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transdermal estradiol patch (Estraderm, Climara)

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; - may be no increased risk [3,4,5,7] - risk is less, but not necessarily absent [6] - lower risk of cardiovascular events than with oral estrogen (RR=0.81) [6]

Interactions

drug adverse effects of estrogens

Related

menopause

General

transdermal estradiol estrogen patch

References

  1. 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: 16831962
  2. Langrish JP et al Cardiovascular effects of physiological and standard sex steroid replacement regimens in premature ovarian failure. Hypertension 2009 May; 53:805. PMID: 19332659
  3. 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: 17309934
  4. 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: 19834106 - Cushman M. Patch instead of pill: A safer menopausal estrogen? Arterioscler Thromb Vasc Biol 2010 Feb; 30:136 PMID: 20089948
  5. 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: 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: 21946050
  6. 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: 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: 27116463
  7. 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: 30626577 https://www.bmj.com/content/364/bmj.k4810