ORAL AND TRANSDERMAL ESTROGEN DOSE EQUIVALENTS | |||
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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 |
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Active Ingredient |
Brand | Source of Estrogen |
Dose Equivalents |
ORAL | |||
equine conjugated estrogen |
Premarin | Pregnant mares urine | 0.625mg |
esterified estrogens |
Menest | Plant derived: Soy/Yams | 0.625mg |
estropipate | — | Plant derived: Yams | 0.625mg |
TRANSDERMAL | |||
17-β-estradiol* patch (reservoir) |
— | Plant derived: Soy/Yams | 0.05mg |
17-β estradiol* patch (matrix) |
Alora | Plant derived: Soy/Yams | 0.05mg |
Climara | |||
Vivelle-Dot | |||
Menostar | |||
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 |
|
17-β estradiol* spray |
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. |
NOTES | |||
*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. |
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REFERENCES | |||
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]. (Rev. 5/2019) |
Oral and Transdermal Estrogen Dose Equivalents