|ORAL AND TRANSDERMAL ESTROGEN DOSE EQUIVALENTS|
|ORAL ESTROGENS||TRANSDERMAL ESTROGENS|
• Plasma estrogen peaks & troughs
• First pass through GI tract & liver
• Increased hepatic enzymes,
• Increased triglycerides
• Increased blood pressure
• Reduced IGF‑1
• Decreased LDL cholesterol and
• Serum E2 levels relatively constant
• Does not pass through liver – lower doses
• No change in inflammatory markers
• No change or decrease in triglycerides
• Decrease in blood pressure
• No effect on GH/IGF‑1
• Decreases LDL but no change in HDL
|Premarin||Pregnant mares urine||0.625mg|
|Menest||Plant derived: Soy/Yams||0.625mg|
|estropipate||—||Plant derived: Yams||0.625mg|
|—||Plant derived: Soy/Yams||0.05mg|
|Alora||Plant derived: Soy/Yams||0.05mg|
|17-β estradiol* gel||Divigel||Plant derived: Soy/Yams, Sunflower seeds, Rapeseed, Poppy seeds, Pine trees||1g Divigel = 34pg/mL estradiol|
|Elestrin||Plant derived: Soy, Rapeseed, Pine tree wood||1 pump (0.87g/d) = 0.0125mg estradiol
2 pumps (1.7g/d) = 0.0375mg estradiol
|Estrogel||Plant derived: Oil seed, Soy, Pine tree wood||No comparison studies done in U.S.
Rate of delivery is 35µg/day which is therapeutically equivalent to Climara 50µg/day
|Evamist||Plant derived: Soy/Yams||No direct comparison trials.
1.53mg/spray. For 1 spray, 21µg gets to blood stream (29µg for 2 sprays, 40µg for 3 sprays).
Premarin 0.625mg = just over 3 sprays of Evamist.
*The only formulation considered bioidentical, as defined by the 2007 Position Statement of the Endocrine Society.
Matrix patch: Estradiol is embedded in the adhesive layer that is applied directly to the skin.
Reservoir patch: Estradiol is contained in a drug reservoir and its release is controlled by a copolymer membrane; contains more layers than matrix patch.
Adapted from: Dong BJ. Hormonal Drugs: Female Sex Hormones in: Anderson PO, Knoben JE, Troutman WG, eds. Handbook of Clinical Drug Data. 10th ed. New York, N.Y. McGraw Hill; 2002:679−697.
Kenigsberg L, Balachandar S, Prasad K, et al. Exogenous Pubertal Induction by Oral versus Transdermal Estrogen Therapy. J Pediatr Adolesc Gynecol. 2011 Nov 22. [Epub ahead of print].
Oral and Transdermal Estrogen Dose Equivalents