Oral and Transdermal Estrogen Dose Equivalents

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ORAL AND TRANSDERMAL ESTROGEN DOSE EQUIVALENTS
ORAL ESTROGENS TRANSDERMAL ESTROGENS

• Plasma estrogen peaks & troughs

• First pass through GI tract & liver
(requires higher dose)

• Increased hepatic enzymes,
inflammatory markers

• Increased triglycerides

• Increased blood pressure

• Reduced IGF‑1

• Decreased LDL cholesterol and
increased HDL

• Serum E2 levels relatively constant

• Does not pass through liver – lower doses
required

• 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

Active
Ingredient
Brand Source of
Estrogen
Dose
Equivalents
ORAL
equine conjugated
estrogen
Premarin Pregnant mares urine 0.625mg
synthetic
conjugated
estrogen
Enjuvia Plant derived: Soy/Yams 0.625mg
esterified
estrogens
Menest Plant derived: Soy/Yams 0.625mg
17-β-estradiol*
(micronized)
Estrace Plant derived: Soy/Yams 1mg
17-β-estradiol* Femtrace Plant derived: Soy/Yams No equivalence data, only studied with placebo
estropipate Ogen Plant derived: Yams 0.625mg
Ortho-Est
TRANSDERMAL
17-β-estradiol*
patch (reservoir)
Estraderm Plant derived: Soy/Yams 0.05mg
17-β estradiol*
patch (matrix)
Alora Plant derived: Soy/Yams 0.05mg
Climara
Vivelle
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*
emulsion
Estrasorb Plant derived: Soy 2 packets (3.48g) = 0.05mg systemic estrogen
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.

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. 5/2015)

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