosing: 1-3 sprays per day on inner Forearm to adjacent areas (not overlapping)
      2. Allow skin to dry for 30 minutes
   2. 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
   3. 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)
   4. 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
8. References
   1. Filer (1994) Am Fam Physician 49(7):1639-42