transdermal estradiol patch (Estraderm, Climara)
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Introduction
Transdermal system: Tradename Estraderm, Climara.
Indications
- symptoms of menopause
* transdermal estrogen is recommended vs oral estrogen for patients with
- moderate risk for coronary artery disease
- increased risk for venous thromboembolism
- hypertriglyceridemia
- high or intermediate risk for breast cancer
Contraindications
- does not improve cognition or quality of life in post-menopausal women
Dosage
- change patch 2X/wk for 1st 3 weeks of month (Estraderm)
- change weekly for 1st 3 weeks of month (Climara) Patches: 0.05 & 0.01 mg.
Therapy may be given continuously in patients without a uterus.
Therapy must be given in a cyclic schedule, i.e. 3 weeks on, 1 week off in women with a uterus. Reportedly gives more consistent blood levels than oral therapy.
Adverse effects
- lower systolic & diastolic blood pressure than with oral estrogen[2]
- risk of venous thromboembolism less than with oral estrogen;
- lower risk of cardiovascular events than with oral estrogen (RR=0.81)[6]
More general terms
Additional terms
References
- ↑ Yaffe K, Vittinghoff E, Ensrud KE, Johnson KC, Diem S, Hanes V, Grady D. Effects of ultra-low-dose transdermal estradiol on cognition and health-related quality of life. Arch Neurol. 2006 Jul;63(7):945-50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16831962
- ↑ 2.0 2.1 Langrish JP et al Cardiovascular effects of physiological and standard sex steroid replacement regimens in premature ovarian failure. Hypertension 2009 May; 53:805. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19332659
- ↑ 3.0 3.1 Canonico M et al Hormone therapy and venous thromboembolism among postmenopausal women: Impact of the route of estrogen administration and progestogens: The ESTHER study. Circulation 2007 Feb 20; 115:840-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17309934
- ↑ 4.0 4.1 Canonico M et al. Postmenopausal hormone therapy and risk of idiopathic venous thromboembolism: Results from the E3N cohort study. Arterioscler Thromb Vasc Biol 2010 Feb; 30:340. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19834106
Cushman M. Patch instead of pill: A safer menopausal estrogen? Arterioscler Thromb Vasc Biol 2010 Feb; 30:136 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20089948 - ↑ 5.0 5.1 Laliberte F et al. Does the route of administration for estrogen hormone therapy impact the risk of venous thromboembolism? Estradiol transdermal system versus oral estrogen-only hormone therapy. Menopause 2011 Oct; 18:1052. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21775912
Canonico M and Scarabin P-Y. Further evidence for promoting transdermal estrogens in the management of menopausal symptoms. Menopause 2011 Oct; 18:1038 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21946050 - ↑ 6.0 6.1 6.2 Simon JA et al. Venous thromboembolism and cardiovascular disease complications in menopausal women using transdermal versus oral estrogen therapy. Menopause 2016 Jun; 23:600. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26953655
Canonico M, Scarabin PY Oral versus transdermal estrogens and venous thromboembolism in postmenopausal women: What is new since 2003? Menopause 2016 Jun; 23:587 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27116463 - ↑ 7.0 7.1 Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ 2019;364:k4810 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30626577 https://www.bmj.com/content/364/bmj.k4810